SHM Converge Scientific Abstract ePoster Gallery-A Case of Triple Vessel Disease in a 34-Year-Old Woman With Systemic Lupus Erythematosus

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This case describes a 34-year-old woman with systemic lupus erythematosus (SLE), antiphospholipid syndrome, hypertension, hyperlipidemia, and a family history of early myocardial infarction who presented with 2 hours of severe substernal chest tightness, nausea, and vomiting. Although her ECG showed only nonspecific T-wave changes and echocardiogram was normal, her troponin was elevated, suggesting acute coronary syndrome.<br /><br />A nuclear stress test performed after three days revealed a large fixed perfusion defect with regional wall motion abnormalities. Cardiac catheterization then showed severe triple-vessel coronary artery disease: diffuse 70% stenosis in the proximal and middle LAD, 90% stenosis in the proximal and distal LCX, and 99% stenosis in the mid RCA. She was started on heparin and evaluated for CABG, but was ultimately not a surgical candidate. She underwent revascularization with drug-eluting stents to the RCA and LAD, received dual antiplatelet therapy, and her statin was intensified. Her lupus treatment was also escalated after rheumatology consultation.<br /><br />The report highlights that patients with SLE, especially young women, have a substantially increased risk of premature atherosclerosis, coronary artery disease, and myocardial infarction that is not fully explained by traditional cardiovascular risk factors. Standard risk prediction tools such as Framingham may underestimate risk in this population. Antiphospholipid syndrome and lupus nephritis are noted as particularly strong associated risk factors.<br /><br />Key takeaways are that SLE should be considered an independent risk factor for acute coronary syndrome in young patients with chest pain, classic cardiovascular risks should be aggressively controlled, and patients with SLE plus antiphospholipid syndrome or lupus nephritis may warrant more intensive prevention and treatment strategies.

Asset Subtitle

Palina Sudnik

Meta Tag

Author List Palina Sudnik

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Cardiovascular Risk Factor

Concept Acute Coronary Syndrome

Concept Antiphospholipid Antibody Syndrome

Concept Coronary Risk

Distinguished Non-Finalist

Presenter Organization St. Luke's University Health Network

Presenting Author Palina Sudnik

Track Adult

Keywords

systemic lupus erythematosus

antiphospholipid syndrome

acute coronary syndrome

triple-vessel coronary artery disease

myocardial infarction

premature atherosclerosis

drug-eluting stents

dual antiplatelet therapy

coronary artery bypass grafting

cardiovascular risk factors

Systemic Lupus Erythematosus

Cardiovascular Risk Factor

Acute Coronary Syndrome

Antiphospholipid Antibody Syndrome

Coronary Risk