Lupus, the Heart and Cardiovascular System
- The Heart and its Role as Part of the Cardiovascular System
- Conditions of the Heart and Cardiovascular System
- Staying Healthy
- In Conclusion
The average heart beats approximately 100,000 times a day. For an 80-year old, that adds up to an astonishing 280,000,000 beats over the years! It stands to reason how resilient the heart is – and how much demand is placed on it by the rest of the body – to keep us healthy, strong, and functioning at our best.
Sometimes things go awry, however, and for individuals with lupus, the risk of developing various heart conditions and cardiovascular disease increases. Black women, for example, are three times as likely as white women to have lupus, and this raises the risk for heart and cardiovascular disease. It is really imperative for everyone – and more so for individuals with lupus – to show the heart some love in order for it to keep beating strong.
Understanding the heart and cardiovascular system and their vulnerabilities can give you the framework you need in order take responsibility for your own well-being and give your heart some tender-loving care.
The Heart and its Role as Part of the Cardiovascular System
Your heart is the size of both of your fists placed together, and consists of four chambers: two large ventricles, and two smaller atria (the singular is atrium). The chambers are organized into two sides, the left and the right – each with an atrium and a ventricle – that operate almost as if they are two separate pumps. It is this double pump function that gives the heart its characteristic thump-thump or “lub-dub” sound when heard through a stethoscope.
Here’s a primer for how blood enters and exits the heart and moves throughout the body:
Blood enters the heart in two ways and from two sets of veins. The blood from most of your body enters the right atrium from two large veins: one from your head and upper body (the superior vena cava) and one from your legs and lower body (the inferior vena cava). This blood has given its oxygen to all parts of the body, and so the job of the right side of the heart is to get this blood to the lungs for more oxygen. The right atrium momentarily holds about one cup of blood at a time before passing it to the right ventricle through a one-way valve.
Actually, there are heart valves where blood both enters and exits each ventricle. These valves keep the blood flowing in one direction so that the entire circulatory system can carry oxygen, nutrients and wastes in the most efficient way. Damage to these valves can hurt this efficiency and is a common cause of heart disease.
From the heart’s right ventricle, blood is pumped to the lungs where it spreads out into the tiny capillaries of the alveoli so that it can pick up the oxygen that we draw in with each breath. Of course, this same blood dumps excess carbon dioxide into the lungs so that it can be removed from the body when we breathe out.
At this point, bright red, newly oxygenated blood now passes into veins, called pulmonary veins, which bring the blood to the left side of the heart – first the left atrium and then the left ventricle. It is from the left ventricle that the biggest push of blood occurs. The left ventricle pumps blood into our largest artery, the aorta, to be distributed to the rest of the body. It is this strong contraction from the left ventricle that creates the noticeable pulse in our wrists. As this blood moves around the body, it gives up oxygen and gains carbon dioxide and begins its journey back to the right atrium of the heart.
In a heart-healthy person, this cycle repeats constantly throughout the day, every day. The cardiovascular system functions like one of those highly-technical and sustainable plumbing systems that constantly recycles and reuses its own water, keeping it clean and toxin-free. Breakdowns in this system can occur, however, and it’s a good idea to understand what can happen and how to get things back into proper working order.
Conditions of the Heart and Cardiovascular System
10% or less of people with lupus will develop myocarditis. Myocarditis is the inflammation of the heart muscle (myocardium). Myocarditis can weaken the heart’s ability to pump blood to the rest of the body. If you have this condition, you may experience a rapid (fast) heartbeat, chest pain, and tests may show an enlarged heart. This is a serious condition that needs very close monitoring.
Diagnostic tools include: blood tests, x-rays, echocardiograms, electrocardiograms, MRIs, and/or cardiac catheterization and endomyocardial biopsy.
Treatment may include: rest and abstinence from intense exercise for a period of time, antibiotics, corticosteroids, immunosuppressive therapy.
