Classically, the pain is in the centre of the chest at the front and sometimes mistaken by patient and doctor for a heart attack. It can be detected clinically or on chest X-ray or echocardiogram. Fortunately, it rarely causes damage to the underlying heart and responds to steroids. A small number of lupus patients develop heart valve disease. Many of these patients were, in the old days, wrongly diagnosed as rheumatic fever, but we now know that this was not the case.
Leaky heart valves result in shortness of breath and require expert cardiological advice.
Ultimately some patients require valve surgery. Fortunately this is exceptionally rare. It was discovered some years ago that a number of lupus patients who have seemingly recovered from their lupus still suffer from coronary disease and have an increased chance of a heart attack. The reasons for this are not clearly known although considerable research work is now going on to look at possible risks. Certainly, steroids have been implicated although they are not the major culprit.