According to abbreviationfinder, LSE stands for Libman-Sacks endocarditis.
In 1924, the American cardiologists Emanuel Libman and Benjamin Sacks at New York’s Mount Sinai Hospital first observed a form of endocarditis that was not caused by an infectious agent. They therefore initially referred to this as “atypical verrucous endocarditis”. In total, they observed and tracked the disease in four different patients.
Over the years, this form of endocarditis was named after its two discoverers and is now known simply as Libman-Sacks endocarditis. It occurs primarily in women over the age of 30 as part of systemic lupus erythematosus. Since their diagnosis is quite difficult, complications and, in the worst case, even valvular or heart failure occur relatively frequently.
What is Libman-Sacks Endocarditis?
Libman -Sacks endocarditis, abbreviated LSE, is a special form of endocarditis, i.e. inflammation of the endocardium of the heart, which is not caused by infection. It usually occurs in the context of chronic systemic diseases, mainly lupus erythematosus, and is characterized by fibrotic changes in the heart valves, primarily the mitral valve and the aortic valve. In the worst case, the disease can progress to heart failure and death.
Libman-Sacks endocarditis is caused by a systemic disease called lupus erythematosus. It is a generalized autoimmune disease that can be associated with changes in all organs. The disease usually progresses in phases and mainly women over the age of 30 are affected, so that Libman-Sacks endocarditis is almost only found in females.
The main symptoms of systemic lupus are a butterfly erythema on the face and joint inflammation (arthritis), but the kidneys, lungs and heart are also often affected. Endocarditis occurs when the body forms autoantibodies and immune complexes that attack connective tissue. Triggers for such immune complex formation are, for example, UV radiation, viral infections, medication or stress.
Symptoms, Ailments & Signs
Libman-Sacks endocarditis is usually asymptomatic or even completely asymptomatic. If symptoms occur, they are usually an expression of concomitant diseases such as valve insufficiency.
© Sergj – stock.adobe.com
Libman-Sacks endocarditis is usually asymptomatic or even completely asymptomatic. If symptoms occur, they are usually an expression of concomitant diseases such as valve insufficiency. Large vegetations are typical on the heart valves, especially the mitral and aortic valves. These are usually fibrotic or consist of proliferating endothelial cells, myocytes, and mononuclear inflammatory cells.
However, most vegetations are very small and have no hemodynamic importance. Only when they become very large can they also cause problems that are either of a mechanical nature or hemodynamic in the form of embolism. The function of the chordae tendineae can be limited by the fact that they show a strong thickening.
Local inflammatory infiltrates are common. It is not uncommon for pleuritis or pericarditis to also occur. Terminal valve insufficiency affects about ten percent of patients. At this stage, pathological heart murmurs can be detected by auscultation and signs of cardiac insufficiency appear.
These include general symptoms such as limited performance, weakness and tiredness, but also dyspnea, cardiac arrhythmia and edema. The patient may become cyanotic and the jugular veins may become engorged. If lupus erythematosus is known, particular attention must be paid to the possible presence of endocarditis.
Diagnosis & course of disease
Diagnosing Libman-Sacks endocarditis is often difficult because signs of the disease cannot always be identified. It is therefore very important to first take a good and detailed medical history. Particular attention should be paid to existing pre-existing conditions, which can already be trend-setting, as well as possible symptoms of a previously unrecognized lupus erythematosus.
Typical changes that can occur in the laboratory are increased transaminases, bilirubin, creatinine and urea. An ECG, a chest X -ray and an echocardiography should always be carried out in the course of diagnostics. The transesophageal echocardiography is clearly superior to the transthoracic one. In addition, sonography to determine the size of the heart, a cardiac catheter for the cardiac output, and coronary angiography to assess the blood flow can also be performed.
If Libman-Sacks endocarditis goes undetected for a long time, it can lead to complications such as pleurisy, pericarditis, valvular insufficiency, heart failure and embolism. The prognosis depends on various factors. These include above all the time of diagnosis, the age of the patient, other chronic diseases, the immune system and the (previous) damage to the heart.
The symptoms and complications of Libman-Sacks endocarditis vary widely. In many cases, the disease progresses completely without symptoms or with only very mild and minor symptoms, so that no direct treatment of this disease is necessary. However, those affected can suffer from heart valve insufficiency and, in the worst case, die from it.
It is not uncommon for this to result in bleeding or a high fever. Furthermore, there is a reduced resilience and general weakness of the patient. Tiredness also sets in and the affected people no longer actively participate in life. In addition, heart disorders and complaints can also occur, which often lead to inner restlessness.
The quality of life of the affected person is significantly reduced and restricted by Libman-Sacks endocarditis. The patient’s concentration can also be reduced by Libman-Sacks endocarditis. There is no causal treatment for Libman-Sacks endocarditis.
