A 41-year-old woman has had increasing dyspnea for the past week. On physical examination, temperature is 37.3deg C, pulse is 85/min, respirations are 20/min, and blood pressure is 150/95 mm Hg. There is dullness to percussion over the lung bases. A chest radiograph shows large bilateral pleural effusions and a normal heart size. Laboratory findings include serum creatinine, 3.1 mg/dL; urea nitrogen, 29 mg/dL; troponin I, 0.1 ng/mL; WBC count, 3760/ mm3; hemoglobin, 11.7 g/dL; and positive ANA and anti-double-stranded DNA antibody test results. Which of the following cardiac lesions is most likely to be present in this patient?
Libman-Sacks endocarditis is an uncommon complication of systemic lupus erythematosus (SLE) that has minimal clinical significance because the small vegetations, although they spread over valves and endocardium, are unlikely to embolize or cause functional flow problems. Calcific aortic stenosis may be seen in older individuals with tricuspid valves, or it may be a complication of bicuspid valves. Although pericardial effusions are common in active SLE, along with pleural effusions and ascites from serositis, they are usually serous effusions, and no significant hemorrhage or scarring occurs. The vegetations of nonbacterial thrombotic endocarditis are prone to embolize. Mural thrombi are most likely to form when cardiac chambers are dilated, or there is marked endocardial damage. Rheumatic heart disease is an immunologic disease based on molecular mimicry; serologic tests would be positive for anti-streptolysin O (ASO), not ANA.
Calcific aortic stenosis
Hemorrhagic pericarditis
Nonbacterial thrombotic endocarditis
Libman-Sacks endocarditis
C.V.S