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CHAPTER 30: CARDIAC MANIFESTATIONS OF SYSTEMIC DISEASE

Eric H. Awtry; Wilson S. Colucci

INTRODUCTION

The common systemic disorders that have associated cardiac manifestations are summarized in Table 30-1.

TABLE 30-1COMMON SYSTEMIC DISORDERS AND THEIR ASSOCIATED CARDIAC MANIFESTATIONS
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TABLE 30-1 COMMON SYSTEMIC DISORDERS AND THEIR ASSOCIATED CARDIAC MANIFESTATIONS
SYSTEMIC DISORDER COMMON CARDIAC MANIFESTATIONS CHAPTERa
Diabetes mellitus CAD, atypical angina, CMP, systolic or diastolic CHF 417
Protein-calorie malnutrition Dilated CMP, CHF 97
Thiamine deficiency High-output failure, dilated CMP 96e
Hyperhomocysteinemia Premature atherosclerosis 96e
Obesity CMP, systolic or diastolic CHF 415e
Hyperthyroidism Palpitations, SVT, atrial fibrillation, hypertension 405
Hypothyroidism Hypotension, bradycardia, dilated CMP, CHF, pericardial effusion 405
Malignant carcinoid Tricuspid and pulmonary valve disease, right heart failure 113
Pheochromocytoma Hypertension, palpitations, CHF 407
Acromegaly Systolic or diastolic heart failure 401e
Rheumatoid arthritis Pericarditis, pericardial effusions, coronary arteritis, myocarditis, valvulitis 380
Seronegative arthropathies Aortitis, aortic and mitral insufficiency, conduction abnormalities 384
Systemic lupus erythematosus Pericarditis, Libman-Sacks endocarditis, myocarditis, arterial and venous thrombosis 378
HIV Myocarditis, dilated CMP, pericardial effusion 226
Amyloidosis CHF, restrictive CMP, valvular regurgitation, pericardial effusion 137
Sarcoidosis CHF, dilated or restrictive CMP, ventricular arrhythmias, heart block 390
Hemochromatosis CHF, arrhythmias, heart block 428
Marfan syndrome Aortic aneurysm and dissection, aortic insufficiency, mitral valve prolapse 427
Ehlers-Danlos syndrome Aortic and coronary aneurysms, mitral and tricuspid valve prolapse 427
Systemic sclerosis Pericardial effusion, CHF (systolic and diastolic), myocarditis, coronary microvascular vasospasm, tachyarrhythmias 382

Abbreviations: CAD, coronary artery disease; CHF, congestive heart failure; CMP, cardiomyopathy; SVT, supraventricular tachycardia.

aFrom Kasper DL, Hauser SL, Jameson JL, Anthony SF, Longo DL, Loscalzo J (eds). Harrison’s Principles of Internal Medicine, 19th ed. New York, McGraw-Hill, 2016, ISBN 978-0-07-180215-4.

DIABETES MELLITUS

Diabetes mellitus, both insulin- and non-insulin-dependent, is an independent risk factor for coronary artery disease (CAD; Chap. 36) and accounts for 14–50% of new cases of cardiovascular disease. Furthermore, CAD is the most common cause of death in adults with diabetes mellitus. In the diabetic population, the incidence of CAD relates to the duration of diabetes and the level of glycemic control, and its pathogenesis involves endothelial dysfunction, increased lipoprotein peroxidation, increased inflammation, a prothrombotic state, and associated metabolic abnormalities.

Compared to their nondiabetic counterparts, diabetic patients are more likely to have a myocardial infarction, have a greater burden of CAD, have larger infarct size, and have more postinfarct complications, including heart failure, shock, and death. Importantly, diabetic patients are more likely to have atypical ischemic symptoms; nausea, dyspnea, pulmonary edema, arrhythmias, heart block, or syncope may be their anginal equivalent. Additionally, “silent ischemia,” resulting from autonomic nervous system dysfunction, is more common in diabetic patients, accounting for up to 90% of their ischemic episodes. Thus, one must have a low threshold for suspecting CAD in diabetic patients. The treatment of diabetic patients with CAD must include aggressive risk factor management. Considerations regarding pharmacologic therapy and revascularization strategies are similar in diabetic and nondiabetic ...

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