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Cardiac manifestations of acquired immune deficiency syndrome: a 1991 update
S Kaul1, M C Fishbein, R J Siegel
1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048-0750.
Insights
Cardiac complications are increasingly recognized in patients with acquired immunodeficiency syndrome (AIDS). This review highlights the diverse cardiac manifestations of HIV infection, including pericardial, myocardial, and endocardial diseases, posing diagnostic challenges.
Area of Science:
- Cardiology
- Infectious Diseases
- Oncology
Background:
- Cardiac involvement is increasingly identified in patients with acquired immunodeficiency syndrome (AIDS), with estimates suggesting significant annual occurrences in the United States.
- Patients with AIDS can present with a spectrum of cardiac conditions, including pericardial, myocardial, and endocardial diseases.
- These cardiac issues can stem from neoplasms, infections, HIV-1 itself (causing myocarditis and dilated cardiomyopathy), or nonbacterial thrombotic endocarditis.
Purpose of the Study:
- To review the cardiac manifestations of acquired immunodeficiency syndrome (AIDS).
- To raise awareness among clinicians regarding the cardiac complications associated with HIV infection.
- To discuss the diagnostic and therapeutic challenges presented by cardiac involvement in AIDS patients.
Main Methods:
- This is a review article.
- It synthesizes current knowledge on cardiac manifestations in AIDS.
- It discusses clinical and autopsy findings related to HIV-associated cardiac disease.
Main Results:
- Cardiac involvement in AIDS encompasses pericardial disease (tamponade, constriction), myocardial dysfunction (neoplastic infiltration, myocarditis, dilated cardiomyopathy), and endocardial disease (nonbacterial thrombotic endocarditis, infective endocarditis).
- HIV-1 plays a significant role in nonspecific myocarditis and dilated cardiomyopathy.
- Overt clinical evidence of cardiac disease is often absent in AIDS patients, and symptoms can be misattributed to noncardiac causes, mimicking heart failure.
Conclusions:
- Cardiac manifestations are a significant, though often overlooked, aspect of acquired immunodeficiency syndrome (AIDS).
- Early recognition and understanding of these cardiac complications are crucial for effective patient management.
- Addressing the diagnostic and therapeutic challenges is essential for improving outcomes in patients with HIV infection and cardiac involvement.
Abstract:
Cardiac involvement is being identified more often clinically and at autopsy in patients with AIDS. Recent estimates suggest that in the United States as many as 5000 patients per year may have cardiac complications resulting from HIV infection. Patients with AIDS may have pericardial, myocardial, and/or endocardial disease. Pericardial tamponade and/or constriction may be related to neoplasms, infections, or nonspecific effusions. Myocardial dysfunction may result from specific neoplastic infiltration or myocarditis. Particularly intriguing is the role of HIV-1 in the nonspecific myocarditis and dilated cardiomyopathy that occurs in patients with AIDS. As in other debilitating conditions patients with AIDS can have nonbacterial thrombotic endocarditis. Infective endocarditis may be a complication, especially in AIDS associated with intravenous drug abuse. Most patients with AIDS have no overt clinical evidence of cardiac disease. When cardiac dysfunction does develop, the signs and symptoms are often misinterpreted to be the result of noncardiac causes (pulmonary failure or infection) which can mimic heart failure. This review is intended to alert the reader to the cardiac manifestations of AIDS, which present a number of diagnostic and therapeutic challenges.