Therapeutic challenges in systemic tissue disease

Introduction: Systemic scleroderma, autoimmune disease with multiorgan damage, requires an individualized approach to visceral determinations. Clinical manifestations correlates with the degree and the predominant location of the inflammatory process. Cardiac implication, having myocardial fibrosis substrate, correlates with a reduction in life expectancy.
Case presentation: We present the case of a 58-year-old patient with occupational exposures to respiratory poisoning (chemical), diagnosed at age 47 with systemic scleroderma – diffuse cutaneous form (currently Rodnan score=39), with multiple affections of the organs of the underlying diseases (cardiac, pulmonary, digestive and renal), with symptomatic tachyarrhythmic repetitive episodes, admitted for clinical deterioration of the general condition based on a acute tracheobronchial respiratory infection.The investigations carried out assessed the severity of the underlying disease and the association of the cardiac pathology with significant echocardiographic segmental kinetic changes, in the presence of atrial fibrillation with normal heart rhythm, with pauses of up to 2 seconds. We mention the spontaneous remission of the supraventricular rhythm disorder with sinus rhythm installation with heart rate=56 beats/minute, the patient being symptomatic only at long periods of absence of cardiac activity. Heart activity suggests the coexistence of sinus node disease, which is contraindicated for any dromotropic or chronotropic drugs. Under complex treatment established significant improvement in comorbidities and withdrawal of respiratory syndrome.
Conclusions: The prognosis in scleroderma is dependent on the degree of damage to the vital organs. Vasculopathy in scleroderma affects endothelial structure and function, having an important role in initiating the atherosclerotic process. Cardiovascular risk assessment and adapting a cardiovascular disease prevention strategy are an integral part of patient management with systemic scleroderma.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)