AIDS and the heart
Rivera del Río, J.R.
Boletin de la Asociacion Medica de Puerto Rico 91(1-6): 11-14
1999
ISSN/ISBN: 0004-4849 Document Number: 703015
Cardiac involvement in HIV/AIDS patient has been extensively studied in the last 10 years. The increased prevalence of heart disease in this population of patients is probably due to improved understanding of the patient symptoms, increased longevity after new developed chemotherapy, and the addition of the echocardiogram to the routine diagnostic armamentarium. The predominant clinical expression are myocardial, pericardial, endocardial, vascular and arrhythmic. Pericardial effusion has a 30% prevalence. Its clinical presentation may range from an asymptomatic condition to tamponade and usually represents a poor prognosis. It is usually seen in the end stage HIV/AIDS patient. The usual reco-mmendation is supportive tare unless a diagnostic pericardio-centesis is required or tamponade develops. Myocarditis is the most frequent pathological expression involving the heart. The specific and definitive etiology are often uncertain. The incidence of dilated cardiomyopathy is greater in patients zvith low CD4 counts. The clinical expression of cardiomyopathy goes frequently undetected unless an echocardiogram or a necropsy are performed. An aggressive and thorough evaluation of asymptomatic patients with HIV/AIDS in order to detect cardiomyopathy is not recommended. If the patients presents clinicalfindings then the echocardiogram is the most sensitive and specific study to be performed. Endocardial involvement is infrequent and it may be marantic or infective endocarditis. Thesefindings are usually seen in patients with intravenous drug use. Arrhythmias are frequently related to myocarditis, pulmonary hypertensíon or drugs. Hypercoagulable states with venous and pulmonary embolism may be the result of an abnormal prothrombotic condition present in the HIV/AIDS patient.
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