An Inflammatory Response: Cardiovascular Complications Of Pneumonia
Each year, community-acquired pneumonia affects an estimated 5 to 6 million Americans and leads to 60,000 deaths.1 In addition to its respiratory effects, CAP and other acute infections can cause or exacerbate cardiovascular complications through various mechanisms. A systematic review and meta-analysis published in 2011 reported that 18% of patients with CAP developed CV complications within 30 days of CAP diagnosis, with higher rates found in hospitalized patients compared with outpatients.2
The strongest risk factor for CV complications in patients with pneumonia is pre-existing CVD, which is present in more than half of elderly patients hospitalized for CAP.3,4 The risk of developing CAP is up to 3 times greater in individuals with chronic CVD, especially heart failure, and those individuals with cerebrovascular disease have twice the risk for CAP.5
Although the precise mechanisms by which CAP may trigger CV complications have not been identified, it has been proposed that many CV complications result from the interactions between demographic characteristics of the patients , pneumonia severity and host reactions to the infection of the lower respiratory tract, wrote the authors of a recent review published in Respirology.2,6Once pneumonia is established, the host remains in a relative hypoxaemic state secondary to alveolar consolidation that affects the normal ventilation/perfusionhomeostasis.
Arrhythmias
Heart Failure
Antibiotics
Pneumonia And Heart Disease Go Together
Abigail Zuger, MD
New research confirms the old association.
Summary
The association between pneumonia and acute cardiac events was of considerable clinical interest in the early 20th century . Houston researchers have reassessed the association using today’s more precise diagnostic tools.
Of 170 patients with culture-confirmed pneumococcal pneumonia treated from 2001 through 2005 at a single Veterans Affairs hospital, 33 presented with 46 acute cardiac problems on admission: MI was diagnosed in 12 , a new arrhythmia in 10 , and new or worsening congestive heart failure in 24 . Thirty-one of the 33 patients had severe pneumonia. Mortality rates varied from 40% in MI patients to 0% in those with new arrhythmias the overall mortality rate of 27% in pneumonia patients with cardiac complications contrasted with the 9% mortality rate in those without.
Interestingly, all 12 patients with acute MI had at least two cardiac risks, but in 8 patients, these risks had not been identified before admission.
Acute bacterial pneumonia might be considered nature’s little stress test. Although this study doesn’t prove a causal relation, it makes sense that pneumonia might worsen preexisting cardiac problems and bring new ones to light. Here’s yet another reason to endorse the pneumococcal vaccine: It also may reduce the likelihood of cardiac decompensation.
Abigail Zuger, MD
The Role Of Platelets
Mirsaeidi et al. , recognising that platelets were inflammatory cells that played an important role in host antimicrobial defences, undertook a study to evaluate the association between abnormalities of the platelet count and 30-day mortality in patients with CAP. These investigators documented that the occurrence of either thrombocytopaenia or thrombocytosis were associated with in-hospital mortality in patients with CAP and that these abnormalities of the platelet count were better predictors of outcome than similar abnormalities of the leukocyte count.
Recent and novel insights into the pathogenesis of CAP-associated CVEs have been provided by the findings reported in a study by Cangemi et al. . This study, which did not distinguish between viral and bacterial CAP, confirmed the high risk for development of myocardial infarction, which peaked within 2 days of hospitalisation. Notwithstanding disease severity and heart ejection fraction, significant predictors of myocardial infarction included elevated concentrations of the circulating biomarkers of platelet activation, soluble CD40 ligand, P-selectin and thromboxane B2 , as well as the mean platelet volume . The contention that platelet activation plays a pivotal role in orchestrating inflammatory events which trigger, or more likely exacerbate, vascular damage and dysfunction is supported by the steadily increasing recognition of the critical role played by these cells in mediating inflammatory and immune responses .
Read Also: Is Wheezing A Symptom Of Pneumonia
Medications Used To Treat Congestive Heart Failure
Treatment of congestive heart failure also includes medications. Doctors prescribe medicine to manage symptoms and to make it easier for the heart to function, which will improve symptoms and reduce the risk of complications.
Medications include:
- Angiotensin-converting enzyme inhibitors , which lower blood pressure and reduce strain on the heart
- Angiotensin-II receptor blockers , which are an alternative to lower blood pressure for those who canât tolerate ACE inhibitors. Examples include losartan and valsartan .
- Combination valsartan-sacubitril , which is used in place of an ARB or ACE inhibitor
- Aldosterone blockers , which may be used for severe congestive heart failure
- Anticoagulants , which prevent the formation of blood clots that can lead to and stroke
- Beta-blockers , which lower blood pressure, control heart rate, and reduce strain on the heart
- Cholesterol-lowering medications , which can reduce the risk of heart attack and . Cholesterol-lowering medications also reduce the risk of recurrent heart attack and stroke.
- Digitalis drugs , which slow and strengthen the beating of the heart to make the heart muscle more effective in pumping blood
- Diuretics , which pull excess fluid out of the lungs and tissues of the body by increasing urine production
Bacteremia And Septic Shock
If bacteria caused your pneumonia, they could get into your blood, especially if you didnt see a doctor for treatment. Its a problem called bacteremia.
Bacteremia can lead to a serious situation known as . Its a reaction to the infection in your blood, and it can cause your blood pressure to drop to a dangerous level.
When your blood pressure is too low, your heart may not be able to pump enough blood to your organs, and they can stop working. Get medical help right away if you notice symptoms like:
Your doctor can test your mucus or the pus in your lungs to look for infection. They may also take an X-ray or a CT scan of your lungs.
Your doctor will likely treat your lung abscesses with antibiotics. They may do a procedure that uses a needle to remove the pus.
Recommended Reading: Pneumonia And Lung Cancer Survival Rate
Hypertension Or High Blood Pressure
Another cause of congestive heart failure is high blood pressure or hypertension. If you have high blood pressure, your heart muscle works extra hard to pump blood through your body.
As time passes, because of the overexertion, the muscles in your heart can become too weak or too stiff to properly circulate blood to your body. If you have high blood pressure, your heart muscle workextra hard to pump blood through your body.
Can Pneumonia Cause Cardiomyopathy
An acute infection like pneumonia increases the stress on the heart and can lead to a cardiac event like heart failure, heart attack or arrhythmias, said Weston Harkness, DO, a cardiology fellow at Samaritan Cardiology Corvallis. For a healthy person, a case of pneumonia is very unlikely to lead to a cardiac event.
You May Like: Does The Pneumonia Vaccine Protect Against Viral Pneumonia
How Does Heart Failure Affect Quality Of Life And Lifestyle
With the right care and treatment plan, heart failure may limit your activities, but many adults still enjoy life. How well you feel depends on how well your heart muscle is working, your symptoms and how well you respond to and follow your treatment plan. This includes caring for yourself and living a healthy lifestyle .
Because heart failure is a chronic long-term illness, talk to your doctor and your family about your preferences for medical care. You can complete an advance directive or living will to let everyone involved in your care know your desires. A living will details the treatments you do or dont want to prolong your life. It is a good idea to prepare a living will while you are well in case you arent able to make these decisions at a later time.
Reviewed by a Cleveland Clinic medical professional.
References
Pneumonia As A Cardiovascular Disease
Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
Department of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
Luis F. Reyes
Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
Department of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
Department of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
Luis F. Reyes
Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
Department of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
Recommended Reading: How Serious Is Septic Pneumonia
If You’re Over 65 Be Sure To Follow The Latest Pneumonia Vaccine Guidelines
Each year, about a million people in the United States end up in the hospital with pneumonia, a serious lung infection that can be caused by an array of different viruses, bacteria, and even fungi. New research suggests that older people hospitalized with pneumonia face four times their usual risk of a having a heart attack or stroke or dying of heart disease in the month following the illness.
The risk declines over the following year, according to the report, published in the Jan. 20, 2015, Journal of the American Medical Association. Infections put added stress on your heart, forcing it to work harder. Your body’s efforts to fight the infection also trigger unhealthy changes inside your arteries, such as releasing chemicals that can make blood more likely to clot, which can lead to a heart attack or stroke.
