Bacterial Pneumonia May Lead To A Heart Attack When Pathogens Invade And Kill Muscle Cells
Pneumonia is often described as the old man’s friend because it can provide a peaceful and dignified death to someone who is elderly and suffering from other more serious conditions, such as cancer. However, there is another face to pneumonia, which is cruel and quite literally heartless: in adults of all ages, bacterial pneumonia elevates the risk for cardiac trouble, including heart attacks. Now, a new study from the University of Texas demonstrates exactly how Streptococcus pneumoniae, responsible for most cases of bacterial pneumonia, invades the heart and causes the death of heart muscle cells. Having gained a better understanding of the interaction between pathogen and our hearts, scientists may work toward better treatments and prevention strategies to protect the heart from damage incurred during this illness which affects millions of people each year.
Pneumonia is an inflammation of the lungs usually caused by infection with bacteria, viruses, and other organisms. Simple triggers, such a case of the flu or a simple respiratory infection, may lead to pneumonia when a patient’s defense system is weakened. With antibiotic treatment , most patients improve within a couple of weeks.
Source: Brown AO, Mann B, Gao G, et al. Streptococcus pneumonia Translocates into the Myocardium and Forms Unique Microlesions That Disrupt Cardiac Function. PLOS ONE. 2014.
Case Presentation And Ethical Statement
A 14-year-old male was referred to us from a peripheral hospital, where he had then presented with complaints of cough, bloody sputum, and nausea. At the time, he was afebrile and had no difficulty in breathing. A chest CT-Scan returned typical results. Nonetheless, he was started on a Cefaclor. Four days during treatment, his general condition worsened it was noted that he was febrile with the highest temperature at around 39.0 deg. Celsius, with associated chills. They then added Clindamycin, Brufen, and Ganciclovir to his treatment regimen. A day later, the patient started having trouble breathing, which was worse when lying flat , and he was also noted to be confused. However, despite treatment with now two antibiotics and antiviral coverage, his general condition continued to deteriorate. A repeat chest CT scan was then done, and it showed multilobar pneumonia that was more severe on the left upper lobe. An echocardiogram was also done and showed moderate PH. Due to his worsening clinical state despite all the medical intervention, he was referred to our EICU for admission and further management.
He presented at our EICU with complaints of cough, difficulty in breathing that was worse when lying flat, bloody sputum, fevers and chills, chest pains which were pleuritic in nature, chest tightness, nausea, and decreased urine output. It should be noted that during his presentation, we did not observe any bouts of confusion that were initially stated.
CT-scan of the chest
Pneumonia Risk Soars In Heart Failure Patients Especially Hfpef
FROM JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Patients with heart failure get pneumonia at a rate almost three times greater than expected and, once they do get pneumonia, have about a fourfold greater risk of death, investigators for a retrospective analysis of 13,000 patients from two landmark randomized HF trials have found.
Dr. John J.V. McMurray
The investigators also found that HF patients with preserved ejection fraction are at the highest risk of developing pneumonia. The findings underscore the importance of patients with HF getting a pneumonia vaccination, they found.
The analysis showed that 6.3% of patients in the PARADIGM-HF trial and 10.6% of those in the PARAGON-HF trial developed pneumonia, reported the study authors, led by John J.V. McMurray, MD, of the British Heart Foundation Cardiovascular Research Center at the University of Glasgow in Scotland .
The main reason for doing this study was the fact that many heart failure patients are not vaccinated, as they should be, against pneumonia both pneumococcus and influenza vaccination, Dr. McMurray said in an interview. We wanted to document the frequency and consequences of pneumonia in patients with heart failure to help highlight this deficiency in care.
Dr. McMurray said he believes this is the first study to document the incidence of pneumonia and pneumonia-related outcomes according to the two major ejection fraction phenotypes.
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What Other Problems Can Pneumonia Cause
Sometimes pneumonia can cause serious complications such as:
- Bacteremia, which happens when the bacteria move into the bloodstream. It is serious and can lead to .
- Lung abscesses, which are collections of pus in cavities of the lungs
- Pleural disorders, which are conditions that affect the pleura. The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity.
- Respiratory failure
Data On Hospitalizations For Pneumonia
We identified patients aged at least 15 years of age, with a first-time hospitalization for pneumonia during the three data collection periods, using counties hospital discharge registries merged into a research database, as previously described . The registries contain key information on all patient discharges from non-psychiatric hospitals in the counties since 1977 . Data include patients civil registration numbers, admission and discharge dates, and up to 20 discharge diagnoses coded exclusively by physicians according to the International Classification of Diseases . The ICD-10 codes used for pneumonia hospitalizations were J12-J18, A481, and A709.