15% of people with lupus may develop Libman-Sacks endocarditis. This form of endocarditis is associated with Antiphospholipid Syndrome antibodies. This his condition causes growths on the surface of the heart valves and can lead to infection and even stroke. It generally occurs when germs (bacteria) spread to your heart from other parts of your body through your bloodstream. The bacteria or “growths” can damage or destroy your heart valves and lead to serious complications.
Diagnosis tools include: blood tests, x-rays, echocardiograms, electrocardiograms, CT scans, and/or MRIs.
Treatment may include: antibiotics and sometimes surgery which may include heart valve replacement.
The most common heart abnormality in individuals with lupus, it’s been reported that pericarditis affects between 6-45% of individuals with lupus and often goes undiagnosed. Pericarditis is the inflammation and irritation of the pericardium, the thin sac-like membrane that surrounds the heart. Symptoms can be acute with quick onset, but don’t last long. Symptoms can also be chronic if they appear gradually and are persistent.
Diagnostic tools may include: chest x-ray, CT scan, MRI, echocardiogram, fluid drainage (rare), and/or electrocardiogram.
Treatment may include: antibiotics, pain relievers, fluid drain, corticosteroids, colchicines, and/or surgery including Pericardiocentesis and/or Pericardiectomy.
Blood Pressure and Hypertension
Blood pressure is the strength at which your blood is pushed against the sides of your blood vessels. The top number in a blood pressure reading – the systolic reading – is the pressure in your blood vessels when the heart contracts. The bottom number – the diastolic reading – is the pressure in your arteries when your heart relaxes between beats. Normal blood pressure should be around 120/80.
It’s important to learn about hypertension because it can really affect anyone at any time and often catches people completely unaware (they just thought they were a little stressed and it would go away). High blood pressure – hypertension – happens when the blood pushes against the walls of your vessels with greater force. Hypertension can occur in stages. Stage 1 hypertension is defined as a blood pressure reading that has a systolic pressure reading of 130-139 (the top number) over a diastolic pressure reading of 80-89 (the bottom number). Stage 2 hypertension is defined as a blood pressure reading of 140+/90+. As hypertension enters the crisis stage, readings can reflect blood pressure of 180+ over 120+. Blood pressure can be more difficult to control in lupus patients because prednisone and other NSAIDS (non-steroidal anti-inflammatory drugs) can elevate it. Kidney disease may also affect your blood pressure and can be one of the first symptoms people experience who have lupus nephritis.
Chronic hypertension can cause damage to the walls of the blood vessels, and can lead to other cardiovascular problems and hardening of the arteries. There are many things you can do on your own to help either lower your blood pressure or not make matters worse and if caught early enough medication may not be needed. We will explore those options later in this article under “Staying Healthy.”
Diagnostic tools include: routine blood pressure checks, often numerous times throughout the day over a period of time.
Treatment may include (depending on the severity and duration of hypertension): diet and weight modifications, limiting alcohol consumption, engaging in stress relief practices. There is a huge list of medications that may be used to treat hypertension if all else fails or in tandem with other treatment. These medications may include: thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), alpha blockers, beta blockers, calcium channel blockers, vasodilators, renin inhibitors, and/or central acting agents.
Cholesterol, Atherosclerosis, and Coronary Artery Disease
First, it helps to understand a bit more about cholesterol. In simple terms, cholesterol is fat that is found in your blood. Your liver makes cholesterol, but you can also get it from what you eat. Dairy products, meat, and fish contain cholesterol. Our bodies need a certain amount of it, but within limits.
There are two types of cholesterol. High-density lipoprotein – HDL – is often referred to as “good” cholesterol. Low-density lipoprotein – LDL – is considered “bad” cholesterol. However, in studies funded by the Alliance for Lupus Research, they have discovered that there are abnormal HDL (referred to as piHDL) levels that may exist in people with autoimmune disorders such as lupus. This could be the catalyst for those with lupus developing atherosclerosis which we will discuss below. However, the presence of piHDL may help serve as a marker to identify those who have a higher risk of developing cardiovascular disease and, in turn, allowing those to take preventive actions if needed.
