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Infective Endocarditis, Device Infections, and Cardiac Manifestations of HIV

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Abstract

Infective endocarditis (IE) is a highly morbid infection with a diversity of clinical presentations and etiologies that is best managed with a multidisciplinary team. Similarly, cardiac device infections are occurring at increasing rates and require a high index of suspicion, careful workup, and a multidisciplinary treatment plan.

HIV-infected patients not on antiretroviral therapy (ART) or with low CD4 cell counts (<200 cells/mm3) are at risk for a broad array of opportunistic conditions (infections and cancers). HIV-infected patients on ART with normal CD4 cell counts are not at risk for opportunistic conditions but have an increased rate of atherosclerosis and cardiovascular events, probably because of ongoing inflammation. Drug interactions with antiretroviral medications should be considered before prescribing commonly used cardiac medications, including statins.

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Abbreviations

Abx:

Antibiotics

AIDS:

Acquired immunodeficiency syndrome

ART:

Antiretroviral therapy

AZT:

Zidovudine

BCx:

Blood cultures

CAD:

Coronary artery disease

CHF:

Congestive HF (Heart Failure)

CIED:

Cardiac implantable electronic devices

CNS:

Central nervous system

CT:

Computed tomography

CVD:

Cardiovascular disease

ECG:

Electrocardiography

HIV:

Human immunodeficiency virus

ICD:

Implantable cardioverter defibrillator

IDU:

Intravenous drug user

IE:

Infective endocarditis

JVP:

Jugular venous pressure

LVAD:

Left ventricular assist device

NSTEMI:

Non-ST elevation myocardial infarction

NVE:

Native valve endocarditis

NYHA:

New York Heart Association

PAH:

Pulmonary arterial hypertension

PCR:

Polymerase chain reaction

PPM:

Permanent pacemaker

PVE:

Prosthetic valve endocarditis

TEE:

Trans-esophageal echocardiography

TIMI:

“Thrombolysis in myocardial infarction” research group

TPN:

Total parenteral nutrition

TTE:

Trans-thoracic echocardiography

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Authors and Affiliations

  1. Harvard Medical School Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Emily P. Hyle MD (Instructor in Medicine), Rocío M. Hurtado MD DTM&H (Instructor in Medicine) & Rajesh TIM Gandhi MD (Associate Professor of Medicine)

  2. Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA

    Rajesh TIM Gandhi MD (Associate Professor of Medicine)

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  1. Emily P. Hyle MD
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  2. Rocío M. Hurtado MD DTM&H
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  1. Cardiology Division Yawkey Building 5B, Room 5850, Massachusetts General Hospital, Boston, Massachusetts, USA

    Hanna K. Gaggin

  2. Cardiology Division Yawkey Building, Suite 5984, Massachusetts General Hospital, Boston, Massachusetts, USA

    James L. Januzzi, Jr.

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Hyle, E.P., Hurtado, R.M., Gandhi, R.T. (2014). Infective Endocarditis, Device Infections, and Cardiac Manifestations of HIV. In: Gaggin, H., Januzzi, Jr., J. (eds) MGH Cardiology Board Review. Springer, London. https://doi.org/10.1007/978-1-4471-4483-0_29

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