Jasmine Rajareegam Princely1, Ranjitha2

Nursing Incharge, Kauvery Heartcity, Trichy, India

Senior Staff Nurse, Kauvery Heartcity, Trichy, India

*Correspondence: +91 8508698000; nursing.heartcity@kauveryhospital.com>

Systemic Lupus Erythematosus (SLE)

Background

Systemic autoimmune conditions may cause morbidity and mortality. Systemic Lupus Erythematosus (SLE) is a prominent example of such diseases. It can result in conduction abnormalities due to accelerated atherosclerosis, vasculitis, or auto antibodies-induced myocarditis. Cardiac conduction abnormalities may produce sinus tachycardia, sinus bradycardia, prolonged QT intervals, atrial fibrillation, or Atrio Ventricular (AV) nodal blocks. Neonatal lupus is sometimes associated with anti-Ro/SSA and anti-La/SSB antibodies, but their role remains a matter of controversy in adults.

Definition

An inflammatory disease occurs when the immune system attacks its own tissue. Lupus (SLE) can affect the joints, skin, kidneys, blood cells, brain, heart and lungs.

Case Presentation

A 40-year-old female, a known case of symptomatic Systemic Lupus Erythematosus (SLE) came with the complaints of palpitation and chest pain on & off for 1 month, and known right ventricular (RV) inferior exit Premature Ventricular Contraction (PVC’s), was admitted for EP study and Radio frequency ablation (RFA). She was diagnosed of SLE 10 years back; she had complaints of hair loss and allergic skin reactions for which she was under the treatment of general physician.

Patient signs & symptoms

  1. Hair loss
  2. Skin allergy reaction

Patient’s clinical details

  1. SLE with CNS involvement
  2. Mild LV dysfunction (? SLE myocarditis)
  3. RV inferoseptal VPC
  4. 3D EP study + RFA under 3D

X-Ray

X-Ray-1

ECHO

ECHO-1

ECG

ECG-2
ECG-3

Procedure

Diagnosis: Symptomatic PVC/EF – 50%

Surface ECG details

PR interval – 112 msec QRS interval – 86 msec

RR interval – 800 msec QT interval – 390 msec

Electrophysiology procedure Info: Procedure & drugs used

Sheaths RFV 7F, RFV 6F X 2

Catheters used: Quadripolar (6F), decapolar (6F), Ablation catheter (7F)

Catheter placement HIS, CS, RV outflow, LVOT

Base line measurement (msec)

AH interval – 63 msec HV interval – 42 msec

HIS interval – 15 msec

V. Pacing: Concentric & Decremental,

VAW – < 200 msec

VERP – 600/250 msec

A Pacing: No pre-excitation

AV cross-over at 320 msec – 500/220 msec

Procedure Details:

Under local anesthesia, catheters were placed in the above-said location. Using 3D ENSITE NAVX mapping, RV geometry was created. Activation mapping showed an early signal (-35 ms) at RV inferoseptum near apex. Unipolar revealed QS complex. Using 7F non-irrigated therapy, ablation at that spot terminated the VPC. No further PVC noted with isoprenaline infusion.

Post RFA: All parameters were normal

Final Diagnosis: VPC (Inferoseptal near Apex)

Using 3D ESNITE Precision NAVX mapping

Medications

Tab. Dolo 650 mg 1-1-1 X 3 DAYS Tab. Hoperab 20 mg 1-0-1 (BEFORE FOOD) Tab. Cadotril 100 mg 1-1-1 X 3 DAYS Tab. Concor 1.25 mg 1-0-0 Tab. Ceftum 250 mg 1-0-1 X 3 DAYS

Nursing Management for a patient with SLE

  1. Teach the client importance of avoiding direct sunlight and the use of protective clothing and sunscreen.
  2. Patient education regarding disease process.
  3. Regular health check up.
  4. Maintain skin integrity
  5. Body image disturbance
  6. Encourage balance rest & activity and to eat a balanced diet with low sodium.
  7. Emphasize sign of exacerbation and early signs of infection.
  8. Diet rich in anti oxidants. Avoid refined foods, red meat and coffee.

Discussion

The exact cause of SLE isn’t known but several factors have been associated with the disease. The disease isn’t linked to a certain gene but people with lupus often have family members with other autoimmune conditions. Investigations to diagnose SLE includes

  1. Blood tests such as an Antibody test
  2. Complete blood count.
  3. Urine analysis
  4. Chest X-ray

Conclusion

As patients with SLE survive their episodes of disease activity, increasing morbidity is shown to be related to chronic cardiovascular complications. After the EP study, patient discharged in good condition.

Ms.-Jasmine-Rajareegam-Princely

Ms. Jasmine Rajareegam Princely

Nursing Incharge

Ms.-Ranjitha

Ms. Ranjitha

Senior Staff Nurse

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