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Cardiovascular lesions in collagen-vascular diseases

  • Other Myocardial Disease
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Summary

In this review, the cardiac lesions which develop in association with the various collagen-vascular diseases are described. In rheumatoid arthritis, the most frequent lesions are: fibrous obliterative pericarditis, with pericardial deposits of calcium, fibrin, cholesterol, and rheumatoid granulomas; granulomatous or nonspecific myocarditis; valvulitis, vasculitis, and amyloid deposits. In ankylosing spondylitis, the lesions involve mainly the valves (aortic and mitral values) and the aorta. In systemic lupus erythematosus, the predominant cardiovascular lesions are: pericarditis, Libman-Sacks endocarditis, nonspecific myocarditis, vasculitis with fibrinoid necrosis, and acceleration of atherosclerosis. In scleroderma, the main cardiac lesion is fibrosis with only scanty inflammatory cells; pericarditis and nonbacterial thrombotic endocarditis also occur. In dermatomyositis/polymyositis, fibrous or fibrinous pericarditis can occur, as well as myocarditis with infiltrates of lymphocytes and plasma cells and with degeneration and necrosis of myocytes; valvulitis is uncommon except when the disease is related to mucinous adenocarcinoma. In polyarteritis nodosa, various stages of necrotizing vasculitis involve all layers of the arterial walls; foci of myocardial necrosis of various sizes can occur in association with these lesions; cardiac hypertrophy related to hypertension and pericarditis related to uremia, may also be found. In Wegener's granulomatosis, pericarditis, inflammatory infiltrates, necrotizing granulomas, and vasculitis have been observed in the heart.

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References

  1. Cathcart ES, Spodick DH (1962) Rheumatoid heart disease: A study of the incidence and nature of cardiac lesions in rheumatoid arthritis. N Engl J Med 266: 959–964

    Google Scholar 

  2. Lebowitz WB (1963) The heart in rheumatoid arthritis (rheumatoid disease): A clinical and pathological study of sixty-two cases. Ann Intern Med 58: 102–123

    Google Scholar 

  3. Sokoloff L (1953) The heart in rheumatoid arthritis. Am Heart J 45: 635–643

    Google Scholar 

  4. McAllister HA (1981) Pathology of the cardiovascular system in chronic renal failure. In: Lowenthal DT, Pennock RS, Likoff W, Onesti G (eds) Davis, Philadelphia, pp 1–16.

    Google Scholar 

  5. Alukal MK, Costello PB, Green FA (1984) Cardiac tamponade in systemic juvenile rheumatoid arthritis requiring emergency pericardiectomy. J Rheumatol 11: 222–225

    Google Scholar 

  6. Carpenter DF, Golden A, Roberts WC (1967) Quadrivalvular rheumatoid heart disease associated with left bundle branch block. Am J Med 43: 922–929

    Google Scholar 

  7. Cruickshank B (1958) Heart lesions in rheumatoid disease. J Pathol Bacteriol 76: 223–240

    Google Scholar 

  8. Cheitlin MD, McAllister HA, DeCastro C (1975) Myocardial infarction without atherosclerosis. JAMA 231: 951–959

    Google Scholar 

  9. Karten I (1969) Arteritis, myocardial infarction and rheumatoid arthritis. JAMA 210: 1717–1720

    Google Scholar 

  10. McAllister HA, Ferrans VJ (1982) The heart and blood vessels. In: Silverberg SJ (ed) Principles and practice of surgical pathology. Wiley, New York, pp 615–652

    Google Scholar 

  11. Howell A, Say J, Hedworth-Whitty R (1972) Rupture of the sinus of Valsava due to severe rheumatoid heart disease. Br Heart J 34: 537–540

    Google Scholar 

  12. Crean PA, Reid DS, Buchanan J (1983) Aorto-atrial fistula in rheumatoid arthritis. Ann Rheum Dis 42: 203–205

    Google Scholar 

  13. Bulkley BH, Roberts WC (1973) Ankylosing spondylitis and aortic regurgitation. Description of the characteristic cardiovascular lesion from study of eight necropsy patients. Circulation 48: 1014–1027

    Google Scholar 

  14. Sadowska-Wroblesuska M, Garwolinska H, Wende Z, Falencik M (1981) Cardiovascular changes in patients with ankylosing spondylitis. Reumatologia 19: 291–297

