HIV and the Heart

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Slide 1 :

HIV and the Heart Macky Natha 09/04

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IRIS Inflammatory process 3/12 of starting HAART Associated with low CD4 counts MAC, MTB, Hep B and C, HZV, HSV, CMV, PCP Less commonly : parvovirus B19, leishmania, B.henselae, C.trachomatis Steroids can be useful

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HIV and the Heart HIV-associated myocarditis Dilated Cardiomyopathy Endocarditis Coronary heart disease Pulmonary hypertension Cardiac neoplasms Pericardial effusions

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Pericardial Effusions and HIV 5-10 % prevalence Clinically significant cardiac disease unusual Associated with high viral loads and low CD4 counts Shorter survival of AIDS patients with pericardial effusion at 6 months (36% vs 93%)

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Common Causes Idiopathic 45% Mycobacteria 22% Bacteria 20% Lymphoma 6% Kaposi’s sarcoma 3% Viruses 3% Fungi 1%

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Symptoms Fever Dyspnoea Dry cough Chest pain Lethargy

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Signs Raised JVP 100% Tachycardia 98% Hypotension 77% Normal heart sounds 66% Pericardial rub 30% Pulsus paradoxicus

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ECG in pericarditis/effusion Low voltage Diffuse ST segment elevation T wave inversion, decreased amplitude PR segment changes Atrial arrhythmias Electrical alternans

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ECHO findings Effusion Diastolic collapse of RV R atrial inversion L atrial collapse LV hypokinesis/dysfunction

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Management Diagnosis and Treatment of underlying cause Pericardiocentesis – therapeutic ?timing HAART Pericardiectomy- recurrent disease

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Summary High index of suspicion Difficult management TB/HIV interaction Increasing problem Good relationships with cardiology

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HIV-associated myocarditis Dilated Cardiomyopathy Endocarditis Coronary heart disease Pulmonary hyp more HIV-associated myocarditis Dilated Cardiomyopathy Endocarditis Coronary heart disease Pulmonary hypertension Cardiac neoplasms Pericardial effusions less
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