I have been advised cardiac catheterization for my breathing difficulty and bluish discoloration of my toes after the diagnosis of lupus. Please help.

Q. Is it safe to perform cardiac catheterization for breathing issues and toe discoloration in a patient with lupus?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 16, 2023 and last reviewed on: Aug 08, 2023

Hello doctor,

I am a 29-year-old black woman with a pre-medical history of lupus, Raynaud's phenomenon, and migraines. Since being diagnosed with lupus two years back, I have been having difficulty breathing and it was found that I have tachycardia, and the doctor is treating me with Metoprolol. Metoprolol helps with shortness of breath when I am at rest, but once I start doing things like brushing my teeth or getting dressed I feel out of breath and sometimes become sweaty the more I move around. I have been extremely tired and it is getting increasingly worse over the months. I have a number of imaging done and the doctors do not have an answer for what could possibly be going on. I also have the lupus anticoagulant. I am worried because I keep getting worse, along with the breathing issues, I am holding a weight in my abdomen area despite eating healthy and exercising within my limits, and notice my toes turn bluish purple a lot more than usual. I used to run miles for exercise, but since being diagnosed with lupus and developing breathing difficulty, I become out of breath walking less than 100 feet. My doctor has a right heart catheterization scheduled for next month but I am wondering if anything can be determined from my reports and images before the catheterization.



Welcome to icliniq.com.

I read your query and can understand your concern. No doubt, it takes a lot of courage to face a health challenge like this. I admire your strength. Your ECG (echocardiogram) report, echocardiography, and cardiac MRI (magnetic resonance imaging) are normal (attachments removed to protect the patient's identity). No cardiac dysfunction and no pulmonary hypertension as well. So, most likely your symptoms are noncardiac. One more test, called NTproBNP (natriuretic peptide) levels should be done. It is basically a screening test. If it is negative, there is usually no need for echocardiography, but if it is positive, then echocardiography is advised. SLE (systemic lupus erythematosus) is a multi-organ disease that affects the lungs, kidneys, heart, skin, etc. Please have a workup for pulmonary diseases like asthma, and interstitial lung disease. You are going for a cardiac catheterization which is done when the symptoms and cardiac imaging data do not match. But I would also recommend having a pulmonary workup done, one of them being a cardio-pulmonary exercise test (CPET). Shortness of breath on exertion has many causes, the heart is one of them. I hope your catheterization will also be normal. Thanks and take care.

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