“Serious infections like pneumonia are linked to a higher risk of heart attack as well as worsening heart failure in people with that condition,” says Dr. Scott Solomon, a professor of medicine at Harvard Medical School. For older people, the pneumonia vaccine may help prevent these dangerous complications, but an annual flu shot is also important, he notes. The same virus that causes the flu can also cause viral pneumonia in some people and nudge others to develop bacterial pneumonia.
What Is Congestive Heart Failure
Heart failure describes the inability or failure of the heart to meet the needs of organs and tissues for oxygen and nutrients. This decrease in cardiac output, the amount of blood that the heart pumps, is not adequate to circulate the blood returning to the heart from the body and lungs, causing the fluid to leak from capillary blood vessels. This leads to symptoms that may include shortness of breath, weakness, and swelling.
Understanding blood flow in the heart and body
The right side of the heart pumps blood to the lungs while the left side pumps blood to the rest of the body. Blood from the body enters the right atrium through the vena cava. It then flows into the right ventricle where it is pumped to the lungs through the pulmonary artery, which carries deoxygenated blood to the lungs. In the lungs, oxygen is loaded onto red blood cells and returns to the left atrium of the heart via the pulmonary veins. Blood then flows into the left ventricle where it is pumped to the organs and tissues of the body. Oxygen is downloaded from red blood cells into the various organs while carbon dioxide, a waste product of metabolism, is added to be removed in the lungs. Blood then returns to the right atrium to start the cycle again. The pulmonary veins are unusual in that they carry oxygenated blood, while the pulmonary artery carries deoxygenated blood. This is a reversal of duties versus the roles of veins and arteries in the rest of the body.
Read Also: If You Have Pneumonia Are You Contagious
What Is The Connection Between Congestive Heart Failure
Congestive heart failure often leads to pneumonia because it leads to buildup of fluids in the lung. The build up can result in infection which can then cause pneumonia if it’s not treated quickly. My grandfather experienced this. He had congestive heart disease and then, he also developed pneumonia. He was in the hospital for a long time.
Congestive Heart Failure Stages Of Dying
The congestive heart failure stages of dying are as follows: Dyspnea. Chronic cough or wheezing. Severe edema. Nausea. Lack of appetite. High heart rate. Confusion or impaired thinking. Unfortunately, congestive heart failure stages of dying are difficult to observe a loved one go through, but with the outlook of this chronic disease, death of …
Read Also: Is The Pneumonia Vaccine A Live Virus
Left Ventricular Dysfunction And Reversible Pulmonary Hypertension Secondary To Severe Pneumonia In A Background Of Sepsis: A Case Report And Review Of The Literature
Elaine N. Gitonga1, Junwu Wang1, Shengwei Yu1, Na Wu2, Haitao Shen1
1Department of Emergency Medicine, Shengjing Hospital of China Medical University , Shengjing Hospital of China Medical University , , China
Correspondence to:
Keywords: Pulmonary hypertension severe pneumonia sepsis sepsis-induced cardiomyopathy left ventricular dysfunction
Submitted Apr 21, 2020. Accepted for publication Sep 08, 2020.
doi: 10.21037/apm-20-1198
Read Also: How Old To Get Pneumonia Vaccine
Cap And Acute Cardiac Events
Seedat and colleagues undertook one of the first studies investigating acute cardiac events in hospitalised patients with acute CAP. The authors prospectively studied consecutive patients with CAP who had no prior or underlying cardiorespiratory illnesses. In addition to recording demographic, clinical, microbiological, laboratory, and outcome data, they also performed electrocardiographic and echocardiographic investigations and measured serum enzyme, including cardiac enzyme levels . A number of ECG changes were documented, which returned to normal after a mean of 2 days in survivors. The so-called S1, Q3, T3 pattern on ECG was associated with CK-MB leak, hypoxia and a high Simplified Acute Physiology Score . The presence of P pulmonale, right axis deviation and clockwise rotation correlated with hypoxia and high SAPS score. Clockwise rotation also correlated with raised serum LDH and CK-MB levels and high pulmonary artery pressures. The overall patient mortality was 10.8 % and a number of negative prognostic factors were documented. While there was no association between the ECG changes and mortality, raised LDH, CK and CK-MB levels correlated, among other factors, with need for intensive care unit admission and mortality.
