Microvascular Angina: An Underappreciated Cause of SLE Chest Pain

Abstract

To the Editor: Data are accumulating that microvascular dysfunction is an unrecognized source of anginal chest pain in patients with autoimmune diseases such as systemic lupus erythematosus (SLE)1,2,3. Studies show that microvascular impairment contributes to cardiovascular disease in other autoimmune conditions such as systemic sclerosis1,2,4. Patients with SLE presenting with anginal chest pain pose a diagnostic challenge. Evaluating the role of microvascular impairment as a cause of chest pain may lead to earlier and improved management of these patients. Chest pain and discomfort are frequently reported by patients with SLE5, the origin of which can be attributed to multiple causes, including valvular disease, conduction abnormalities, pericardial disease (pericarditis, pericardial effusion), myocarditis, pulmonary hypertension, coronary artery disease (CAD), esophageal disease, musculoskeletal manifestations (costochondritis, myofascial pain, muscle spasm), and even psychiatric illness. However, upon clinical examination, diagnostic testing is often generally negative or minimally abnormal. Normal or minimally abnormal cardiovascular findings on … Address correspondence to Dr. M.L. Ishimori, Division of Rheumatology, Cedars-Sinai Medical Center, B-131, 8700 Beverly Blvd., Los Angeles, CA 90048, USA., E-mail: Mariko.Ishimori{at}cshs.org