Cardiac Dysfunction in Active Pulmonary Tuberculosis: Double Trouble!!

Abstract

Methods: Prospective observational and interventional study conducted during July 2013 to December 2018, included 600 case of active pulmonary tuberculosis confirmed microscopically or with Gene Xpert MTB/RIF. Cases with known risk factor for cardiac disease and taking cardiac medicines, were excluded from study. Disproportionate tachycardia and tachypnea with or without shock and hypoxemia were key entry point criteria in this study. Statistical analysis were carried out by chi-square test.

Observations and Analysis: Cardiac dysfunction were documented in 26% cases, females were 44%; and 56% cases were having age>65 years. Echocardiography abnormality were documented as global hypokinesia in 62% cases, depressed left ventricular systolic and diastolic function in 44% & 28 % cases respectively, dilated right atrium and right ventricle in 32% cases, and pulmonary hypertension in 6% cases. Hypoxemia has significant association with right and left heart dysfunction (p<0.00001). Cachexia, anemia, Hypoalbuminemia and lower serum cortisol level was documented to have significant association with cardiac dysfunction (p<0.00001).Treatment outcome shows significant improvement in cardiac function (p<0.00001).

Conclusion: Cardiac dysfunction in active pulmonary tuberculosis is underestimated and less evaluated routinely; disproportionate tachycardia and tachypnea with or without shock are clinical indicators to suspect early, especially in cases with risk factors like advanced pulmonary TB on chest radiograph, cachexia with BMI<18, advanced age, females, cases with anemia and hypoalbuminemia and lower serum cortisol levels. Global hypokinesia is predominant reversible echocardiography abnormality documented.