From the Research
Yes, lupus can cause chest pain even if all tests are negative, and it is essential to consider cardiac involvement, such as coronary microvascular dysfunction or myocarditis, in patients with systemic lupus erythematosus (SLE) and chest pain. Lupus can cause pleuritis (inflammation of the lining around the lungs) or pericarditis (inflammation of the sac around the heart), both of which commonly cause chest pain 1. Some patients may have seronegative lupus, where standard blood tests like ANA (antinuclear antibody) are negative despite having the condition. If you're experiencing chest pain, it's essential to seek medical evaluation promptly as chest pain can also indicate serious conditions unrelated to lupus, such as heart attack or pulmonary embolism.
The most recent and highest quality study, published in 2024, found that cardiac involvement is common in SLE and constitutes one of the main causes of mortality, and that ultrasound imaging techniques, such as transthoracic ultrasound (TTE) with strain evaluation, can be useful in detecting cardiac involvement 1. Another study published in 2022, found that coronary microvascular dysfunction is reported in approximately half of SLE patients with suspected ischemia with no obstructive coronary arteries (INOCA) 2.
Key points to consider:
- Lupus can cause chest pain due to various mechanisms, including pleuritis, pericarditis, and coronary microvascular dysfunction
- Cardiac involvement is common in SLE and can be asymptomatic
- Ultrasound imaging techniques, such as TTE with strain evaluation, can be useful in detecting cardiac involvement
- It is essential to consider cardiac involvement in patients with SLE and chest pain, even if all tests are negative
- A comprehensive evaluation, including medical history, physical examination, and additional tests, such as chest X-rays, ECGs, or more specialized lupus antibody panels, may be necessary to diagnose and manage lupus-related chest pain.