Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Pericardial effusion Lymphocytic myocarditis Dilated cardiomyopathy and left ventricular systolic dysfunction Myocardial Kaposi’s sarcoma and non-Hodgkin’s lymphoma Pulmonary hypertension secondary to multiple pulmonary infarctions, or primary pulmonary hypertension Accelerated atherosclerosis as a consequence of longer survival and the use of antiretroviral agents +++ GENERAL CONSIDERATIONS ++ Most HIV-infected patients with cardiac abnormalities have acquired immunodeficiency syndrome (AIDS) Pericardial effusion is less common today but is associated with a poor prognosis The cause of idiopathic myocarditis is uncertain but may be due to direct myocardial infection by the HIV virus, autoimmune mechanisms, other viruses, or opportunistic infection Clinically important dilated cardiomyopathy is the most common finding in low socioeconomic populations Cardiac tumors such as Kaposi’s sarcoma, intracavity growth, and obstruction should be considered Pulmonary hypertension is unusual in HIV-infected patients and is associated with poor survival Protease inhibitors, which are part of most HAART (highly active antiretroviral treatment) regimens, are associated with metabolic abnormalities that lead to accelerated atherosclerosis and increased cardiovascular risk Coronary artery disease is the most common finding in higher socioeconomic populations Prolonged QT interval and torsades de pointes have been described in hospitalized patients with HIV infection, even without drug therapy +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Worsened fatigue Breathlessness/dyspnea Edema Chest pain +++ PHYSICAL EXAM FINDINGS ++ Patients with significant pericardial disease – Elevated jugular venous pressure – A pericardial friction rub Patients with a dilated cardiomyopathy – Elevated jugular venous pressure – Pulmonary rales – Displaced sustained apical impulse – Gallop rhythms Patients with pulmonary hypertension – Increased P2 – Right ventricular lift – Murmur of tricuspid regurgitation +++ DIFFERENTIAL DIAGNOSIS ++ Idiopathic dilated cardiomyopathy from other causes Other causes of myocardial ischemia Dilated cardiomyopathy secondary to interferon-alfa used to treat Kaposi’s sarcoma Other causes of pericardial effusion +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ HIV serology CD4 count Other tests based on the clinical situation +++ ELECTROCARDIOGRAPHY ++ Low-voltage QRS and/or electrical alternans may suggest a pericardial effusion Rare patients may have PR depression and/or diffuse ST elevation with acute pericarditis Q waves in patients with prior myocardial infarction Prolonged QT interval +++ IMAGING STUDIES ++ Chest x-ray: – Enlarged cardiac silhouette due to a pericardial effusion or cardiomegaly Echocardiogram (routine echo not indicated to screen for cardiovascular involvement): – Pericardial effusion – Cardiac chamber enlargement – Reduced ventricular function Stress testing: – May be indicated in patients with symptoms of myocardial ischemia or ventricular dysfunction +++ DIAGNOSTIC PROCEDURES ++ Cardiac catheterization: – Coronary angiography may be indicated in patients presenting with signs or symptoms of myocardial ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth