Lupus-Fatty tissue around heart due to predisone therapy

Posted By  CCF Cardio MD-SGM on October 07, 1997 at 17:11:13:

In Reply to: Lupus-Fatty tissue around heart due to predisone therapy posted by Nancy c. on October 02, 1997 at 21:38:22:

: What causes this, and what do they do about it? Do you keep chest pains all the time with this? Does your heart go back to normal size?

[CCF Cardio MD-SGM]

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Dear Nancy,
Systemic Lupus Erythematosis, or SLE, is an autoimmune disease that can adversely affect multiple organ systems, including the heart. There are numerous cardiac, or heart-related, manifestations of SLE, and some of these, as appears to be the case in your instance, occur as a result of therapy with corticosteroids,  namely prednisone.   Therapy with predisone and other immunosuppressive medications has been clearly shown to reduce the serious complications that can occur as a result of SLE, but prednisone is not without its side-effects, many of them troublesome for patients.  
The literature describes several cardiac complications of prednisone therapy, including hypertension(high blood pressure) and left ventricular hypertrophy, or increased thickening of the main pumping chamber of the heart, in response to the higher blood pressure. Also described are cases of congestive heart failure, an increased incidence of coronary artery disease, and increased deposition of myocardial and subepicardial fatty deposits.   Your questions concerns the last of these problems.
Myocardial and epicardial fat, or fatty tissue in the heart muscle itself, can occur as a complication of therapy with prednisone.  In itself, it should not produce chest pains, and is unlikely to cause serious problems such as irregular heart beats.  Extensive infiltration of the heart muscle with fatty tissue could lead to congestive heart failure, but this would not be a common occurrence.  In answer to your question, I would recommend that your doctors pursue other causes for your chest pains, such as pericarditis or myocarditis, two inflammatory conditions that can occur as a result of the lupus, not the prednisone.  Cessation of therapy with prednisone would likely stop the accumulation of fatty tissue in the heart muscle, but such a change in therapy would have to be carefully weighed against the risk of progression of the lupus.   Regarding the size of your heart, if it is in fact enlarged, this may be due to several causes:  hypertension leading to left ventricular hypertrophy, dilated cardiomyopathy, or enlargement of the heart's pumping chamber, which may occur as a result of therapy for lupus, and secondary to valvular leakage which sometimes occurs with lupus itself.  Clearly, there are numerous, interrelated concerns here that need to be discussed with your cardiologist and rheumatoligist.  If you like, we'd be happy to arrange an appointment at the Cleveland Clinic, by calling 1 800 CCF-CARE.  
Information provided in the Heart Forum is intended for general medical informational purposes only.  Actual diagnosis and treatment of any particular medical condition can only be made by your physician(s).