ABSTRACT
Cardiac complications associated with the AIDS may present to emergency physicians and are often secondary to opportunistic infections or malignancy, but may also be associated with other aspects of the human immunodeficiency virus (HIV) or its treatment. In this review article, we will discuss HIV-associated cardiac disease which may be encountered in the ED, emphasizing the prevalence, pathogenesis, and treatment of related disorders.
Subject(s)
Anti-HIV Agents/adverse effects , HIV Infections/complications , Heart Diseases/etiology , Hypertension, Pulmonary/virology , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/drug therapy , Arrhythmias, Cardiac/etiology , Cardiomyopathies/diagnosis , Cardiomyopathies/drug therapy , Cardiomyopathies/epidemiology , Cardiomyopathies/virology , Endocarditis/diagnosis , Endocarditis/drug therapy , Endocarditis/epidemiology , Endocarditis/virology , HIV Infections/drug therapy , Heart Diseases/diagnosis , Heart Diseases/drug therapy , Heart Diseases/epidemiology , Heart Failure/diagnosis , Heart Failure/drug therapy , Heart Failure/epidemiology , Heart Failure/virology , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/drug therapy , Hypertension, Pulmonary/epidemiology , Pericarditis/diagnosis , Pericarditis/epidemiology , Pericarditis/virologySubject(s)
Cardiology , HIV Infections/complications , Heart Diseases/virology , Physician's Role , Antiretroviral Therapy, Highly Active , Cardiomyopathy, Dilated/drug therapy , Cardiomyopathy, Dilated/pathology , Cardiomyopathy, Dilated/virology , Coronary Disease/drug therapy , Coronary Disease/pathology , Coronary Disease/virology , Endocarditis/drug therapy , Endocarditis/pathology , Endocarditis/virology , HIV Infections/drug therapy , Heart Diseases/drug therapy , Heart Diseases/pathology , Humans , Prospective StudiesABSTRACT
The epidemiology of cardiac complications related to HIV including cardiomyopathy, increased left ventricular mass, myocarditis, pericardial effusion, endocarditis, and malignancy are discussed. A large number of HIV-infected individuals will present with cardiac complications in the next decade as chronic viral infection, co-infections, drug therapy, and immunosuppression affect the heart. Understanding the nature and course of cardiac illness related to HIV infection will allow appropriate monitoring, early intervention and therapy, and will provide a baseline to evaluate the effects of new therapeutic regimens such as highly active antiretroviral therapy on the cardiovascular system.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , HIV Infections/complications , Adolescent , Child , Humans , Pericardial Effusion/etiology , Prospective Studies , Ventricular Dysfunction, Left/etiologyABSTRACT
Cardiac manifestations of HIV infection in children are common, but etiologies, contributing factors, and the natural history are largely unexplored. The Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted Human Immunodeficiency Virus Infection Study (P2C2 HIV Study) was initiated in 1989 by the National Heart, Lung and Blood Institute, USA. A primary objective of this study is to examine the epidemiology of cardiovascular problems associated with HIV infection in a cohort of children vertically infected. Findings of the study thus far show that cardiovascular problems associated with HIV infection including left ventricular dysfunction and increased left ventricular mass are common and clinically important indicators of survival for children infected with HIV.
Subject(s)
Cardiomyopathies/etiology , HIV Infections/complications , Cardiomyopathies/epidemiology , Cardiovascular Diseases/congenital , Child, Preschool , Fetal Diseases/etiology , Humans , Infant , Myocarditis/etiology , Risk Factors , Ventricular Dysfunction, Left/etiologyABSTRACT
Cardiovascular complications are important contributors to morbidity and mortality in HIV-infected patients. These complications can usually be detected at subclinical levels with monitoring, which can help guide targeted interventions. This article reviews available data on types and frequency of cardiovascular manifestations in HIV+ patients and proposes monitoring strategies aimed at early subclinical detection. In particular, we recommend routine echocardiography for HIV+ patients, even those with no evidence of cardiovascular disease. We also review preventive and therapeutic cardiovascular interventions. For procedures that have not been studied in HIV+ patients, we extrapolate from evidence-based guidelines for the general population.
Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , HIV Infections/complications , Cardiovascular Diseases/blood , Cardiovascular Diseases/etiology , Humans , Monitoring, PhysiologicABSTRACT
Reviews and studies published before the introduction of highly active antiretroviral therapy (HAART) have tracked the incidence and course of HIV infection in relation to cardiac illness in both children and adults. The introduction of HAART regimens has significantly modified the course of HIV disease, with longer survival rates and improvement of life quality in HIV-infected people expected. However, early data raised concerns about HAART being associated with an increase in both peripheral and coronary arterial diseases. In this review we discuss HIV-associated cardiovascular complications focusing on pathogenetic mechanisms that could have a role in diagnosis, management, and therapy of these complications in the HAART era.
Subject(s)
AIDS-Related Opportunistic Infections , Cardiomyopathy, Dilated , Coronary Disease , HIV Infections/drug therapy , AIDS-Related Opportunistic Infections/etiology , AIDS-Related Opportunistic Infections/pathology , Adult , Animals , Antiretroviral Therapy, Highly Active , Cardiomyopathy, Dilated/epidemiology , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Dilated/pathology , Child , Coronary Disease/epidemiology , Coronary Disease/etiology , Coronary Disease/pathology , HIV Infections/transmission , Humans , Incidence , Macaca mulatta , Models, Animal , Simian Acquired Immunodeficiency Syndrome/pathologyABSTRACT
Cigarette smoking is linked to increased cardiac morbidity and mortality, and has been shown to affect both lipid profiles and thrombotic factors in healthy subjects. However, the influence of smoking on the atherothrombotic environment has not been studied in a large population of patients after acute myocardial infarction (AMI). Blood samples and medical history, including smoking status, were obtained from 1,045 patients at a 2-month visit after AMI. Smokers were asked to refrain 24 hours before the visit, but not all complied. Measurements included total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein-B, apolipoprotein-A, triglycerides, factor VII, factor VIIa, von Willebrand factor, D-dimer, and plasminogen activator inhibitor. There were 247 current, 443 past, and 349 nonsmokers. After adjustment for clinical variables, current smokers had higher levels of total cholesterol and apolipoprotein-B than past and nonsmokers (p <0.01). High-density lipoprotein cholesterol and apolipoprotein-A levels were similar between groups. Fibrinogen was elevated in current (p = 0.001) and past (p = 0.029) smokers, compared with nonsmokers. Smokers who smoked within 24 hours of blood sampling had higher apolipoprotein-B (p = 0.005), total cholesterol (p = 0.001), and fibrinogen (p = 0.015) levels than those who refrained from smoking. In conclusion, postinfarction patients, who historically have higher levels of atherogenic lipids than healthy subjects, have increased levels of these lipids attributed to active smoking. After smoking cessation, lipid profiles approach nonsmoker levels, but fibrinogen remains elevated. Smoking within 24 hours of blood sampling was associated with further adverse prothrombotic and lipogenic effects.
Subject(s)
Lipids/blood , Myocardial Infarction/blood , Smoking/adverse effects , Aged , Apolipoproteins B/blood , Cholesterol/blood , Female , Fibrinogen/analysis , Humans , Logistic Models , Male , Middle Aged , Myocardial Infarction/epidemiology , Smoking/epidemiology , Time FactorsABSTRACT
STUDY OBJECTIVES: To evaluate the relationship between perioperative ischemia and serial concentrations of D-dimer, which is a sensitive and specific marker of fibrinolytic activity. Myocardial ischemia and infarction are well-recognized complications of peripheral vascular surgery. We hypothesized that patients at increased risk of perioperative myocardial ischemia might be identified preoperatively by abnormal hemostatic indices. DESIGN: Prospective clinical outcomes study. SETTING: A 1,124-bed tertiary care medical center. PATIENTS: 42 ASA physical status II, III, and IV patients undergoing peripheral vascular surgery. INTERVENTIONS: Serial D-dimer concentrations were measured preoperatively, and at 24 and 72 hours postoperatively. Continuous 12-lead ST-segment monitoring (Mortara Instrument, Inc., Milwaukee, WI) was performed with the acquisition of a 12-lead ECG every 20 seconds for 72 hours. MEASUREMENTS AND MAIN RESULTS: D-dimer measurements were performed in duplicate using the Dimer Gold assay (American Diagnostica, Greenwich CT). Ischemic episodes, as defined by continuous 12-lead ST-segment monitoring, occurred in 49% of patients. There were no demographic differences between ischemic and nonischemic groups. Although baseline D-dimer concentrations were not statistically significantly different between groups, patients experiencing perioperative myocardial ischemia generated significantly less D-dimer during the perioperative period (p = 0. 014). CONCLUSIONS: PATIENTS with an impaired fibrinolytic response, as defined by reduced generation of D-dimer, experienced an increased incidence of perioperative myocardial ischemia.
Subject(s)
Antifibrinolytic Agents/blood , Fibrin Fibrinogen Degradation Products/analysis , Fibrinolysis/drug effects , Myocardial Ischemia/etiology , Vascular Surgical Procedures/adverse effects , Aged , Biomarkers/blood , Chi-Square Distribution , Electrocardiography, Ambulatory , Female , Follow-Up Studies , Humans , Incidence , Intraoperative Complications , Male , Middle Aged , Outcome Assessment, Health Care , Prospective Studies , Risk FactorsABSTRACT
We describe an unusual case of transient resolution of preexisting mitral valve (MV) prolapse during acute cardiac dysfunction and the development of dynamic left ventricular (LV) outflow tract obstruction. The patient presented with lightheadedness, chest pain, and compromised hemodynamic status. Echocardiography revealed akinesis and deformation of the LV anterior wall and apex, hyperdynamic activity in the bases, anterior MV leaflet systolic anterior motion without prolapse, and a dynamic outflow tract gradient. Myocardial function fully recovered over 1 month. Repeat ultrasonography showed posterior MV leaflet prolapse and no anterior MV leaflet systolic anterior motion. Elongated MV leaflets may have contributed to dynamic outflow tract obstruction and life-threatening hemodynamic compromise during LV conformational change.
Subject(s)
Mitral Valve Prolapse/complications , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Outflow Obstruction/diagnostic imaging , Ventricular Outflow Obstruction/etiology , Female , Humans , Middle Aged , Ultrasonography , Ventricular Dysfunction, Left/etiologyABSTRACT
Comparability of clinical and research data sets may be undermined if the instruments used to acquire them vary. Even when standard 12-lead electrocardiographic formats are used for monitoring, proprietary signal processing techniques and sampling intervals may differ among devices. In order to directly compare the two commercially available standard 12-lead devices with monitoring capabilities, bifurcated wires from a single standard lead set were attached to each device in elective angioplasty patients. Neither device was used as a standard; rather, a method was designed to analyze the output from each device independently, and then, if results differed, data from both monitors were reviewed by consensus to determine the source of the differences. Analysis endpoints for each study included study quality, baseline ST-segment levels, the presence of ischemia, number of ischemic episodes, peak lead location, and peak lead amplitude. Sources of differences in these endpoints visible to consensus review included variations between devices in baseline stability, noise/artifact levels, stability of the QRS complex onset, and temporal sampling intervals.
Subject(s)
Angioplasty, Balloon, Coronary , Electrocardiography/instrumentation , Signal Processing, Computer-Assisted , HumansABSTRACT
We tested the hypothesis that a special population of people who maintain exotic beliefs and report frequent subjective psi experiences should display more frequent temporal lobe signs and symptoms. Clusters of items, that reflect various temporal lobe factors for 20 women who were actively (greater than 1 year) involved with a local psychic and spiritual development group, were compared to items for an age-matched reference group (n = 61). T-scores for the reference group did not differ from those of the normal population. Whereas the psychic group did not differ from the reference group on various control and psychiatric measures, mean T-scores on clusters that infer complex partial epileptic signs (specifically a sense of presence, olfactory experiences, and intense meaning) ranged between 65 and 70. Group affiliation explained 22 to 50% of the variance for each of these variables; with discriminant analysis, they correctly classified 95% of both groups of participants.