    Google Scholar 

  15. Lawasuji M, Hetzer H, Stauch G, Borst HG (1982) Aortic valve replacement and ascending aorta replacement in ankylosing spondylitis: Report of three surgical cases and review of the literature. Thorac Cardiovasc Surg 30: 310–314

    Google Scholar 

  16. Liv SM, Alexander CS (1969) Complete heart block and aortic insufficiency in rheumatoid spondylitis. Am J Cardiol 23: 888–892

    Google Scholar 

  17. Alexander B, Feiner H (1979) Ankylosing spondylitis with cardiac dysrhythmia. Pathologic changes in cardiac conduction system. NY State J Med 79: 1585–1588

    Google Scholar 

  18. Good AE (1974) Reiter's disease: A review with special attention to cardiovascular and neurologic sequelae. Semin Arthritis Rheum 3: 253–286

    Google Scholar 

  19. Paulus HE, Pearson CM, Pitts W (1972) Aortic insufficiency in five patients with Reiter's syndrome. A detailed clinical and pathological study. Am J Med 53: 464–472

    Google Scholar 

  20. Rodman GP, Benedek TG, Shaver JS, Fennell RH (1964) Reiter's syndrome and aortic insufficiency. JAMA 189: 889–894

    Google Scholar 

  21. Bottiger LE, Edhag O (1972) Heart block in ankylosing spondylitis and uropolyarthritis. Br Heart J 34: 487–492

    Google Scholar 

  22. Neu LT, Reider RA, Mack RE (1960) Cardiac involvement in Reiter's disease: Report of case with review of literature. Ann Intern Med 53: 215–220

    Google Scholar 

  23. Csonka GW, Litchfield JW, Oates JK, Cillcox RR (1961) Cardiac lesions in Reiter's disease. Br Med J I: 243–247

    Google Scholar 

  24. Machado H, Befeler B, Morales AR, Vargas A, Aranda J (1976) Aortic insufficiency in Reiter's syndrome. Southern Med J 69: 955–957

    Google Scholar 

  25. Podell TE, Wallace DJ, Fishbein MC, Bransford K, Klinenberg JR (1982) Severe giant cell valvulitis in a patient with Reiter's syndrome. Arthritis Rheum 25: 232–234

    Google Scholar 

  26. Brigden W, Bywaters EGL, Lessof MH, Ross JP (1960) The heart in systemic lupus erythematosus. Br Heart J 22: 1–16

    Google Scholar 

  27. Hejmancik MR, Wright JC, Quint R, Jennings FL (1964) The cardiovascular manifestations of systemic lupus erythematosus. Am Heart J 68: 119–130.

    Google Scholar 

  28. Klemperer P, Pollack AD, Baehr GG (1941) Pathology of disseminated lupus erythematosus. Arch Pathol 32: 569–631

    Google Scholar 

  29. Györkey F (1969) Systemic lupus erythematosus and myxovirus. N Engl J Med 280: 333

    Google Scholar 

  30. Bonfiglio TA, Botti RE, Hagstrom JWC (1972) Coronary arteritis, occlusion, and myocardial infarction due to lupus erythematosus. Am Heart J 83: 153–158

    Google Scholar 

  31. McAllister HA, Mullick FG (1982) The cardiovascular system. In: Pathology of drug-induced and toxic diseases. Ridell R (ed) Churchill Livingstone, New York, pp 201–228.

    Google Scholar 

  32. Libman E, Sacks B (1924) A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med 33: 701–737

    Google Scholar 

  33. Shapiro RF, Gamble CN, Weisner KB, Castles JJ, Wolf AW, Hurley EJ, Salel AF (1977) Immunopathogenesis of Libman-Sacks endocarditis. Ann Rheum Dis 36: 508–516

    Google Scholar 

  34. Bidani AK, Roberts JL, Schwarz MM, Lewis EHJ (1980) Immunopathology of cardiac lesions in fatal systemic lupus erythematosus. Am J Med 69: 849–858

    Google Scholar 

  35. Mossard JM, Walter P, Brechenmacher C, Voegtlin R (1977) Atteinte cardiaque au cours d'un syndrome lipidique. Etude clinique et morphologique à propos d'un cas ayant necessité un double remplacement valvulaire. Arch Mal Coeur 70: 1203–1208

