Patients infected with the human immunodeficiency virus
(HIV) have an increased risk of developing heart disease. Among the most common
heart problems associated with HIV are pericarditis (inflamed sac surrounding
the heart), endocarditis (infection of the lining inside the heart), cancer
that affects the heart, pulmonary high blood pressure, and coronary artery
There are many reasons why HIV patients may have an
increased risk of developing heart disease. Since HIV attacks the body's immune
system, patients are vulnerable to infections that may spread to the heart and
cause disease. Also, some HIV medications may cause conditions such as
dyslipidemia (high levels of fat in the blood), diabetes, or metabolic
syndrome, which are risk factors for heart disease.
In addition, conditions unrelated to HIV, such as obesity,
smoking, and family history of heart disease, may predispose patients to heart
Treatment for heart disease varies depending on the type and
severity of the specific condition. Because most cases of heart disease in HIV
patients are associated with infections, antimicrobials are a common treatment.
Antibiotics are used to treat bacterial infections, antifungals are used to
treat fungal infections, and antivirals are used to treat viral infections.
Patients can reduce their risks of heart disease by
exercising, eating healthfully, and not smoking. HIV patients should also
receive a combination of antiretrovirals called highly active antiretroviral
therapy (HAART). This therapy suppresses HIV and boosts the immune system,
making the patient less vulnerable to infections.
Since HIV patients have weakened immune systems, they have
an increased risk of developing cancers that may spread to the heart. This is
because they have fewer immune cells, which are the body's first line of
defense against cancerous cells. There have been reports of HIV/AIDS patients
who developed Kaposi's sarcoma and non-Hodgkin's lymphoma that involved the
Kaposi's sarcoma is a cancer that develops in connective
tissues, such as bone, cartilage, fat, blood vessels, muscle, or tissues
related to tendons or ligaments. A herpes virus called human herpes virus 8
(HHV-8) has been shown to cause AIDS-related Kaposi's sarcoma.
In rare cases, Kaposi's sarcoma may spread to the heart. If
this happens, most patients do not experience functional problems with the
heart. In fact, Kaposi's sarcoma that has spread to the heart is rarely
diagnosed because patients do not usually experience symptoms that suggest the
heart has cancer. Most of these cases are identified during an autopsy, after a
patient has died.
Lymphoma describes a group of cancers that affect the
lymphatic system, which is part of the body's immune defense system.
Non-Hodgkin's lymphoma affects about 20% of HIV/AIDS patients and it has been
associated with the Epstein-Barr virus or hepatitis. In rare cases, this type
of cancer may spread to the heart.
AIDS-related cancer that spreads to the heart has become
uncommon since the introduction of highly active antiretroviral therapy
(HAART). This therapy is a combination of anti-HIV drugs (antiretrovirals) that
suppress HIV and boost the body's immune system. Patients receiving HAART are
less likely to develop infections associated with these cancers.
HIV patients have an increased risk of developing coronary
artery disease (CAD), also called coronary heart disease (CHD). CAD occurs when
the blood vessels that supply oxygenated blood to the heart muscle (coronary
arteries) gradually become narrowed or blocked by plaque deposits. Plaque is
combination of fatty material, calcium, scar tissue, and proteins.
Plaque build up in the arteries is associated with several
risk factors, including high cholesterol and low-density lipoprotein (LDL)
levels in the blood, low levels of high-density lipoprotein (HDL), high blood
pressure, smoking, diabetes mellitus, obesity, age, family history of heart
disease, sedentary or inactive lifestyle, stress, and male gender.
The plaque deposits decrease the space through which blood
can flow. As platelets (disc-shaped particles in the blood that aid clotting)
come to the area, blood clots form around the plaque, causing the artery to
narrow even more.
Sometimes the blood clot breaks apart, and blood supply is
restored. In other cases, the blood clot may completely block the blood supply
to the heart muscle. This lack of blood flow (called ischemia) can
"starve" some of the heart muscle of oxygen and lead to chest pain
(angina). A heart attack, also known as a myocardial infarction, results when
blood flow is completely blocked. Heart attacks usually happen when a blood
clot forms over a plaque that has ruptured.
It remains unknown exactly why HIV patients are more likely
to develop CAD than HIV-negative patients. Researchers are investigating
whether HIV treatment or HIV itself plays a role. Some studies suggest that
patients who take antiretrovirals called protease inhibitors have an increased
risk of heart attacks.
