Dilated cardiomyopathy |
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Drug-related:
cocaine, AZT, IL-2, doxorubicin, interferon |
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Infectious:
HIV, Toxoplasma, coxsackievirus group B, EBV, CMV, adenovirus
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Metabolic or
endocrine: selenium or carnitine deficiency, anemia, hypo-calcemia,
hypophos-phatemia, hyponatremia, hypokalemia, hypo-albuminemia, hypo-thyroidism,
growth hormone deficiency, adrenal insufficiency, hyper-insulinemia,
hemochromatosis, pheochromocytoma, sarcoidosis, amyloidosis |
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Cytokines:
TNF-α, nitric oxide, TGF-β, endothelin-I, interleukins |
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Immunodeficiency: CD4 <
100 cells/mm3 |
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Autoimmune
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Up to 8% of
asymptomatic patients |
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Up to 25% of
autopsy cases |
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Systolic >
diastolic |
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Chest
radiographic findings: non-specific conduction abnormalities, PVCs, PACs
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Echocardiographic findings:
low-normal LV wall thickness, increased LV mass, dilated LV, systolic LV
dysfunction |
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Possible
laboratory studies: troponin T, brain natriuretic peptide level, CD4 count,
viral load, viral PCR, Toxoplasma serology, thyroid-stimulating hormone,
cortisol, carnitine, selenium, serum ACE, vanillylmandelic acid, amyloid, urine
analysis, stress testing, myocardial biopsy, cardiac catheterization
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Diuretics,
digoxin, ACE inhibitors, beta blockers |
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Adjunctive treatment
in HIV patients: treatment of infection; nutritional replacement; IVIG;
intensify antiretroviral therapy |
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Follow-up:
serial echocardiography |
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Pericardial |
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Bacteria:
Staphylococcus, Streptococcus, Proteus, Klebsiella, Enterococcus, Listeria,
Nocardia, Mycobacterium |
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Viral
pathogens: HIV, HSV, CMV, adenovirus, echovirus |
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Other
pathogens: Cryptococcus, Toxoplasma, Histoplasma |
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Malignancy:
Kaposi sarcoma, lymphoma, capillary leak, wasting, malnutrition
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Hypothyroidism
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Immunodeficiency
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Uremia
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11%/year, spontaneous resolution in 42% of affected patients; ∼
30% increase in 6-month mortality |
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Pericardial
rub on examination |
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Echocardiography
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Fluid analysis
for Gram stain and culture, cytology |
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ECG: low
voltage, PR depression |
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Associated
pleural and peritoneal fluid analysis |
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Pericardial
biopsy |
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Treat the cause Follow-up: serial echocardiography;
intensify antiretroviral therapy; pericardiocentesis or window |
Infective endocarditis |
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Autoimmune |
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Bacteria:
Staphylococcus aureus or S. epidermidis, Salmonella, Streptococcus,
Haemophilus para-influenzae, Pseudallescheria boydii, HACEK
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Fungal:
Aspergillus fumigatus, Candida, Cryptococcus neoformans
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6% increased incidence in IVDA, regardless of HIV status |
Blood cultures; echocardiography |
IV antibiotics, valve replacements |
Nonbacterial thrombotic endocarditis |
Valvular damage, vitamin C deficiency, malnutrition, wasting,
DIC, hypercoagulable state, prolonged acquired immunodeficiency |
Rare but clinically relevant emboli in 42% of cases |
Echocardiography |
Anticoagulation, treat vasculitis or underlying illness |
Malignancy |
Kaposi sarcoma, non–Hodgkin lymphoma, leiomyosarcoma, low CD4
count, prolonged immunodeficiency, HHV-8, EBV |
Approximately 1% incidence, usually metastatic in HIV-positive
patients |
Echocardiography, biopsy |
Chemotherapy possible |
Right ventricular and pulmonary disease |
Recurrent pulmonary infections, pulmonary arteritis,
microvascular pulmonary emboli |
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ECG, echocardiog-raphy, right heart catheterization |
Diuretics, treat underlying lung infection or disease,
anticoagulation |
Primary pulmonary hypertension |
Plexogenic pulmonary arteriopathy |
0.5% |
ECG, echocardiog-raphy, right heart catheterization |
Anticoagulation, vasodilators, prostacyclin analogues |
Vasculitis |
Drug therapy with antibiotics and antivirals |
Increasing incidence |
Clinical diagnosis |
Systemic corticosteroids, withdrawal of drug |
Accelerated atherosclerosis |
Protease inhibitors, atherogenesis with virus-infected
macrophages, chronic inflammation, glucose intolerance, dyslipidemia |
Up to 8% prevalence |
Stress testing, echocardiography, lipid profile, CT angiography,
calcium scoring |
Minimize risk factors |
Autonomic dysfunction |
CNS disease, drug therapy, prolonged immunodeficiency,
malnutrition |
Increased in patients with CNS disease |
Tilt-table test, Holter monitoring |
Procedural precautions |
Arrhythmias |
Drug therapy, pentamidine, autonomic dysfunction, acidosis,
electrolyte abnormalities |
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ECG: long QT, Holter monitoring, exercise stress testing |
Discontinue drug, procedural precautions |
Lipodystrophy |
Drug therapy: protease inhibitors |
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Echocardiography, lipid profile, cardiac catheterization,
coronary calcium score |
Lipid therapy (beware of drug interactions), aerobic exercise,
altered antiretroviral therapy, cosmetic surgery, fat
implantation |