A 41-year-old woman has had increasing dyspnea for the past week. On physical examination, temperature is 37.3deg C, pulse is 85/min, respirations are 20/min, and blood pressure is 150/95 mm Hg. There is dullness to percussion over the lung bases. A chest radiograph shows large bilateral pleural effusions and a normal heart size. Laboratory findings include serum creatinine, 3.1 mg/dL; urea nitrogen, 29 mg/dL; troponin I, 0.1 ng/mL; WBC count, 3760/ mm3; hemoglobin, 11.7 g/dL; and positive ANA and anti-double-stranded DNA antibody test results. Which of the following cardiac lesions is most likely to be present in this patient?
A 41-year-old woman has had increasing dyspnea for the past week. On physical examination, temperature is 37.3deg C, pulse is 85/min, respirations are 20/min, and blood pressure is 150/95 mm Hg. There is dullness to percussion over the lung bases. A chest radiograph shows large bilateral pleural effusions and a normal heart size. Laboratory findings include serum creatinine, 3.1 mg/dL; urea nitrogen, 29 mg/dL; troponin I, 0.1 ng/mL; WBC count, 3760/ mm3; hemoglobin, 11.7 g/dL; and positive ANA and anti-double-stranded DNA antibody test results. Which of the following cardiac lesions is most likely to be present in this patient?
💡 Explanation
**Core Concept**
The patient's presentation suggests systemic lupus erythematosus (SLE) with pulmonary involvement, and cardiac involvement is a known complication. Cardiac lesions in SLE can be due to the deposition of immune complexes and complement activation, leading to inflammation and damage to cardiac tissues.
**Why the Correct Answer is Right**
The patient's laboratory findings, including positive ANA and anti-double-stranded DNA antibody test results, are characteristic of SLE. The presence of pleural effusions and normal heart size on chest radiograph, along with elevated serum creatinine and urea nitrogen, suggests renal involvement. The cardiac lesion most likely to be present in this patient is Libman-Sacks endocarditis, which is a non-bacterial endocarditis characterized by the deposition of immune complexes on the valve leaflets. This condition is specifically associated with SLE and antiphospholipid syndrome.
**Why Each Wrong Option is Incorrect**
* **Option A:** Myocarditis is an inflammatory condition of the heart muscle, which can be caused by various infections or autoimmune diseases. However, it is not the most likely cardiac lesion in a patient with SLE and pulmonary involvement.
* **Option B:** Pericarditis is an inflammatory condition of the pericardium, which can be caused by various conditions, including autoimmune diseases. However, it is not the most likely cardiac lesion in a patient with SLE and pulmonary involvement.
* **Option D:** Cardiac tamponade is a condition characterized by fluid accumulation in the pericardial space, which can lead to cardiac compression. However, it is not a specific cardiac lesion associated with SLE.
**Clinical Pearl / High-Yield Fact**
In patients with SLE, cardiac involvement can occur due to the deposition of immune complexes and complement activation, leading to inflammation and damage to cardiac tissues. Libman-Sacks endocarditis is a specific type of non-bacterial endocarditis associated with SLE and antiphospholipid syndrome.
**Correct Answer:** C. Libman-Sacks endocarditis.
✓ Correct Answer: D. Libman-Sacks endocarditis
📤 Share this MCQ
Share Card Preview
👆 1080x1080 square card — fills the full width in WhatsApp and Telegram