Libman-Sacks Endocarditis Clinical Presentation

Updated: Dec 14, 2020
  • Author: Mary C Rodriguez Ziccardi, MD; Chief Editor: Richard A Lange, MD, MBA  more...
  • Print


Persons with Libman-Sacks endocarditis are usually asymptomatic. Patients who do become symptomatic, however, can display the following:

  • Cardiac failure - May develop secondary to valvular dysfunction (most commonly mitral regurgitation), leading to dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, and lethargy

  • Cerebrovascular embolism - Can lead to symptoms of cerebral ischemia, including focal weakness and/or numbness, visual loss, dysphasia, dysarthria, dysphagia, and memory loss

  • Systemic thromboembolism - A rare manifestation that can result in a wide spectrum of symptoms, including pain, coldness and numbness of the peripheries, or acute abdominal syndromes with pain and vomiting

  • Secondary infective endocarditis - May manifest as fever, weight loss, night sweats, lethargy, and chest pain; these symptoms can be difficult to distinguish from underlying systemic lupus erythematosus disease activity

In addition, symptoms of systemic lupus erythematosus may be noted, including a history of rash, arthritis (joint pain and swelling), and sweating.

Antiphospholipid syndrome

Features of antiphospholipid syndrome may be noted in the history, including recurrent miscarriage, arterial thromboses, venous thromboses, and/or thrombocytopenia.

Patients may report pain, focal neurologic symptoms (eg, focal weakness and/or numbness, visual loss, dysphasia, dysarthria, dysphagia, memory loss), numbness and discoloration of the extremities, and ischemic chest pain with arterial thromboses.

Venous thromboembolism may result in peripheral swelling, pleuritic chest pain, dyspnea, and hemoptysis. Neurologic symptoms due to cerebral ischemia can also occur in the event of a paradoxical embolus.


Physical Examination

Physical examination findings can be normal. In symptomatic cases, however, the following cardiac murmurs may be heard:

  • Ejection systolic murmur (crescendo decrescendo) - This is most commonly the result of a hyperdynamic state caused by associated conditions and can indicate aortic valve thickening with or without stenosis

  • Holosystolic murmur of mitral regurgitation or tricuspid regurgitation

  • Early diastolic murmur of aortic regurgitation - With or without an Austin-Flint murmur

  • Middiastolic, rumbling murmur of mitral stenosis

Other valvular dysfunction (eg, pulmonary stenosis or regurgitation, tricuspid stenosis) may occur, but only rarely is this due to Libman-Sacks endocarditis.

The following signs of ventricular enlargement and cardiac failure may be noted in Libman-Sacks endocarditis:

  • Tachypnea and cyanosis

  • Pulse - Plateau pulse, low-volume pulse, pulsus alternans

  • Jugular venous distention

  • Displaced apex beat

  • Third and/or fourth heart sounds

  • Pulmonary rales

  • Congestive hepatomegaly

  • Sacral and peripheral edema

A focal neurologic deficit secondary to embolic phenomena or thrombosis with or without the antiphospholipid syndrome may be noted.

Signs due to underlying systemic lupus erythematosus may be present, including rash and joint swelling.