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23 - Cardiac problems

Published online by Cambridge University Press:  23 December 2009

By
Gul H. Dadlani  and
Steven E. Lipshultz
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Gul H. Dadlani
Affiliation:
Congenital Heart Institute of Florida, All Children's Hospital and University of South Florida, St. Petersburg, FL, USA
Steven E. Lipshultz
Affiliation:
Sylvester Comprehensive Cancer Center University of Miami and Miller School of Medicine, Holtz Children's Hospital, University of Miami-Jackson Memorial Medical Center, FL, USA
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Institutes of Health, Bethesda, Maryland
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Summary

Introduction

As the survival of HIV-infected patients improves, the cardiovascular complications of HIV infection are becoming an increasingly common cause of morbidity and mortality. The prevalence of cardiovascular disease is estimated to be more than 90% in pediatric HIV patients [1–3]. The spectrum of cardiovascular disorders includes abnormalities in left ventricular performance, wall thickness, contractility, dilated cardiomyopathy, myocarditis, pericarditis, and rhythm disturbances. Cardiac complications have surpassed pulmonary disease as the leading cause of death in HIV-infected patients [4]. The recognition of cardiovascular complications can be very difficult because many patients are asymptomatic until late in the disease course. In addition, the cardiac symptoms can be inadvertently attributed to other causes such as pulmonary or infectious etiologies. Early detection of these symptoms is only possible if clinicians have a fundamental understanding of the wide array of cardiovascular complications associated with HIV infection. The initiation of routine screening and monitoring will allow clinicians the ability to intervene and hopefully prevent or delay the onset of these complications in the future.

Risk factors

Several risk factors for cardiovascular disease among HIV-infected children have been described. The triad of encephalopathy, wasting, and low CD4 counts in children with HIV have been shown to be associated with an increased the risk of cardiovascular complications and decreased survival [5]. Encephalopathy can lead to an autonomic neuropathy, which may precipitate arrhythmias or even sudden death [5].

Type
Chapter
Information
Handbook of Pediatric HIV Care , pp. 554 - 566
Publisher: Cambridge University Press
Print publication year: 2006

