5.4.16 – VA Ambulatory Report Pearls – Cardiac manifestations of apls

Common Cardiac Manifestations of APLS

  1. Valvular disease
  2. Coronary artery disease
  3. Intracardiac thrombus formation
  4. Pulmonary hypertension
  5. Dilated cardiomyopathy

More details on some of the most common cardiac manifestations listed above:

  • Valvular disease: deposition of immune complexes –> vegetations/irregular thickening of the valve leaflets –> valve dysfunction
    • Leads to increased risk for CVA
    • Note that 40% of APLS patients also have SLE and thus valvular disease can be secondary to SLE versus APLS
    • The most commonly affected valve is the mitral valve (MR) >> aortic and tricuspid valves which is thought to be due to the fact that left-sided valves are more vulnerable to micro injuries from stress/jet/turbulence
    • There is a positive correlation between APLS titers and severity of valvular heart disease
  • Coronary artery disease: patients with APLS are at risk of accelerated atherosclerosis
  • Intracardiac thrombus formation: rare complication
    • Thrombus is most likely to form on the right side
    • A quick word on other thrombogenic complications (e.g., recurrent DVTs) – of patients who present with thrombosis, up to 85% will present with venous > arterial thrombosis and repeat episodes are often of the same type
    • Thrombotic events, unlike intracardiac thrombus formation, are common and occur frequently in microvasculature or smaller vessels and are often recurrent and can impair myocardial function via recurrent microthromboses or microemboli

Reference (article attached here):

Koniari I, Siminelakis SN, Baikoussis NG, Papadopoulos G, Goudevenos J, Apostolakis E. Antiphospholipid syndrome; its implication in cardiovascular diseases: a review. Journal of Cardiothoracic Surgery. 2010;5:101. doi:10.1186/1749-8090-5-101.

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