Cardiac dysfunction in patients with community-acquired pneumonia

• Main Authors: El-Saied Shaheen, Ehab Elmelegy, Wael Hossam El Din
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Journal of Medicine in Scientific Research
• Subjects: arrhythmia; heart failure; myocardial infarction; pneumonia
• Online Access: http://www.jmsr.eg.net/article.asp?issn=2537-091X;year=2019;volume=2;issue=3;spage=209;epage=213;aulast=Shaheen

Background Community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality worldwide especially in the elderly. Evidence shows a high correlation between acute respiratory infections and increased risk of cardiovascular events (CVEs). The occurrence of CVE in hospitalized patients with CAP may significantly affect the clinical status, and a severe CVE could be the primary cause of clinical failure. Aim To study the incidence of cardiac complications in patients with CAP. Patients and methods This clinical study was carried out on 120 patients (63 males and 57 females) hospitalized with a primary diagnosis of CAP. Patients with the presence of an alternative diagnosis that likely explained the pulmonary symptoms and radiographic infiltrate (e.g. lung carcinoma, pulmonary edema, or pulmonary embolus) were excluded. All patients were subjected to complete medical history, general and local chest examination, laboratory investigations, complete blood count, liver function tests, serum electrolytes, blood glucose, arterial blood gases, and serum troponin I. For microbial etiology, at least two sets of separate blood and sputum samples of each patient were gram stained and cultured. Radiological investigations (plain radiography and computed tomography on the chest), ECG, and echocardiography were also done. Results Among the studied 120 patients, 30 (25%) patients had a cardiac complication, such as new or worsening heart failure (12.5%), new arrhythmia (9.2%), and acute myocardial infarction in 3.3%. Patients who developed cardiac complication had significantly higher percentage of blood urea nitrogen (more than or equal to 30 mg/dl), hematocrit less than 30%, sodium less than 130 mm/l, pH less than 7.35, and PaO2 less than 60 and/or O2 saturation less than 90 mmHg than patients without cardiac complication. Regarding the outcome of the studied patients, patients who developed cardiac complication had a significantly higher percentage of patients who needed mechanical ventilation, needed inotropes and vasopressors, had higher occurrence of an acute renal failure, had prolonged hospital stays, and had higher mortality than patients without cardiac complication. Conclusion Incident cardiac complications are common in patients with CAP and are associated with increased mortality, acute renal failure, prolonged hospital stay, and need for mechanical ventilation. Further studies are required to test risk stratification and prevention and treatment strategies for cardiac complications in this population.