Libman-Sacks endocarditis

Libman-Sacks Endocarditis is a form of non-bacterial endocarditis that is a complication of systemic lupus erythematosus (SLE) and less commonly of antiphospholipid syndrome. The condition was first described by Emanuel Libman and Benjamin Sacks in 1924. It is characterized by the presence of sterile vegetations on the valve leaflets and sometimes on the endocardium.

Etiology

Libman-Sacks endocarditis is associated with autoimmune diseases, primarily systemic lupus erythematosus (SLE) and the antiphospholipid syndrome. These conditions lead to a hypercoagulable state and inflammation, contributing to the formation of vegetations.

Pathophysiology

The pathogenesis of Libman-Sacks endocarditis involves the deposition of immune complexes on the heart valves, leading to inflammation and vegetations. These vegetations are composed of fibrin, platelets, and immune cells. Unlike infective endocarditis, the vegetations in Libman-Sacks endocarditis are sterile and do not contain bacteria.

Clinical Features

Patients with Libman-Sacks endocarditis may be asymptomatic or present with symptoms related to valvular dysfunction, such as shortness of breath, chest pain, or heart murmurs. The condition can lead to serious complications, including valve regurgitation, heart failure, and embolic events.

Diagnosis

Diagnosis of Libman-Sacks endocarditis involves a combination of clinical assessment, echocardiography, and laboratory tests. Echocardiography is the primary imaging modality used to detect vegetations and assess valvular function. Laboratory tests may include markers of inflammation, autoantibodies associated with SLE and antiphospholipid syndrome, and coagulation studies.

Treatment

Treatment of Libman-Sacks endocarditis focuses on managing the underlying autoimmune condition with immunosuppressive therapy and anticoagulation to prevent thromboembolic complications. In cases of severe valvular dysfunction, surgical intervention may be necessary.

Prognosis

The prognosis of Libman-Sacks endocarditis varies depending on the severity of valvular involvement and the presence of underlying autoimmune conditions. With appropriate treatment, the progression of valvular disease can be slowed, and the risk of complications reduced.

See Also

• Endocarditis
• Systemic Lupus Erythematosus
• Antiphospholipid Syndrome
• Valvular Heart Disease

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