Symptomatic cardiac dysfunction in children with human immunodeficiency virus infection

Abstract

Eight children with human immunodeficlency virus (HIV) infection had symptomatic cardiac dysfunction. The median age was 1.4 years (range 0.2 to 7.9 years). All had hepatospienomegaly, fever, pneumonia with tachypnea, and tachycardia ascribed to infection and anemla. An S 3 gallop was present in six of elght. All had normal creatine phosphokinase values. Chest x-rays did not ald in the diagnosis of cardiac dysfunction. ECG showed flattened T waves in flve of eight with left ventricular hypertrophy, right ventricular hypertrophy, or both in seven of eight. Results of echocardiography showed decreased left ventricular function in all eight, despite anemia, with dilated left ventricular myopathy in six, concentric left ventricular wall thickening in two of eight, an enlarged right ventricle in two, and paricardial fluld in three. Medical therapy improved cardiac function in all. All patients subsequently died of noncardiac causes. Results of autopsies on four of eight patients showed focal myocarditis in two (with cytomegalovirus inclusions in one) and dilated cardiomyopathy in two others. We conclude: (1) Preexistent hepatosplenomegaly, fever, infection, and anemia result in physical findings that mimic findings of heart fallure, thereby masking the occurrence of cardiac dysfunction; (2) an S 3 gallop may indicate the presence of impaired heart function when other clinical signs are masked; (3) confirmation of cardiac compromise may be accomplished by noninvasive evaluation with echocardiography and (4) medical therapy can improve cardiac dysfunction in HIV-infected children.