Also Check: Is There A Cure For Pneumonia
Pneumonia And Cardiovascular Complications
Pneumonia is a disease affecting the lung parenchyma causing inflammation of the alveoli leading to inflammatory exudate filling the alveolar spaces. The main causative agents are bacteria, fungi, and viral agents despite the respiratory tract being always in contact with air that has hundreds to thousands of microorganisms per cubic meter, it is well adapted to defend our bodies from any virulent organism . Nonetheless, in a case where the host defenses fail, and a virulent factor penetrates through our protective mechanisms, and get to the lung, the inflammatory reaction triggered by the macrophages within the lungs cause histopathological changes within the lung itself and in turn affects the functionality of the lungs leading to hypoxia, and if left untreated may lead to respiratory failure . Despite respiratory failure due to hypoxemia being one of the most commonly noted complications of pneumonia, pneumonia has also been found to cause other cardiovascular complications or worsening of preexisting cardiac conditions .
How Pulmonary Edema Happens In Case Of Congestive Heart Failure
Congestive Heart failure gives rise to pulmonary edema. The initial stage of congestive heart failure may not be that problematic for lungs, but when the heart is unable to pump blood properly and insufficiently to the whole part of the body for a long term, the blood starts backing up in the veins which carry blood through the lungs. With the increase in the pressure, the blood in these vessels leak and the fluid is pushed in the alveoli or the air sacs of the lungs. As the heart failure worsens and slowly fluid starts accumulating in lungs. The fluid accumulates in the other parts of the body and produces edema especially in the legs, ankles and feet.
To prevent pulmonary edema, it is important to check, diagnose and correct the congestive heart failure diseases, if it is present. Below are few symptoms which are indicative of a Congestive Heart Failure:
- Impaired thinking, delirium and confusion.
- Appetite loss.
- Tiredness, fatigue.
If these occur, it is important to get it diagnosed and treated on proper time or else it can be fatal in the near future. Fortunately there are improvements and advancements in the treatment of congestive heart failure, but only 50% of the patients will have an average expectancy of about five years or less. Those who have serious CHF have more risk of life and 90% of patients may die within one year.
Don’t Miss: How Long Is The Pneumonia Vaccine Last
Why Its Important To Know Your Ef
If you have a heart condition, it is important for you and your doctor to know your EF. Your EF can help your doctor determine the best course of treatment for you. Measuring your EF also helps your healthcare team check how well our treatment is working.
Ask your doctor how often you should have your EF checked. In general, you should have your EF measured when you are first diagnosed with a heart condition, and as needed when your condition changes.
Also Check: How Do I Cure Pneumonia
What Are The Stages Of Heart Failure
Heart failure is a chronic long-term condition that gets worse with time. There are four stages of heart failure . The stages range from âhigh risk of developing heart failureâ to âadvanced heart failure,â and provide treatment plans. Ask your healthcare provider what stage of heart failure you are in. These stages are different from the New York Heart Association clinical classifications of heart failure that reflect the severity of symptoms or functional limits due to heart failure.
As the condition gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. You cannot go backwards through the stages. For example, if you are in Stage B, you cannot be in Stage A again. The goal of treatment is to keep you from progressing through the stages or to slow down the progression.
Treatment at each stage of heart failure may involve changes to medications, lifestyle behaviors and cardiac devices. You can compare your treatment plan with those listed for each stage of heart failure. The treatments listed are based on current treatment guidelines. The table outlines a basic plan of care that may apply to you. If you have any questions about any part of your treatment plan, ask a member of your healthcare team.
Read Also: Apple Watch Heart Rate Monitor Accuracy
Read Also: Is Nausea A Sign Of Pneumonia