A buildup of bad cholesterol can lead to atherosclerosis and coronary artery disease. Atherosclerosis, also known as ASVD or premature coronary heart disease, is a form of arteriosclerosis where the artery wall thickens in result of a build up of white blood cells. The build up of the cells causes a fibrofatty plaque – cholesterol, or in particular, the bad, LDL cholesterol – that affects the elasticity of the artery walls. Atherosclerosis can cause hardening and narrowing of the arteries, and after time, slowly block the artery from obtaining proper blood flow. It can cause strokes, heart attacks, and peripheral vascular disease. Some studies have shown that people with lupus are more than 50 times more like to develop atherosclerosis than that of the general population.
Coronary artery disease develops when the major blood vessels that carry blood to the heart become damaged and diseased over time if cholesterol levels are not kept in check.
Diagnostic tools may include: a physical examination including a complete medical history, blood tests, ultrasounds, stress tests, heart scans, CT scans, and/or cardiac catheterization and angiogram.
Treatment may include: diet and weight modifications, cholesterol-modifying medications such as statins; angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, calcium channel blockers, ranolazine, and/or nitroglycerine; surgery including angioplasty, stent implants, and/or coronary artery bypass grafting (CABG).
Be proactive when it comes to your health. Take charge of feeling good and pay heed when you don’t. Don’t be afraid to talk to a trusted healthcare practitioner if you feel off physically or are having a hard time dealing with what life often throws at us unexpectedly. All of these things can take a toll on the body over time and individuals with lupus are at higher risk of developing complications.
Here are several things you can start doing today that can help you achieve your health goals. It’s important to remember, however, that you are human and can be easily overwhelmed. Even trying to implement one healthy practice a week or in one meal a day is a great way to start your journey on the road to good holistic health!
- Maintain a healthy diet and achieve a healthy weight – limit fat, sugar, and salt intake. Eat whole grains, fruits and vegetables – try to stay away from processed foods. Even those yummy fruity yogurts can be full of sugar! What you drink can be equally as suspect (insert Starbucks here), and full of bad – albeit delicious – things. Learn to make healthy changes to that latte (no whip cream, no sprinkles, two pumps vanilla instead of four, nonfat milk or almond milk) without skimping on taste. Speaking of coffee, limit your caffeine intake.
- Make sure you receive regular testing for diabetes.
- Floss! Practicing good oral hygiene is a MUST! Periodontal (gum) disease can often make one susceptible to heart disease. Keep your teeth and mouth clean and see your dentist regularly.
- Make sure that on most nights you get between seven and eight hours of sleep.
- Many of us have sedentary jobs these days or sit too long on the couch binge-watching Netflix – get up and move! Make it a goal to get up and move around at least once every 20 minutes. Set your timer on your phone or download an app for more assistance with remembering to be active.
- Stop smoking and avoid secondhand smoke. Period.
- Moderate alcohol intake. Happy hour can still be happy sipping on mineral water spiked with a lime while catching up on the office gossip!
- Incorporate and practice stress-relief habits into your daily routine. Take a walk in nature. Perform gentle yoga. Meditate and practice mindfulness. Consider seeing a therapist to learn better coping skills. Develop a good support system of friends and family. Do more of what you love and celebrate life!
Being proactive and taking your health seriously can go a long, long, way….possibly almost 800,000,000 heart beats or more away. By taking as many preventative measures as you can – without forsaking what you enjoy – you stand a greater chance of warding off unwanted illness and disease while protecting your precious heart. Understanding lupus, the risks involved, and maintaining a trusting, open, and honest relationship with your healthcare practitioner will also enable you to make and meet realistic healthcare goals, paving the way to a life worth celebrating!
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Author: The KFL Team
Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.
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All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.