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How Is Myocarditis Treated
Treatment for myocarditis usually depends on the cause. It can involve close monitoring and medication, including anti-inflammatory medicines and antibiotics.
In long term cases myocarditis can affect your heart muscle and tissue, meaning you could develop heart failure. If the damage is severe you may need a heart transplant.
Data On Heart Failure
Data on markers for heart failure among study patients were obtained from the counties hospital discharge registries. Heart failure was defined as a previous hospital discharge diagnosis or outpatient diagnosis of congestive heart failure pulmonary edema left ventricular failure unspecified heart failure cardiomyopathy or hypertensive heart disease with congestive heart failure . We considered diagnoses recorded within five years preceding the date of hospitalization for pneumonia . We further disaggregated patients with heart failure into five categories of heart failure-related conditions: 1) cardiomyopathy 2) heart valve disease 3) myocardial infarction , 4) atrial fibrillation only 5) none of the above diagnoses.
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What Is The Best Sleeping Position For Your Heart
If you sleep on your right side, the pressure of your body smashes up against the blood vessels that return to your ticker, but sleeping on your left side with your right side not squished is supposed to potentially increase blood flow back to your heart. And anything you can do to help your most important organ pump
Catecholamine And Sympathetic Nerve
Due to inflammatory response, psychological stress, and other reasons, the catecholamine levels of patients with viral pneumonia would considerable increase and there would be increased activity of sympathetic nerves activity. Previous studies have shown that catecholamines had myocardial toxicity and could cause vasospasm and microcirculation disturbance, which would lead to myocardial damage and induce arrhythmias., In addition, patients with coronary heart disease and/or heart failure showed increased sympathetic activity along with decreased heart rate variability and baroreflex sensitivity. This autonomic dysfunction has been confirmed to increase the mortality of patients with acute myocardial infarction and the complications after cardiac surgery. Sribhutorn et al. found that administration of beta blockers and influenza vaccine had a synergistic effect on improving the prognosis of patients with ACS. Moreover, this protective effect was related to the down-regulation of sympathetic nerve activity.
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What Are The Effects Of Pneumonia On The Lungs
The effects of pneumonia on the lungs involve overproduction of mucus and other fluids, leading to difficulty breathing and inhibiting gas exchange in the lungs, making it harder to supply the body with oxygen. In the long term, pneumonia can be associated with permanent lung damage, putting people at risk of respiratory failure in the future because their lungs are no longer as strong and healthy as they once were. Treating pneumonia early can help limit permanent lung problems.
In patients with pneumonia, an infection becomes active in the lungs. Fungi, bacteria, viruses, and other organisms can all potentially colonize the lungs if someone’s immune system is unable to fight them off. The infection causes the small air sacs in the lungs, known as alveoli, to fill with fluid. It becomes harder to inflate the lungs because the pressure inside the lung is disrupted, people have difficulty breathing, and the oxygen with each breath doesn’t reach as far as it should.
How Is Myocarditis Diagnosed
Sometimes symptoms may go away on their own, so a diagnosis wont be needed.However, if symptoms dont go away you may need tests such as:
- an electrocardiogram to check for an abnormal heart rhythm, if you have experienced palpitations
- a chest X-ray, to check for fluid in or around the heart
- an echocardiogram , if your doctor is concerned there may be heart muscle damage
- blood tests to check for infection.
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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
The Effects Of Pneumonia On The Body
Pneumonia is an infection in one or both lungs. Bacteria and viruses are the most common causes of pneumonia. Fungi can induce pneumonia, too. The infection causes inflammation in the air sacs of the lungs. This results in a buildup of fluid that makes it hard to breathe. Pneumonia can be a medical emergency, especially among high-risk groups like people over 65 and children 5 or younger.
Pneumonia typically affects the lungs, but complications can lead to problems in other areas of the body, too. These can be very serious and even deadly. Your risk, treatment, and recovery time depend on what caused the infection, your age, and any additional health issues you had before getting pneumonia.
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Risk Of Heart Failure After Community Acquired Pneumonia: Prospective Controlled Study With 10 Years Of Follow
- Accepted 11 January 2017
Pneumonia Can Increase Danger To The Heart
Pneumonia is a common lung infection with more than one million people admitted to the hospital for treatment each year, according to the Department of Health and Human Services. And, research published in JAMA found that the risk of cardiovascular disease increases for up to a year following a pneumonia infection.
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. The danger, according to Dr. Harkness, is for people with other cardiac risk factors such as high blood pressure, high cholesterol, diabetes and tobacco use.