The treatment of the disease is therefore symptomatic, but does not always lead to a positive course of the disease. As a rule, patients are dependent on taking medication for their entire life. Whether this will lead to a reduced life expectancy cannot be generally predicted.
When should you go to the doctor?
Determining when to see a doctor for Libman-Sacks endocarditis is often difficult. In many cases, the disease is symptom-free for a long time, so that incidental findings occur at this stage of the disease. In principle, the affected person should consult a doctor as soon as he perceives a feeling of illness, a general malaise or a diffuse feeling of physical changes. If there are changes in the skin’s appearance for no apparent reason, it is advisable to consult a doctor. If poplars form, discoloration or itching, consult a doctor. Tiredness, exhaustion or apathy are indications of irregularities that should be investigated.
Disorders of the heart rhythm, problems with restful sleep or irregularities in the circulatory system must be examined and treated. In many cases, a variety of exams and tests are required to diagnose Libman-Sacks endocarditis. The affected person should therefore consult a doctor if the symptoms persist or increase. If edema develops, if there is a decrease in performance or if inner weakness sets in, the affected person needs medical help. If you have breathing problems or shortness of breath, you need to see a doctor. If the symptoms persist for a long time, it can put a lot of strain on the heart. A doctor’s visit should be initiated early to avoid serious complications.
Treatment & Therapy
An optimal therapy for the treatment of Libman-Sacks endocarditis is not yet known. The focus is on treating the underlying disease with immunosuppressive drugs such as cortisone, even if their benefit for LSE has not been clearly proven. Surgical interventions are not recommended because they are associated with high complication rates.
General measures include lowering blood pressure, physical rest, exercise therapy, breathing exercises and abstinence from smoking. Medications used when heart failure is already present include: glucocorticoids, diuretics, ACE inhibitors, beta- blockers, antiarrhythmics, and anticoagulants.
Outlook & Forecast
The earliest possible diagnosis is important for a good prognosis. Difficulties often arise at this point, since the symptoms of the disease often occur in parallel with other diseases, making it difficult to precisely clarify the cause. In addition, the symptoms of the patient are individually pronounced and therefore often lead to very different results when the doctor assesses the state of health.
Left untreated and unnoticed, the course of the disease becomes difficult and the prognosis is unfavorable. Complications arise which can lead to the premature death of the person concerned. Cardiac activity is significantly restricted, so that in the further course organ activity can fail or life-threatening embolisms can occur. In addition, a chronic course of the disease can appear. Patients who are advanced in life and have pre-existing medical conditions are more likely to experience permanent impairment from Libman-Sacks endocarditis. The stress caused by the disease is often difficult for the organism to regulate.
In basically healthy people, early diagnosis and initiation of medical treatment, the prognosis is significantly improved. Nevertheless, long-term measures to support the heart’s activity are necessary and regular checks of the heart’s function must be carried out. Otherwise there is a risk of complications and irreparable organ damage.
Unfortunately, there is no effective prevention for the occurrence of Libman-Sacks endocarditis. However, since it is associated with systemic lupus erythematosus, as already mentioned, care should be taken to avoid possible known relapse triggers as much as possible.
First and foremost, this means avoiding intense exposure to the sun, i.e. UV radiation, but also stress or some medications. If SLE already exists, it is important to treat it according to the guidelines and to try to get it under control.
Libman-Sacks endocarditis comes with a variety of complications and discomfort, so it should always be treated by a doctor. Most patients feel permanently tired and exhausted as a result of this disease and can no longer actively participate in everyday life. Since the disease is generally not completely curable, aftercare is primarily aimed at containing the symptoms and improving the quality of life of those affected.
Patients should also inform themselves about any complications. Excessive physical exertion and stress should be avoided as far as possible. Due to the relatively high risk of complications, it is advisable to work out all measures in cooperation with a cardiologist. The heart condition also means psychological stress, which can be dealt with in the context of a therapeutic consultation.
Many sufferers suffer from depression or other mental health problems, which can also have a negative impact on the symptoms of the disease. The further course of this disease depends strongly on the time of diagnosis, so that a general prognosis with regard to the effectiveness of follow-up care is usually not possible. The life expectancy of the person affected may also be reduced by Libman-Sacks endocarditis.
You can do that yourself
There is no causal treatment for Libman-Sacks endocarditis. Medical treatment focuses on relieving symptoms and protecting the patient with a pacemaker and other preventive measures.
The self-help measures focus on regular visits to the doctor and discussions with other affected people. In addition, attention must be paid to unusual symptoms and signs that indicate a worsening of the heart disease. Patients are allowed to engage in moderate exercise. However, any physical activity should be discussed with the doctor in charge beforehand. The diet must be changed in cooperation with a nutritionist. Foods that could overload or even damage the heart should be avoided. These include foods high in salt and sugar, but also coffee and alcohol. Relaxation exercises help with tachycardia and stress. This can greatly reduce the risk of a heart attack.