They are associated with lupus duration, disease activity, anticardiolipin antibodies and APS manifestations. Abnormalities on ultrasound may be found in around a third with APS. The presence of these findings, as with the disease, is 5 to 9 times more frequent in women than in men. The typical patient is a young woman, although it can rarely occur in children. History Most patients with Libman-Sacks endocarditis are asymptomatic. If valves are severely affected there may be features of the valve disease.
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Abdisamad M. Ibrahim1; Momin S. It is a term which is used for sterile vegetations on the cardiac valves. The first time this form of endocarditis was described was in by Emanuel Libman and Benjamin Sacks. It is also associated with increased mortality. The initial development of Libman-Sacks endocarditis is thought to be an endothelial injury in the setting of a hypercoagulable state.
This causes deposition of platelet thrombi and inflammatory molecules in the cardiac valves. They can dislodge and cause devastating embolic infarctions. The vegetations can involve the entire surface of the leaflets, and appear in coalescent or clusters.
They also have a granular or verrucous appearance. The most common manifestations are secondary to embolism. Patient with underlying SLE may show manifestations of the underlying disease such as malar rash, pleuritis, pericarditis, and nephrotic syndrome.
A hypercoagulable workup should also be obtained in each case suspected of LS endocarditis including lupus anticoagulant and antiphospholipid antibodies. However, the primary evaluation for LSE is by echocardiography. Trans-esophageal echocardiography has greater sensitivity and specificity than trans-thoracic echocardiography.
Irregular borders, heterogeneous echo density, and an absence of independent motion characterize the masses i. The masses are usually small and sessile, but they can be as large as 10 mm. The basal and mid portion of the mitral and aortic valves are involved most commonly. Diffuse or focal leaflet thickening of the mitral and aortic valves can be observed. The involved valves may exhibit regurgitation.
Coexistent cardiac complications of systemic lupus erythematosus may include pericardial effusion or thickening. Anticoagulation should be considered as secondary prevention for thromboembolic phenomena in patients who have had a thromboembolic event. In cases of significant valvular dysfunction, surgery should be performed according to established guidelines for valvular heart disease.
Laboratory studies should include a complete blood count, complete metabolic panel, and blood cultures to exclude infective endocarditis. Prognosis The prognosis of LS endocarditis has not been fully studied and there continues to be a need for further studies to better define prognosis. From clinical observations, the prognosis of LS is considered poor.
Patients may develop recurrent thromboembolic events, cognitive disability, and death. Prognosis is poor as patients usually have recurrent thromboembolic events, cognitive disability, and death.
Enhancing Healthcare Team Outcomes LS endocarditis is not common but when it presents it is often associated with high morbidity and mortality. The healthcare team including the pharmacists and nurses should be aware that the vegetations can embolize not only to the brain but also the extremities and intestine. If this is not recognized, then it can result in ischemica and necrosis of the organ involved. Serial echos are required to follow the vegetations. The treatment for LS endocarditis is not well established but anticoagulation is recommended.
The outcomes depend on the age of patient, presence of malignancy and other comorbidity. Questions To access free multiple choice questions on this topic, click here.
References 1. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. J Am Soc Echocardiogr. Non-bacterial thrombotic endocarditis: clinicopathologic correlations. Heart J. Non-bacterial thrombotic endocarditis in cancer patients.
Acta Cardiol. Libman-Sacks endocarditis and embolic cerebrovascular disease. An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. This book is distributed under the terms of the Creative Commons Attribution 4.
Endocarditis de Libman-Sacks