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References

Lipshultz, S. E., Chanock, S., Sanders, S. P.et al.Cardiovascular manifestations of human immunodeficiency virus in infants and children. Am. J. Cardiol. 1989;63:1489–1497.CrossRefGoogle ScholarPubMed
Starc, T. J., Lipshultz, S. E., Kaplan, S.et al.Cardiac complications in children with human immunodeficiency virus infection. Pediatrics 1999;104(2): e14.CrossRefGoogle ScholarPubMed
Starc, T. J., Lipshultz, S. E., Easley, K. A.et al.Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: the prospective P2C2 human immunodeficiency virus study. J. Pediatr. 2002;141(3): 327–334.CrossRefGoogle Scholar
Langston, C., Cooper, E. R., Goldfarb, J.et al.Human immunodeficiency virus-related mortality in infants and children: data from the pediatric pulmonary and cardiovascular complications of vertically transmitted human immunodeficiency virus P2C2 study. Pediatrics 2001;107(2): 328–338.CrossRefGoogle ScholarPubMed
Luginbuhl, L. M., , Orav E. J., McIntosh, K., Lipshultz, S. E.Cardiac morbidity and related mortality in children with human immunodeficiency virus infection. J. Am. Med. Assoc. 1993;269:1869–1875.CrossRefGoogle Scholar
Keesler, M. J., Fisher, S. D., Lipshultz, S. E.Cardiac manifestations of human immunodeficiency virus infection in infants and children. Ann. NY Acad. Sci. 2001;946:169–178.CrossRefGoogle ScholarPubMed
Moorthy, L. N., Lipshultz, S. E. Cardiovascular monitoring of human immunodeficiency virus-infected patients. In Lipshultz, S. E., ed. Cardiology in acquired immune deficiency syndrome. New York: Chapman and Hall, 1998:345–384.Google Scholar
Lipshultz, S. E., Easley, K. A., Orav, E. J.et al.Cardiac dysfunction and mortality in human immunodeficiency virus-infected children. The prospective P2C2 human immunodeficiency virus multicenter study. Circulation 2000;102:1542–1548.CrossRefGoogle Scholar
Fisher, S. D., Easley, K. A., Orav, E. J., et al., Pediatric pulmonary and cardiovascular complications of vertically transmitted human immunodeficiency virus infection (P2C2 human immunodeficiency virus) study group. Am. Heart J. 2005;150(3):439–447.CrossRefGoogle Scholar
Lipshultz, S. E., Easley, K. A., Orav, E. J., et al., Pediatric pulmonary and cardiovascular complications of vertically transmitted human immunodeficiency virus infection (P2C2 human immunodeficiency virus) study group. Lancet 2002; 360(9330): 368–373.CrossRefGoogle Scholar
Al-Attar, I., Orav, E. J., Exil, V., Vlach, S. A., Lipshultz, S. E.Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndromes. J. Am. Coll. Cardiol. 2003;41(9):1598–1605.CrossRefGoogle Scholar
Aretz, H. T., Myocarditis: the Dallas criteria. Hum. Pathol. 1987;18:619–624.CrossRefGoogle ScholarPubMed
Kasten-Sportes, C., Weinstein C. Molecular mechanisms of human immunodeficiency virus cardiovascular disease. In Lipshultz, S. E., ed. Cardiology in acquired immune deficiency syndrome. New York: Chapman & Hall, 1998: 265–282.Google Scholar
Barbaro, G., Fisher, S. D., Lipshultz, S. E.Pathogenesis of human immunodeficiency virus-associated cardiovascular complications. Lancet Infect. Dis. 2001;1;115–124.CrossRefGoogle Scholar
Lipshultz, S. E., Fisher, S. D., Lai, W. W., Miller, T. L.Cardiovascular risk factors, monitoring, and therapy for human immunodeficiency virus-infected patients. acquired immune deficiency syndrome 2003;17 (Suppl. 1): S96–S122.Google Scholar
Lipshultz, S. E., Rifai, N., Sallan, S. E.et al.Predictive value of cardiac troponin T in pediatric patients at risk for myocardial injury. Circulation 1997;96;2641–2648.CrossRefGoogle ScholarPubMed
Pearson, T., New tools for coronary risk assessment. Circulation 2002;105:886–892.CrossRefGoogle ScholarPubMed
Lipshultz, S. E., Orav, E. J., Sanders, S. P.et al.Immunoglobulins and left ventricular structure and function in pediatric human immunodeficiency virus infection. Circulation 1995;92:2220–2225.CrossRefGoogle Scholar
Rosenthal, D., Chrisant, M. R., Edens, E., et al.International Society for Heart and Lung Transplantation: practice guidelines for management of heart failure in children. J. Heart Lung Transpl. 2004;23(12):1313–1333.CrossRefGoogle ScholarPubMed
Dadlani, G. H., Gingell, R. L., Orie, J. D.et al.Coronary artery calcifications in the long-term follow-up of Kawasaki disease. Am. Heart J. 2005: in press.CrossRefGoogle ScholarPubMed

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  • Cardiac problems
    • By Gul H. Dadlani, Congenital Heart Institute of Florida, All Children's Hospital and University of South Florida, St. Petersburg, FL, USA, Steven E. Lipshultz, Sylvester Comprehensive Cancer Center University of Miami and Miller School of Medicine, Holtz Children's Hospital, University of Miami-Jackson Memorial Medical Center, FL, USA
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.025
Available formats
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Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Cardiac problems
    • By Gul H. Dadlani, Congenital Heart Institute of Florida, All Children's Hospital and University of South Florida, St. Petersburg, FL, USA, Steven E. Lipshultz, Sylvester Comprehensive Cancer Center University of Miami and Miller School of Medicine, Holtz Children's Hospital, University of Miami-Jackson Memorial Medical Center, FL, USA
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.025
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Cardiac problems
    • By Gul H. Dadlani, Congenital Heart Institute of Florida, All Children's Hospital and University of South Florida, St. Petersburg, FL, USA, Steven E. Lipshultz, Sylvester Comprehensive Cancer Center University of Miami and Miller School of Medicine, Holtz Children's Hospital, University of Miami-Jackson Memorial Medical Center, FL, USA
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.025
Available formats
×