A woman holding her chest looking scared.

Lupus and Chest Pain

Reviewed by: HU Medical Review Board | Last reviewed: January 2020

Chest pain is a frequent symptom of lupus. This is because it is common for lupus to inflame the cardiovascular and pulmonary systems. Cardio means the heart, vascular refers to the arteries and veins, and pulmonary means the lungs. In fact, cardiovascular disease is the number one cause of death in people with lupus, not lupus itself.1

Why does lupus cause chest pain?

The inflammation that lupus causes can impact the cardiovascular and pulmonary systems in several ways that may result in the symptom of chest pain.

Pleurisy is chest pain that happens when taking a deep breath. Lung issues like pleurisy occur in about 50 percent of people with lupus. Pleurisy, also known as pleuritis, is caused by inflammation of the pleura, the sac that surrounds the lungs.2-3

Acute lupus pneumonia is a serious condition that affects up to 10 percent of those with lupus. It causes chest pain, shortness of breath, and a dry, bloody cough.2-3

Pericarditis is the most common heart problem in people with lupus, occurring in 25 percent. Pericarditis occurs when the pericardium, a sac that surrounds the heart, becomes swollen or inflamed and leaks fluid around the heart. This causes chest pain that is usually worse when lying down versus sitting up.1,3

Myocarditis, or inflammation of the heart muscle itself (the myocardium), occurs in less than 10 percent of people with lupus. Myocarditis causes chest pain and a rapid heartbeat. Left untreated, it may weaken the heart muscle.1,3

Angina is a type of chest pain or tightness caused when your heart muscle doesn’t get enough oxygen-rich blood. Angina may occur in people with lupus because they often develop atherosclerosis (hardening of the arteries) which narrows the blood vessels and reduces blood flow throughout the body.1,3

How are the causes of lupus chest pain diagnosed?

Your doctor may order a combination of blood tests, chest x-rays, an electrocardiogram (EKG), or an echocardiogram (ECG) to find out if you have a lupus-related heart condition. Pleurisy and myocarditis can be detected on an x-ray. Pericarditis can be diagnosed through an EKG.2-3

How is lupus chest pain treated?

Prevention is the first line of defense against lupus-related chest pain, so it is important to do what you can to keep your lupus under control as much as possible. However, many people with lupus will experience heart and lung complications despite their best efforts. If that happens, the treatment will depend on what is causing your chest pain.1-3

Pleurisy may be treated with NSAIDs pain relievers or steroids, while antimalarials may help prevent the condition.

Lupus pneumonia requires high doses of steroids and possibly immunosuppressants.

Pericarditis may be treated with NSAIDs pain relievers or steroids.

Myocarditis is treated with high doses of steroids over weeks or months. It is a serious complication of lupus so your doctor will follow you closely.

Once arteries have built-up plaque and hardened, controlling angina may require a multi-step approach that includes some combination of quitting smoking, losing weight, taking medicines for high blood pressure, angioplasty, surgery to open blocked arteries.

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