Common symptoms of CAD include chest pain, shortness of
breath, irregular or fast heartbeat, weakness or dizziness, nausea, and increased
The standard diagnostic procedure for CAD is a carotid
ultrasonography. This procedure evaluates blood flow using a wand-like device,
called a transducer. The transducer sends high-frequency sound waves into the
neck to determine if there is any narrowing or clotting in the arteries.
Drugs used to treat CAD include platelet inhibitors such as
aspirin or clogidogrel (Plavix©); beta blockers such as metoprolol (Lopressor©
or Toprol©); calcium channel blockers such as amlodipine (Norvasc©) or diltiazem
(Cardizem©); angiotensin inhibiting drugs or ACE inhibitors such as lisinopril
(Prinivil© or Zestril©) or ramipril (Altace©); statins; or HMG-CoA reductase
inhibitors such as atorvastatin (Lipitor©) or lovastatin (Mevacor©).
Arteries that are severely blocked may need to be expanded
using angioplasty and stent placement. This procedure involves using a wire
mesh that expands in the blood vessel, allowing more blood to flow normally. A
specialized doctor called a cardiologist performs these procedures at a
hospital. A tube or catheter is inserted into a blood vessel. Several types of
balloons, stents, and/or catheters are available to treat the plaque inside the
vessel. Some of these surgical tools contain anti-clotting medications. The
physician chooses the type of procedure based on individual patient needs.
Coronary artery bypass graft (CABG) surgery is when one or
more blocked blood vessels is bypassed by a graft (transplant of healthy
arteries or veins) to restore normal blood flow to the heart. These grafts
usually come from the patient's own arteries and veins located in the chest,
leg, or arm. The graft goes around the clogged artery to create new pathways
for oxygen-rich blood to flow to the heart. Some problems associated with CABG
include a heart attack, stroke, blood clots, death, and sternal wound infection.
Infection is most often associated with obesity, diabetes, or having had a
previous CABG. Some patients may develop post-pericardiotomy syndrome a few
days to six months after surgery. Symptoms typically include fever and chest
pain. The incision in the chest or the graft site may be itchy, sore, numb, or
bruised after surgery. Some patients report memory loss or loss of mental
clarity after a CABG.
Some HIV patients may develop endocarditis, which occurs
when the inner lining of the heart is infected. The infection starts in the
bloodstream and spreads to the heart. Since HIV patients have weakened immune
systems, they are more susceptible to developing infections that cause
Bacteria cause most cases of endocarditis, but viruses,
fungi, and other microorganisms can also lead to the condition. There have been
reports of a fungus called Candida albicans causing endocarditis. Candida
albicans is present in the mouth and gut. Healthy individuals are able to
prevent the fungus from multiplying and causing an infection called
candidiasis. Since HIV patients have weakened immune systems, the fungus may
grow uncontrollably and can potentially spread to the heart, causing
Common symptoms include fever, chills, fatigue, weakness,
aching muscles and joints, shortness of breath, night sweats, pale complexion,
persistent cough, blood in urine, unexplained weight loss, tenderness in the
spleen, new heart murmur (abnormal sound of the heart that can be heard with a
stethoscope), and swelling in the legs or abdomen. Some patients may develop
tender, red spots under the skin of the fingers (called Osler's nodes). Some
may also experience tiny purple or red spots on the skin called petechiae.
Similar spots may be present in the whites of the eyes or under the
Several tests, including blood tests, echocardiograms, and a
chest X-ray, may be necessary to confirm a diagnosis. Blood tests may reveal
low levels of iron in the blood, called anemia. This condition is characteristic
of endocarditis. Because endocarditis can make it harder for the heart to pump
blood, an X-ray may reveal blood and fluid backed up in the lungs. An
echocardiogram uses sound waves to produce images of the heart. Patients with
endocarditis may have abnormal thickening or leakage of heart valves or
abnormal growths that contain collections of bacteria.
Left untreated, endocarditis can damage the heart valves and
permanently damage the lining of the heart. If the heart suffers from permanent
damage, it may lead to heart failure, which is fatal. However, most patients
who are diagnosed and treated promptly experience a full recovery. Patients
receive intravenous (IV) antibiotics to treat the infection. The type of
antibiotic and duration of treatment depends on the type and severity of the
infection, as well as the patient's overall health.
Pericarditis is a possible complication of HIV/AIDS.
Pericarditis occurs when the sac-like membrane that surrounds the heart becomes
inflamed. Symptoms may include chest pain, shortness of breath, fever, fatigue,
dry cough, and swollen legs and/or abdomen.
