Question

Which cardiac abnormality is most characteristically associated with systemic sclerosis (scleroderma)?

• A. Aortic regurgitation (AR)
• B. Mitral stenosis (MS)
• C. Pericarditis / pericardial effusion
• D. Dilated cardiomyopathy (DCM) from myocardial fibrosis

Hint:

Think collagen and repeated micro-ischaemia in the myocardium, not a rheumatic valve.

Answer 1

The Correct Option is D

Step 1: Understand scleroderma cardiac involvement. Systemic sclerosis causes a small-vessel vasculopathy and excessive collagen deposition. In the heart this produces patchy myocardial fibrosis from repeated focal ischaemia (a “Raynaud of the myocardium”), the hallmark structural lesion.

Step 2: Trace the consequence. Diffuse myocardial fibrosis impairs both systolic and diastolic function, leading to a cardiomyopathy (restrictive early, dilated with progressive damage), conduction-system disease, and arrhythmias. This myocardial process is the most characteristic and prognostically important cardiac deformity in scleroderma.

Step 3: Evaluate the recalled key (MS). Mitral stenosis is overwhelmingly rheumatic and is not a feature of scleroderma; valvular involvement in scleroderma is minor and not stenotic. Therefore the circled answer “MS” is medically incorrect and is not adopted here.

Step 4: Eliminate other options. AR is seen with aortic root disease/connective-tissue disorders like Marfan, not typically scleroderma. Pericarditis/effusion does occur in scleroderma but is usually subclinical and far less defining than myocardial fibrosis. Hence the best answer is myocardial fibrosis to cardiomyopathy (DCM).

Key fact: The signature cardiac lesion of scleroderma is patchy myocardial fibrosis causing cardiomyopathy, not mitral stenosis.