Cardiac involvement has been reported in from one-quarter to one-half of the patients with AIDS, as defined by echocardiographic, endomyocardial biopsy, or autopsy findings. This involvement may cause clinically apparent manifestations in only 10-25% of patients, depending on the stage of disease and whether the patients are hospitalized.
List the common lesions in cardiac involvement in AIDS.
Metastatic or primary involvement of Kaposi’s sarcoma or other malignant lymphomas involving the myocardium, epicardium, or pericardium
Myocarditis (infectious, viral, lymphocytic, noninfectious), endocarditis, or pericarditis
Cardiomyopathy (right, left, or biventricular)
Toxic effects of drugs used against the infectious or anti-HIV drugs
What are the most common clinical manifestations of AIDS when there is heart involvement?
Pericarditis (in up to 15% of cases, with an effusion in 18%^40%)
Congestive heart failure due to left ventricular dilatation and dysfunction (10-42%)
These lesions may present as angina, dyspnea, fatigue, and dyspnea on exertion. Also ventricular arrhythmias, endocarditis, and right-heart failure may be presenting abnormalities. Anderson and Virman proposed the use of four clinical categories of AIDS heart disease: (1) endocardial disease, (2) myocardial disease, (3) pericardial disease, and (4) neoplasms.
When a patient with HIV infection presents with dyspnea, should we have concerns about a cardiac etiology?
Yes. AIDS patients have multiple symptoms for which the system involved may be unclear. For example, chest pain, dyspnea, fatigue, edema, and palpitations are general symptoms which may have multisystem etiologies. Because these patients may not have overt clinical evidence for cardiac disease, only through a heightened awareness of the frequent involvement of the heart will correct diagnosis and management be initiated.
Describe the diagnostic workup for the AIDS patient with dyspnea.
The physical examination may help implicate a pulmonary or cardiac etiology. However, usually this is not sufficient, and a chest x-ray may be inconclusive since old and/or new pulmonary infiltrates do not rule out a cardiac problem. An echo-Doppler study, however, may be very helpful in evaluating a patient for pericardial effusion, tamponade, cardiomyopathy, valve disease, (especially tricuspid regurgitation secondary to pulmonary hypertension), or segmental wall motion abnormalities. Many of these patients also may have risk factors for coronary artery disease (i.e., male smokers) and ischemia or infarction should be considered; therefore, an electrocardiogram should be routinely obtained.