Table 7 Possible causes of cardiac symptoms with a suggestion for further exploration and therapeutic management
From: French recommendations for the management of systemic sclerosis
Disease type/symptom | Order of prevalence | Examinations to be discussed on a case-by-case basis | Treatment proposals to be discussed on a case-by-case basis |
|---|---|---|---|
Coronary microcirculatory disorder |  > 60% | EKG Troponin Myocardial scan* Cardiac MRI | Calcium channel blocker ACE/ARB II Control of risk factors |
Coronary macrocirculatory disorder |  < 10% | EKG Troponin Myocardial scan* Cardiac stress MRI Stress echocardiography Coronary scan Coronary angiography | Control of risk factors Treatment based on recommendations Revascularization |
Systolic heart failure If LVEF ≤ 40% | 5% | EKG Echocardiogram Natriuretic peptides Troponin Myocardial MRI | Based on recommendations: ACEi or ARB II (ANRI, sacubitril, valsartan in second line)/cardioselective beta-blocker to be discussed according to ILD and Raynaud/digital ulcers Mineralocorticoid receptor antagonists Defibrillator… |
Preserved LVEF heart failure | 30–35% | EKG Echocardiogram Natriuretic peptides Troponin Cardiac MRI | Diuretics |
Isolated VD dysfunction | 38% | EKG Echocardiogram Natriuretic peptides Troponin Cardiac MRI Right heart catheterization | Diuretics |
Pericardial effusion | Frequent | Echocardiogram Cardiac MRI | Usually monitoring Colchicine+++ |
Constriction | Rare | Echocardiogram Cardiac MRI Right heart catheterization | Diuretics, lower doses if bradycardia medication Pericardiectomy |
Pulmonary hypertension Precapillary |  < 15% | EKG Echocardiogram (VTI) Natriuretic peptides Troponin Right heart catheterization | Specific treatment of PAH if group 1 Treatment of ILD if group 3 |
Pulmonary arterial hypertension With veno-occlusive component | Rare | Right heart catheterization Chest scan | Diuretics Specific treatment of PAH |
Pulmonary hypertension Post-capillary |  < 12% | EKG Echocardiogram Natriuretic peptides Troponin Cardiac MRI Right heart catheterization | Treatment of heart failure |
Tachycardia Supraventricular | 15% | EKG Holter monitor | Anti-arrhythmic treatment based on recommendations Anticoagulant treatment |
Tachycardia Ventricular | Rare | EKG Holter monitor Echocardiogram Look for myocardial ischemia | Antiarrhythmic treatment based on recommendations Defibrillator Treatment of ischemia |
Bradycardia and conduction disorders | Rare | EKG Holter | Stop bradycardia medication Stimulator |