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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
  1. *Myocardial MRI is still being evaluated for the study of microcirculation; myocardial scintigraphy is still more suitable now
  2. NSAIDs nonsteroidal antiinflammatory drugs, ANRI angiotensin II receptor neprilysin inhibitor, ARB II angiotensin II receptor blockers, LVEF left ventricular ejection fraction, PAH pulmonary arterial hypertension, ACE angiotensin-converting enzyme inhibitor, MRI magnetic resonance imaging, ILD diffuse infiltrating lung disease, VTI rate of tricuspid insufficiency