Systemic Lupus Erythematosus (SLE), commonly referred to as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks healthy tissues and organs throughout the body. This inflammatory process can affect the skin, joints, kidneys, lungs, and the cardiovascular system. Heart palpitations are the sensation of a fast-beating, pounding, fluttering, or skipped heartbeat. For individuals with lupus, these episodes are a recognized symptom. Palpitations can signal either direct inflammatory damage to the heart itself or be a consequence of the systemic effects of the chronic disease.
Direct Cardiac Involvement
The autoimmune activity in lupus can directly target the heart’s structures, leading to inflammation that disrupts its normal rhythm. The most frequent cardiac manifestation is pericarditis, the inflammation of the fluid-filled sac surrounding the heart. Pericarditis affects up to 40% of people with SLE and often results in chest pain, but it can also cause a rapid heartbeat felt as palpitations.
A more serious, though less common, complication is myocarditis, the inflammation of the heart muscle itself. When the heart muscle becomes inflamed, its ability to contract and conduct electrical signals efficiently is compromised, which directly leads to arrhythmias. These rhythm disturbances are perceived as a fluttering or pounding sensation in the chest.
Lupus can also affect the heart valves, a condition known as endocarditis, or more specifically, Libman-Sacks endocarditis. The presence of inflammatory deposits on the valves can interfere with blood flow and contribute to an irregular heart rhythm. Any of these direct inflammatory attacks on the heart can disrupt the delicate electrical system that controls the timing of heartbeats.
Systemic and Secondary Factors
Beyond direct inflammation, systemic issues related to chronic disease activity or its treatment can trigger palpitations.
Anemia is a common complication in SLE, often due to chronic inflammation interfering with the body’s ability to produce red blood cells efficiently. When the red blood cell count is low, the heart must beat faster to circulate the reduced supply of oxygenated blood throughout the body, resulting in a rapid heartbeat.
Lupus nephritis, inflammation of the kidneys, can also indirectly affect heart rhythm. Impaired kidney function can lead to imbalances in electrolytes like potassium and magnesium, which are essential for maintaining the stable electrical activity of the heart. An imbalance in these minerals can make the heart more prone to developing an irregular rhythm or arrhythmia.
The body’s overall stress response to chronic illness, including lupus flares, can affect the autonomic nervous system, which regulates involuntary body functions like heart rate. This dysfunction can lead to inappropriate speeding up or slowing down of the heart, resulting in palpitations. Additionally, certain medications used to manage lupus activity may have cardiovascular side effects.
Corticosteroids, such as prednisone, are frequently used to control inflammation but can elevate blood pressure and increase the risk of heart disease factors. The antimalarial drug hydroxychloroquine is a common lupus treatment, but in rare cases, long-term use has been associated with changes in the heart’s electrical conduction, which can lead to rhythm issues.
When to Seek Medical Evaluation
While heart palpitations can sometimes be benign, they should always be evaluated in a person with lupus, as they may indicate active heart involvement or a systemic problem. Consult a doctor if the palpitations become more frequent, last longer, or change in character. Tracking symptoms, including frequency, duration, and any potential triggers, provides valuable information for the healthcare team.
Immediate medical attention should be sought if palpitations are accompanied by more concerning symptoms. These include chest pain or tightness, particularly if it radiates to the arm or jaw, or is accompanied by shortness of breath. Other red flags are episodes of lightheadedness, dizziness, or fainting, which may suggest a more serious disruption of the heart’s rhythm.
A physician will often begin the evaluation with an electrocardiogram (ECG or EKG) to record the heart’s electrical activity. If palpitations are intermittent, a Holter monitor, a portable ECG device worn for one or more days, may be used to capture the rhythm during normal daily activities. Blood tests will also be ordered to check for anemia, electrolyte imbalances, and markers of inflammation that could point toward active lupus disease.