There are a number of ways in which the heart can be affected in APS, but the three main complications are:
Heart attacks are another very serious complication of APS and it is estimated that 1 in 6 people under the age of 50 who have a heart attack test positive for anticardiolipin antibodies.
People with APS can sometimes develop blood clots in the coronary arteries which supply the blood and oxygen to the heart – these clots can cause a sudden heart attack (known medically as a coronary thrombosis or myocardial infarction). Some heart attacks can be mild and not lead to any significant damage, while others can be more serious and lead to heart failure.
Based on research studies, our charity advocates that anyone who has had an unexplained heart attack under the age of 50 should be tested for APS so they can receive the correct anticoagulation therapy.
It is estimated that 30% of APS patients will experience some form of valve disease. The heart valves regulate blood transfer within the heart, and symptoms of disease can include shortness of breath, feeling faint during exertion and fatigue. In most cases the condition is mild but in more severe cases, it can lead to heart failure and patients may require surgery.
The most common manifestation of heart valve disease in APS is heart valve thickening. If a valve is narrowed, the heart may have to work much harder to pump blood across the valve, and can cause heart murmurs and valve leakage.
Another heart valve problem is endocarditis. The endocardium is the tissue that lines the inner walls of your heart and valves and, in some APS patients, this lining can become inflamed by clusters of wart-like growths (lesions) on the valves. These lesions can become infected, causing a condition known as bacterial endocarditis, which is a serious medical condition; fortunately this is rare.
Anticoagulation treatment may be needed for some APS patients with heart valve disease especially if the valves are very damaged or the heart rhythm is disturbed (known medically as atrial fibrillation).
Coronary artery disease
The heart muscle receives its own blood supply from the coronary arteries and, in APS patients, these arteries can become clogged which can block the blood supply to the heart. Symptoms can range from mild chest pains caused by angina, to serious heart attacks.
Coronary heart disease is caused by atherosclerosis – the hardening and narrowing of the arteries caused by fatty deposits – and is fairly common in older people, but in APS it happens at a much younger age.
One study found that approximately 40% of their patients with coronary artery disease were positive for antiphospholipid antibodies (aPL). This research highlights the need for testing in younger people who have coronary artery disease.
A number of patients who have been diagnosed with cardiac Syndrome X - an illness that largely remains a mystery, hence its name - have also been found to be positive for antiphospholipid antibodies (aPL). Cardiac Syndrome X occurs most often in women and causes chest pain similar to angina, together with signs which suggest the blood flow to the heart is reduced; however, the coronary arteries appear to be normal. It is possible that the aPL may be causing the angina and such patients should try anticoagulation treatment.