Angina pectoris bei einer jungen Frau mit Lupus erythematodes

Zusammenfassung

Anamnese und klinische Befunde Eine 31-jährige Patientin, die seit 6 Jahren an einem kutanen Lupus erythematodes (CLE) litt, präsentierte sich mit typischen pektanginösen Beschwerden. Das Ruhe-EKG und die transthorakale Notfall-Echokardiografie waren nicht wegweisend. Bei lediglich dezenter Troponin-Erhöhung ohne relevante Dynamik wurde die Arbeitsdiagnose einer Perikarditis gestellt und eine Therapie mit NSAR initiiert sowie die bisherige Immunsuppression intensiviert, worunter die Patientin beschwerdefrei entlassen werden konnte. Wenige Tage später erfolgte eine Wiedervorstellung in der rheumatologischen Klinik mit zunehmenden Beschwerden. In der Laborchemie fielen neben einer deutlichen Troponin-Erhöhung auch erhöhte Herzenzyme auf, sodass die Indikation zur Herzkatheteruntersuchung gestellt wurde. In der Koronarangiografie zeigte sich eine koronare 3-Gefäßerkrankung.

Therapie und Verlauf Die Patientin wurde einer dringenden operativen Myokardrevaskularisation zugeführt. Der postoperative Verlauf gestaltete sich trotz immunsuppressiver Therapie komplikationslos.

Folgerung Lupus-Patienten besitzen ein deutlich erhöhtes Risiko für eine koronare Herzerkrankung. Gerade bei jungen Frauen, die sich mit Brustschmerzen präsentieren, muss daher neben den klassischen kardiopulmonalen Lupusmanifestationen wie Pleuritis und Perikarditis differenzialdiagnostisch stets an ein akutes Koronarsyndrom gedacht werden.

Abstract

History and clinical findings We present a 31-year old woman with a 6-year history of cutaneous lupus erythematosus (CLE) who presented to the emergency room with typical chest pain. ECG and transthoracic echocardiography were normal. Her working diagnosis of pericarditis was made due to systemic progression of her lupus erythematosus (LE). Treatment with NSAIDs was initiated and her immunosuppressive regimen intensified. The patient was discharged after resolution of her symptoms. A week later, the patient was seen at the rheumatology clinic with recurrence and aggravation of her symptoms. She was found to have elevated troponin and cardiac enzymes and therefore underwent cardiac catheterization, revealing three vessel coronary artery disease.

Therapy and course The patient underwent urgent open surgical myocardial revascularization. Despite the immunosuppressive therapy the postoperative course was uneventful.

Conclusions The risk for coronary artery disease in LE patients is very high. Particularly in young women presenting with chest pain, regardless of typical cardiopulmonary manifestations of LE such as pericarditis and pleurisy, acute coronary syndrome should always be considered.

Schlüsselwörter

Lupus erythematodes (LE) - Perikarditis - koronare Herzerkrankung - Myokardrevaskularisation

Key words

lupus erythematosus (LE) - pericarditis - coronary artery disease - myocardial revascularization

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