Pneumonia is an infection that causes inflammation throughout the body. This can have implications in the form of an increased risk of loose plaque breaking away from blood vessel walls, which can lead to a heart attack or stroke. The relationship between pneumonia and cardiovascular disease is bidirectional: pneumonia increases the risk of heart disease, while a history of heart disease may increase the risk of developing pneumonia. Although long considered the domain of pulmonary infections, pneumonia significantly impairs the cardiovascular system at all levels of severity. Pneumonia also disproportionately affects populations most likely to be at risk for cardiopulmonary events. Recent studies have shown that almost a quarter of adults admitted to hospital with pneumonia experience a major acute cardiac event during their hospitalization, leading to a 60% increase in short-term mortality. These findings highlight the potential for improved patient outcomes as management of cardiac complications of pneumonia improves.
Pneumonia and cardiovascular diseases are among the leading causes of morbidity and mortality worldwide. Community-acquired pneumonia affects more than 5 million adults, leading to more than 1.1 million hospitalizations and more than 60,000 deaths each year in the United States. Cardiovascular disease affects more than 30 million adults each year in the United States, leading to 5 million hospitalizations and more than 300,000 deaths each year. . Likewise, Europe faces comparable disease burdens. Most of these patients suffer from both pneumonia and cardiovascular disease; for example, more than half of older adults hospitalized with pneumonia also have chronic heart disease, a trend that will only increase as the population ages.
Mechanisms linking pneumonia and cardiovascular health
Our current understanding of the cardiovascular response to infections, such as pneumonia, derives primarily from studies of critically ill patients with septic shock. It is characterized by the inability of peripheral blood vessels to contract despite adequate levels of catecholamines and activation of the renin-angiotensin-aldosterone system. The myocardium also exhibits dysfunction, particularly left ventricular dysfunction, with some degree of myocardial injury that may manifest as myocardial infarction or cardiogenic shock.
Vulnerability of patients with pre-existing heart conditions
Patients with pre-existing cardiac conditions are at higher risk of poor prognostic outcomes due to cardiovascular disease following a diagnosis of pneumonia. In cases of severe pneumonia, whether caused by a virus or bacteria in hospitalized patients, comorbid heart disease appears to be a greater mortality factor than risk factors alone, particularly in patients younger than 70 years. There are likely more cardiac complications and myocardial damage associated with preexisting cardiovascular disease. The breakdown of pre-existing heart disease occurs quickly. Proper management of existing cardiovascular diseases can improve the condition of their pneumonia-related conditions. The identification and intervention of possible arrhythmias and myocardial damage is also important in the case of people who already have existing heart problems.
How Pneumonia Causes Inflammation Leading to Cardiovascular Impact
Pneumonia could potentially contribute to myocardial dysfunction through several mechanisms, including through the circulation of inflammatory mediators such as cytokines and endotoxins or through direct infection of cardiac muscle cells by the pneumonia-causing organisms and thus leading to damage. non-ischemic myocardium. Acute myocardial ischemia may occasionally occur and lead to myocardial infarction, heart failure, or arrhythmias.
Preventive measures for people with heart disease
Vaccination may decrease the incidence of pneumonia complicated by heart disease in patients with heart disease, particularly through influenza and pneumococcal vaccines, which patients should be encouraged to receive, especially elderly patients or patients with chronic heart disease. Because more than half of cardiac complications are identified within 24 hours of the onset of pneumonia, it is imperative that healthcare providers carefully assess for cardiovascular complications when patients first present with pneumonia. This includes examining established cardiovascular disease and looking for markers of cardiac damage.
Dr Haresh Shah, Consultant Pulmonologist, Bhailal Amin General Hospital, Vadodara