A middle aged woman with a pmh of SLE, DM1, and CKD who initially presented with exertional shortness of breath and underwent a workup to rule out PE and ACS: negative V/Q scan, negative myocardial perfusion study, and a normal ECHO. It was thought that her symptoms were potentially related to ILD for which she was scheduled for outpatient workup with PFTs and HRCT. She then presented 6 weeks later with typical chest pain, ischemic EKG changes, and a positive troponin found to have a 98% lesion of her proximal LAD.
– SLE confers a significant risk for CAD – patients with lupus inherently have a higher risk for CAD, they are also more likely to have other risk factors associated with CAD; + antiphospholipid antibodies and lupus nephritis confer the highest risk
– Ddx of SLE + chest pain: ischemia, pleuritis/pericarditis, PE, pHTN, and all other causes of chest pain seen in non-SLE patients
-This was an odd presentation given her previous negative myocardial perfusion scan