Why is it important to perform an echocardiogram on an AIDS patient with chest pain or shortness of breath?

Because there may be specific findings on the echocardiogram that will change the management, improve the quality of life, and provide symptomatic improvement for the patient. For example, if the patient has a cardiomyopathy, diuretics and angiotensin-converting enzyme (ACE)-inhibitors may markedly alleviate the shortness of breath not otherwise treated if the patient is diagnosed as having a chronic pulmonary infection. Also, specific antibiotics are indicated for infectious myocarditis and pericarditis, as well as antineoplastic therapy for specific neoplasms. When a pericardial effusion is present, arrangements need to be made for pericardiocentesis and possibly biopsy for specific diagnosis. Tuberculous pericarditis often presents with tamponade and requires urgent drainage.

How common is pericarditis in AIDS, and what are the common etiologies?

Pericarditis occurs in 5-15% of patients with AIDS and usually presents as chest pain. The causes may be viral disease, bacterial infection, tuberculosis, neoplasm, or fungal infection.

Does the patient’s clinical status affect the likelihood of cardiac abnormalities?

Only a few studies have looked at this issue. It was shown that patients with more advanced disease, i.e., AIDS, had more cardiac abnormalities on echo-Doppler than patients who were HIV-positive but pre-AIDS. Also, patients with CD4+ lymphocyte counts 100/mm3 had a higher prevalence of abnormalities on echo-Doppler compared to patients with higher CD4+ counts. The presence of an active opportunistic infection, however, did not correlate with the presence of abnormalities. One study showed an association of opportunistic infection with more cardiac abnormalities but no association with left ventricular dysfunction. They also showed that the highest relationship with a low CD4+ count was pericardial effusion.

How common is endocarditis in AIDS patients?

Endocarditis is not a common finding in AIDS patients. Because most of the larger studies have been done in centers where the major HIV-positive population is not intravenous drug abusers though, this may be an unidentified area of concern. We have reported in a study of a large group of patients who were HIV-positive intravenous drug abusers frequent valve abnormalities (67%). However, only 7% of the patients had active endocarditis at the time of evaluation.

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