    Google Scholar 

  36. Walter P, Weill-Bousson M, Mossart JM, Voegtlin R (1977) Lupus erythemateux disseminé et insuffisance cardiaque. Etude histologique et ultrastructurale du myocarde. Virchows Arch A [Pathol Anat] 375: 71–82

    Google Scholar 

  37. Boor PJ, Ferrans VJ, Jones M, Kawanami O, Thiedemann KU, Herman EH, Roberts WC (1979) Tubuloreticular structures in myocardium: An ultrastructural study. J Mol Cell Cardiol 11: 967–979

    Google Scholar 

  38. Bulkley BH, Ridolfi RL, Salyer WR, Hutchins GM (1976) Myocardial lesions of progressive systemic sclerosis. A cause of cardiac dysfunction. Circulation 53: 483–490

    Google Scholar 

  39. Oram S, Stokes W (1961) The heart in scleroderma. Br Heart J 23: 243–259

    Google Scholar 

  40. Ridolfi RL, Bulkley BH, Hutchins GM (1976) The cardiac conduction system in progressive systemic sclerosis. Clinical and pathologic features of 35 patients. Am J Med 61: 361–366

    Google Scholar 

  41. James TN (1974) De subitaneus mortibus. VIII. Coronary arteries and conduction system in scleroderma heart disease. Circulation 50: 844–856

    Google Scholar 

  42. D'Angelo WA, Fries JF, Masi AT, Shulman LE (1969) Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med 46: 428–440

    Google Scholar 

  43. Gottidiener JS, Sherber HS, Hawley RJ, Engel WK (1978) Cardiac manifestations in polymyositis. Am J Cardiol 41: 1141–1149

    Google Scholar 

  44. Hill DL, Barrows HS (1968) Identical skeletal and cardiac muscle involvement in a case of fatal polymyositis. Arch Neurol 19: 545–551

    Google Scholar 

  45. Lynch PG (1971) Cardiac involvement in chronic polymyositis. Br Heart J 33: 416–419

    Google Scholar 

  46. Rodman GP, McEwen C, Wallace SL (1973) Primer on the rheumatic diseases. JAMA 224 (Suppl): 662–812

    Google Scholar 

  47. Haupt HM, Hutchins GM (1982) The heart and cardiac conduction system in polymyositis-dermatomyositis: A clinicopathologic study of 16 autopsied patients. Am J Cardiol 50: 998–1006

    Google Scholar 

  48. Denbow CE, Lie JT, Tancredi RG, Bunch TW (1979) Cardiac involvement in polymyositis. A clinicopathologic study of 20 autopsied patients. Arthritis Rheum 22: 1088–1092

    Google Scholar 

  49. Alarcon-Segovia D, Brown AL Jr (1964) Classification and etiologic aspects of necrotizing angiitides: An analytical approach to a confused subject, with a critical review of the evidence for hypersensitivity in polyarteritis nodosa. Proc Staff Meet Mayo Clin 39: 205–222

    Google Scholar 

  50. Moskowitz RW, Baggenstoss AH, Slocumb CH (1963) Histopathologic classification of periarteritis nodosa: A study of 56 cases confirmed at necropsy. Proc Staff Meet Mayo Clin 38: 345–357

    Google Scholar 

  51. Zeek PM (1953) Medical progress: Periarteritis nodosa and other forms of necrotizing angiitis. N Engl J Med 248: 764–772

    Google Scholar 

  52. Fauci AS, Wolff SM (1977) Wegener's granulomatosis and related diseases. Disease-A-Month 23 (No. 7)

  53. McCrea PC, Childers RW (1964) Two unusual cases of giant cell myocarditis associated with mitral stenosis and with Wegener's syndrome. Br Heart J 26: 490–493

    Google Scholar 

  54. Longauer F, Takáč M, Halásová K (1969) Über die Schädigung des Reizleitungssystems bei Wegenerścher Granulomatose. Arch Kreislaufforsch 58: 412–421

    Google Scholar 

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Authors and Affiliations

  1. Pathology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA

    Victor J. Ferrans & E. René Rodríguez

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  1. Victor J. Ferrans
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  2. E. René Rodríguez
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Ferrans, V.J., Rodríguez, E.R. Cardiovascular lesions in collagen-vascular diseases. Heart Vessels 1 (Suppl 1), 256–261 (1985). https://doi.org/10.1007/BF02072405

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