Conclusion
Often, symptoms of congestive heart failure or pericardial effusion in HIV-infected patients are nonspecific and may be attributed to generalized illness or coinfection. Echocardiography noninvasively and accurately aids diagnosis during any change in clinical status and it also directs therapy.
Patients will usually respond to early therapy for left ventricular dysfunction and increased left ventricular mass. Treatment based on these findings may prolong the quality and duration of life, and may also direct further patient evaluation.The role of the ED cardiologist in the evaluation and treatment of patients with HIV infection should, therefore, be expanded to include patients who are being evaluated for or who are receiving HAART regimens, especially those with underlying risk factors, since the HAART-associated metabolic syndrome may increase the risk of acute coronary syndromes and stroke. Careful clinical and echocardiographic evaluation is also required for HIV-infected patients who receive drugs with a recognized cardiotoxic action (doxorubicin, interferon alpha, pentamidine), since they may worsen the clinical outcome of HIV-associated cardiomyopathy and increase the risk of potentially fatal arrhythmias [1].
References
1. Barbaro G, Fisher SD, Giancaspro G, Lipshultz SE (2001) HIV-associated cardiovascular complications: a new challenge for emergency physicians. Am J Emerg Med 19:566-574
2. Morris A, Huang L (2004) Intensive care of patients with HIV infection: HAART warming improvement but beware of future HAART (and heart) attacks. Chest 15:1602-1604
3. Aretz HT (1987) Myocarditis: the Dallas criteria. Hum Pathol 18:619-624
4. Lipshultz SE, Orav EJ, Sanders SP, Colan SD (1995) Immunoglobulins and left ventricular structure and function in pediatrics HIV infection. Circulation 92:2220-2225
5. Nzuobontane D, Blackett KN, Kuaban C (2002) Cardiac involvement in HIV-infected people in Yaounde, Cameroon. Postgrad Med J 78:678-681
6. Barbaro G, Pellicelli A, Barbarini G et al. (2006) Takotsubo-like left ventricular dysfunction in HIV-infected patient. Curr HIV Res; 4:239-241
7. Barbaro G, Di Lorenzo G, Grisorio B, Barbarini G (1996) Clinical meaning of ventricular ectopic beats in the diagnosis of HIV-related myocarditis: a retrospective analysis of Holter electrocardiographic recordings, echocardiographic parameters, histopathological and virologic findings. Cardiologia 41:1199-1207
8. Boccara F, Teiger E, Cohen A et al (2006) Percutaneous coronary intervention in HIV-infected patients: immediate results and long- term prognosis. Heart 92:543-544.
9. Frater RW, Sisto D, Condit D (1989) Cardiac surgery in human immunodeficiency virus (HIV) carriers. Eur J Cardiothorac Surg 3:146-150