Cardiovascular Complications of Catastrophic Antiphospholipi
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Antiphospholipid syndrome (APS) is an autoimmune response characterized clinically by arterial or venous thrombosis. One of the rare and series forms of APS is the catastrophic antiphospholipid syndrome (CAPS). The incidence of CAPS has been reported in 0.8% of patients with APS. There have been very few case reports with cardiac involvement in CAPS. Common cardiac manifestations include valvular thickening and lesions, coronary artery disease, and myocardial infarction due to microvascular thrombosis. Here, we are reporting a case of CAPS associated with heart failure and a literature review of similar cases.

A 24-year-old woman with a history of antiphospholipid syndrome presented with shortness of breath and right-sided pleuritic chest pain. Computed tomography pulmonary angiogram (CTPA) revealed new pulmonary emboli in the right lung. After five days, she developed high-grade fever with negative infectious workup, acute hypoxic respiratory failure with pulmonary edema, shock, acute kidney injury, and transthoracic echocardiography (TTE) showed reduced ejection fraction and global hypokinesia. The constellation of multi-organ failure, symptoms within a week, the presence of antiphospholipid antibodies, and exclusion of other causes, CAPS was diagnosed. The patient showed significant improvement with pulse steroids, IV plasmapheresis and got discharged on oral prednisone taper and anticoagulation with home health.

There are different cardiac complications associated with CAPS, including congestive heart failure, acute coronary syndrome, valvular lesions, and thrombus. Heart failure management in CAPS includes triple therapy of IVIg, IV plasmapheresis, and corticosteroids rather than conventional treatment.

Source: https://academic.oup.com/ehjcr/advance-article/doi/10.1093/ehjcr/ytac199/6583508?rss=1
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