The inflammatory response in the body during an infection can increase the risk of a cardiovascular event, but there is some evidence that pneumonia specifically can contribute to plaque breaking off the artery walls and causing a clot which can lead to a heart attack, said Dr. Harkness.
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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 .
Pathophysiology Of Hypoxia And Ph
Respiratory failure secondary to hypoxia is usually a result of two main mechanisms. The first one being that during inflammation, the alveoli are filled with inflammatory exudate. The inflammatory exudate reduces the available surface area of the alveoli that are used in gas exchange . The second mechanism is through V/Q mismatch . The V/Q ratio is the amount of air reaching the alveoli per minute to the amount of blood reaching the alveoli from the capillaries per minute. Perfusion within the lung is affected by subatmospheric intrapleural pressure and gravity as a result, perfusion is higher at the lower lobes than at the peak of the lungs. These differences have a significant impact on the V/Q ratio-the V/Q ratio is higher on the apex of the lung than on the base of the lung . If the lung is taken as a whole, the mean V/Q ratio is around 0.8. During the acute phase of pneumonia, the pulmonary vascular system continues to maintain blood flow to the affected regions of the lung, and this causes an intrapulmonary shunt . In such cases, if there is a low V/Q ratio, it causes a decrease in the PAO2 which later causes a decrease in the PaO2 causing hypoxemia.
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Pleural Effusions Empyema And Pleurisy
There are two layers of tissue surrounding your lungs called the pleura. One wraps around the outside of your lungs and the other lines the part of your chest where your lungs sit. They help your lungs move smoothly when you breathe.
If your pneumonia isn’t treated, the pleura can get swollen, creating a sharp pain when you breathe in. If you don’t treat the swelling, the area between the pleura may fill with fluid, which is called a pleural effusion.
If the fluid gets infected, it leads to a problem called empyema. Tell your doctor if you are having any of these symptoms:
- Hard time breathing
- You don’t want to breathe deeply because it hurts
Your doctor may look for swelling or fluid with an X-ray, ultrasound, or CT scan. They might also give you an electrocardiogram to make sure that a heart problem isn’t the cause of your chest pain.
If you do have pleurisy, you may need medications that can stop the swelling.
For pleural effusions and empyema, your doctor may suggest a procedure that removes fluid from your body with a needle. Antibiotics are also an option to treat empyema.
Cardiovascular Complication After Cap
Involvement of the cardiovascular system after developing CAP is as an important short- and long-term co-morbidity., Corrales-Medina et al. performed a systematic review and meta-analysis of observational studies, and found that CC occurred in 18% of CAP patients. Most of the studies showed that the rate of CC is higher among hospitalized patients than outpatients.
Several risk factors are associated with the development of CC in patients with pneumonia. The strongest associated risk factor is preexistent CVD preceding the pneumonia event. Patients with CAP older than 65âyears tend to have higher rates of co-morbidities. The most common co-morbidities include chronic obstructive pulmonary disease , ischaemic heart disease, congestive heart failure, diabetes and stroke. However, all these conditions seem to be overrepresented among hosts with compromised immunological status, potentially leading to poor clinical outcomes. In addition, many of these co-morbidities are associated with poor functional and disability status, usually requiring admission to long-term care facilities.,
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Take Steps To Protect Yourself And Others
The following steps can help you prevent spreading the infection to others around you.
- Cover your nose and mouth while coughing or sneezing.
- Get rid of used tissues right away.
- Limit contact with family and friends.
- Wash your hands often, especially after coughing and sneezing.
Some people get pneumonia again and again. Tell your doctor if this happens. Return to Prevention to find more strategies to help prevent pneumonia.
Conclusions And Future Directions
It is widely recognised that pneumonia in young children causes a considerable worldwide burden of mortality and short-term morbidity in survivors. What is less well known is that infectious insults to the rapidly growing and still developing lungs in the first 13 years of life are independently associated with an increased risk of impaired lung function in adulthood. The risks appear greatest for those whose illness is of sufficient severity to warrant treatment in hospital. The long-term effects associated with early childhood pneumonia include restrictive or obstructive lung function deficits and an increased risk of adult asthma, non-smoking related COPD, and bronchiectasis. The studies underpinning these observations do however have important limitations. They are a mixture of prospective and retrospective studies, involving both community- and hospital-based populations experiencing illness of varying severity, with incomplete follow-up and opportunities for sampling and recall bias, and diagnostic misclassification of bronchitis, bronchiolitis, viral-induced wheezing and asthma as pneumonia. Most important of all is that most studies do not have prior lung function data for their pneumonia cases and subsequent impairments in lung function might simply reflect pre-existing abnormalities in already susceptible infants and young children.
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