Echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania

Abstract

ObjectiveTo determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania.MethodsPatients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital’s care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed.ResultsA total of 102 patients were recruited from September 2009 to April 2010. The patients’ mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively.ConclusionCardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.

Factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania

“…Of note, we have previously reported that neither the duration of HIV nor the use of antiretroviral medications was independently associated with hypertensive heart disease in HIV infected patients with cardiac symptoms. (Chillo et al, 2012). On the other hand, our findings that pulmonary hypertension, dilated cardiomyopathy and large pericardial effusion were also important causes of heart failure is in keeping with findings from previous reports that the three are important cardiac pathologies in HIV infected patients in Africa (Cegielski et al, 1990;Longo-Mbenza et al, 1998;Nzuobontane et al, 2002;Magula et al, 2003;Twagirumukiza et al, 2007).…”

“…This could have contributed to the occurrence of specific forms of HIV associated cardiomyopathy like dilated cardiomyopathy, which is known to occur in patients with advanced immunodepression (Jacob et al, 1992;Nzuobutane et al, 2002;Twagirumuikiza et al, 2007;Chillo et al, 2012). Of note is the fact that in our study low CD4 + count was associated with heart failure in univariate analysis.…”

Cardiac Critical Care in Resource-Limited Environments: Lessons from Tanzania

“…These patients may present with acute aortic dissection requiring care in acute cardiac units. Pulmonary hypertension and cor pulmonale related to frequent respiratory tract infections including tuberculosis are common among HIV-infected patients in our population [16]. Massive pericardial effusion with tamponade is another important cause of acute admission requiring critical care management in our setting and is primarily due to tuberculous pericarditis [17].…”

“…However, aneurismal dilation of major blood vessels is not uncommon among patients with HIV infection [16]. These patients may present with acute aortic dissection requiring care in acute cardiac units.…”

Human Immunodeficiency Virus–Associated Pulmonary Arterial Hypertension

“…Furthermore, several studies indicate that there is a higher incidence of cardiac involvement in HIV patients residing in Africa, including biventricular systolic and diastolic dysfunction, that may contribute to the incidence of pulmonary hypertension attributable to left heart disease, which is reported to be as high as 12.7% in some local regions. 71,[84][85][86][87][88][89][90] Nevertheless, careful analysis of the published data suggests that the estimated prevalence of HIV-associated PAH ranges from 0.4 to 5% globally. Despite this, many studies and clinical reports involve only symptomatic patients, thereby introducing potential selection bias to these estimates and underestimating the magnitude of the disease.…”