Pericarditis is usually caused by an infection such as
staphylococcus, tuberculosis, or herpes simplex that spreads to the heart.
Patients with pericarditis may also have pleural effusions,
which occur when the membrane that surrounds the heart fills with fluid.
Research suggests that the six-month survival rate of AIDS patients who have
pericarditis with pleural effusions is 36%, compared to 93% of AIDS patients
who have pericarditis without pleural effusions.
During a physical examination, a healthcare provider listens
to the patient's heart. When the sac around the heart is inflamed, it will make
a distinct noise when it rubs against the outer layer of the heart. If abnormal
sounds are present, a chest X-ray is warranted. Pericarditis is diagnosed after
a chest X-ray reveals inflammation around the heart.
Treatment of pericarditis depends on the underlying cause.
If an infection is causing the inflammation, patients will receive antibiotics.
The specific medication and duration of treatment depends on the type and
severity of the infection, as well as the patient's overall health. If the
patient also has pleural effusions, the fluid will need to be drained at a
hospital. During the procedure, called pericardiocentesis, a healthcare
provider will administer a local anesthetic to numb the patient's chest. Then,
a thin needle is inserted into the heart and fluid is removed. This treatment
may last several days during the course of the patient's hospitalization.
PULMONARY HIGH BLOOD
Pulmonary high blood pressure is common among patients who
have advanced HIV disease. This condition occurs when the arteries in the lungs
become narrowed or blocked. As a result, there is an increased pressure of
blood moving into the lungs and the heart has to work harder to pump blood to
It remains unknown exactly why HIV patients have an
increased risk of developing pulmonary high blood pressure. However, many HIV
patients with the condition have other known risk factors, such as intravenous
drug abuse or chronic liver disease (such as hepatitis).
Common symptoms of pulmonary high blood pressure include
shortness of breath, fatigue, dizziness, chest pressure or pain, bluish colored
lips and skin, increased heartbeat, and swelling of the ankles, legs, and
According to one Swiss cohort study, pulmonary artery
pressure increased in HIV patients who were not receiving antiretrovirals and
it decreased in patients who were receiving antiretrovirals. Therefore, HIV
patients with pulmonary high blood pressure should begin antiretroviral therapy
if they are not already receiving it.
In addition to antiretrovirals, patients may receive
diuretics, blood vessel dilators such as prostacyclin, endothelin receptor
antagonists, such as bosentan (Tracleer©), high-dose calcium channel blockers
such as amlodipine (Norvasc©), and anticoagulants such as warfarin (Coumadin©).
Some patients may also receive supplemental oxygen. Patients who have severe
pulmonary high blood pressure and do not respond to other treatments may need a
heart or lung transplant.
Diabetes control: Managing diabetes with diet, exercise,
weight control, and medication is essential. Strict control of blood sugar may
reduce damage to the heart.
Exercise: Regular exercise may help reduce the risk of heart
disease. According to the American Heart Association, patients should engage in
30-60 minutes of exercise at 50-80% aerobic capacity, at least three or four
days per week.
Healthy diet: Eating a healthy and well-balanced diet may
also reduce the risk of heart disease. In 2005, in an effort to help Americans
live healthier, the U.S. government issued a revised food pyramid with which
patients can determine their daily calorie and exercise needs.
The US Food and Drug Administration (FDA) has announced that
whole grain barley and barley-containing products are allowed to claim that
they reduce the risk of coronary artery disease.
Highly active antiretroviral therapy (HAART): Since some
infections and cancers can spread to the heart, patients should receive a
combination of anti-HIV medications called highly active antiretroviral therapy
(HAART). This therapy suppresses HIV and boosts the body's immune system. This
therapy helps prevent infections, including those that may cause heart disease.
Patients should take medications exactly as prescribed to ensure that the drugs
Monitor lipid levels: Patients taking protease inhibitors
have an increased risk of developing dyslipidemia (high levels of fat in the
blood) as a side effect. Since dyslipidemia is a risk factor for heart disease,
patients who are taking protease inhibitors should undergo regular blood tests
to monitor their levels of fat in the blood.
Smoking cessation: Patients should not smoke because it
increases the risk of developing heart disease.
Stress management: Stress can cause an increase in blood
pressure along with increasing the blood's tendency to clot. Managing stress
can be vital to keeping a heart healthy.
Weight control: Being overweight contributes to other risk
factors for stroke, such as high blood pressure, cardiovascular disease, and
diabetes. Weight loss of as little as 10 pounds may lower blood pressure and
improve cholesterol levels.
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Natural Standard (www.naturalstandard.com)