Cardiac diseases in AIDS medical therapy: Difference between revisions
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Majority of the [[AIDS]] patients with [[pericarditis]] are asymptomatic. Small [[pericardial effusion]]s without [[tamponade]] can be followed up without any further testing. In symptomatic patients with large effusions with or without a tamponade, [[pericardiocentesis]] is indicated to obtain culture and cytology <ref name="pmid8017317">{{cite journal |author=Hsia J, Ross AM |title=Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection |journal=[[The American Journal of Cardiology]] |volume=74 |issue=1 |pages=94–6 |year=1994 |month=July |pmid=8017317 |doi= |url=}}</ref>. If tamponade occurs, immediate drainage is necessary <ref name="pmid10047635">{{cite journal |author=Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M |title=Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature |journal=[[American Heart Journal]] |volume=137 |issue=3 |pages=516–21 |year=1999 |month=March |pmid=10047635 |doi= |url=}}</ref>. | Majority of the [[AIDS]] patients with [[pericarditis]] are asymptomatic. Small [[pericardial effusion]]s without [[tamponade]] can be followed up without any further testing. In symptomatic patients with large effusions with or without a tamponade, [[pericardiocentesis]] is indicated to obtain culture and cytology <ref name="pmid8017317">{{cite journal |author=Hsia J, Ross AM |title=Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection |journal=[[The American Journal of Cardiology]] |volume=74 |issue=1 |pages=94–6 |year=1994 |month=July |pmid=8017317 |doi= |url=}}</ref>. If tamponade occurs, immediate drainage is necessary <ref name="pmid10047635">{{cite journal |author=Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M |title=Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature |journal=[[American Heart Journal]] |volume=137 |issue=3 |pages=516–21 |year=1999 |month=March |pmid=10047635 |doi= |url=}}</ref>. | ||
It is recommended that patients with pericarditis of unknown etiology be treated emperically for ''[[Mycobacterium tuberculosis]]'' (4-drug therapy ([[isoniazid]], [[rifampicin]], [[pyrazinamide]], and [[ethambutol]]) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months). Addition of [[prednisolone]] to anti-tubercular therapy is associated with rapid recovery, lower mortality rates and decreased need for surgical intervention <ref name="pmid17976506">{{cite journal |author=Syed FF, Mayosi BM |title=A modern approach to tuberculous pericarditis |journal=[[Progress in Cardiovascular Diseases]] |volume=50 |issue=3 |pages=218–36 |year=2007 |pmid=17976506 |doi=10.1016/j.pcad.2007.03.002 |url=}}</ref>. | It is recommended that patients with pericarditis of unknown etiology be treated emperically for ''[[Mycobacterium tuberculosis]]'' (4-drug therapy ([[isoniazid]], [[rifampicin]], [[pyrazinamide]], and [[ethambutol]]) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months). Addition of [[prednisolone]] to anti-tubercular therapy is associated with rapid recovery, lower mortality rates and decreased need for surgical intervention <ref name="pmid17976506">{{cite journal |author=Syed FF, Mayosi BM |title=A modern approach to tuberculous pericarditis |journal=[[Progress in Cardiovascular Diseases]] |volume=50 |issue=3 |pages=218–36 |year=2007 |pmid=17976506 |doi=10.1016/j.pcad.2007.03.002 |url=}}</ref><ref name="pmid3723722">{{cite journal |author=Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB |title=Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS) |journal=[[JAMA : the Journal of the American Medical Association]] |volume=256 |issue=3 |pages=362–6 |year=1986 |month=July |pmid=3723722 |doi= |url=}}</ref>. | ||
Bacterial and fungal causes of pericarditis are treated with appropriate anti-bacterials and anti-fungals. | Bacterial and fungal causes of pericarditis are treated with appropriate anti-bacterials and anti-fungals. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Medical Therapy
Pericarditis
Majority of the AIDS patients with pericarditis are asymptomatic. Small pericardial effusions without tamponade can be followed up without any further testing. In symptomatic patients with large effusions with or without a tamponade, pericardiocentesis is indicated to obtain culture and cytology [1]. If tamponade occurs, immediate drainage is necessary [2].
It is recommended that patients with pericarditis of unknown etiology be treated emperically for Mycobacterium tuberculosis (4-drug therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months). Addition of prednisolone to anti-tubercular therapy is associated with rapid recovery, lower mortality rates and decreased need for surgical intervention [3][4].
Bacterial and fungal causes of pericarditis are treated with appropriate anti-bacterials and anti-fungals.
Pericarditis secondary to lymphoma can be treated with radiation and/or chemotherapy. However, combination chemotherapy has been shown to significantly increase the risk of early death from opportunistic infections.
Heart Failure
Treatment of heart failure in patients with AIDS is similar to that of in general population. ACE inhibitors, diuretics, beta-blockers and digoxin are indicated as usual. Also, drugs that are known to cause cardiac side effects should be discontinued.
Lifestyle modification (smoking cessation, weight reduction) and control of hypertension, diabetes and elevated cholesterol should be paid special attention.
Cardiac Tumors
Chemotherapy and radiation therapy have been shown to have a variable effect in the treatment of primary cardiac lymphoma [5].
References
- ↑ Hsia J, Ross AM (1994). "Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection". The American Journal of Cardiology. 74 (1): 94–6. PMID 8017317. Unknown parameter
|month=ignored (help) - ↑ Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999). "Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature". American Heart Journal. 137 (3): 516–21. PMID 10047635. Unknown parameter
|month=ignored (help) - ↑ Syed FF, Mayosi BM (2007). "A modern approach to tuberculous pericarditis". Progress in Cardiovascular Diseases. 50 (3): 218–36. doi:10.1016/j.pcad.2007.03.002. PMID 17976506.
- ↑ Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986). "Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS)". JAMA : the Journal of the American Medical Association. 256 (3): 362–6. PMID 3723722. Unknown parameter
|month=ignored (help) - ↑ Montalbetti L, Della Volpe A, Airaghi ML, Landoni C, Brambilla-Pisoni G, Pozzi S (1999). "Primary cardiac lymphoma. A case report and review". Minerva Cardioangiologica. 47 (5): 175–82. PMID 10479855. Unknown parameter
|month=ignored (help)