7.5. Tuberculosis and cardiovascular diseases


The lung tuberculosis affects on a condition of blood circulation system, in the following aspects:

  1. Specific (tubercular) defeat of heart and vessels;
  2. Functional disturbances caused by not specific diseases of cardio-vascular system, due to lung tuberculosis;
  3. Concomitant to lung tuberculosis diseases of cardiovascular system, etiologically not connected with tuberculosis.

1. Specific (tubercular) damage of the heart and vessels.

Tuberculosis can damage endocardium, myocardium and pericardium.
Endocardial tuberculosis meets extremely rare, due to hystoanatomical structure of valves. Clinical signs of tubercular damage of the endocardium, is extremely poor and meets basically at the heavy forms of tuberculosis, which hide the poorly expressed symptoms.

Myocardial tuberculosis meets also extremely rare. Myocardial tuberculosis could be milliary, nodal and diffuse-infiltrative myocardidtis. Clinical signs of these forms are similar. It can vary from asymptomatic clinical picture up to progressing heart decompensation.

Pericardial tuberculosis – specific damage of serous layer of the heart, visceral (epicardium) and parietal (itself pericardium). This inflammation arises at penetration of tubercular bacteria into pericardial cavity through lymphagenic, hematogenic or contact ways from the mediastinum organs damaged by tuberculosis. According to course of illness acute, subacute and chronic tubercular pericarditis are distinguished. According to character of effusion the pericarditis could be exudative and dry (fibrinous). Exudative pericarditis, most meets among all pericrdidtis of tubercular causation. Exudative pericarditis differs on serous-fibrinous, purulent and hemorrhagic. Tubercular exudative pericarditis quite often represents one of displays of polyserositis, or the combination with tubercular defeat of other organs.

Symptomatology of perciarditis is conditioned by pressure of exudates on the heart, large vessels, lungs, respiratory tract of lower lung parts. Sharp pains in the heart location, reminding the attack of angina, accompany the development of acute pericarditis. The pains in the heart location also have pressing, aching character, irradiating in a neck, shoulder, in a hand, epigastria area, back to under scapular area (usually at the left). The fast accumulation even of small amount of exudates aggravates decompensation of the heart. At X-ray examination of exudative pericarditis the increase of the sizes of the heart shadow, could be revealed, depending on amount of a liquid in a pericardium cavity. The shadow can be triangular, spherical, and square. Subacute or chronic form of disease develops in a case of acute tubercular pericarditis when the exudates could not be totally dissolved. Distinctive feature of chronic tubercular pericarditis is the formation of comissures between epicardium and pericardium with other organs of the chest. At dry fibrinous pericarditis, on the heart’s sac leaflets and on a surface of heart at presence of small amount of liquid, rich deposits of fibrin appear, mount to thickness from 0,5 up to 1,5 cm.. Under action of leaflets friction, fibrin layer converts to threads and nets. The deposits on epicardium look like villus (cor villosum). In the further process deposits grow together with bordering organs (accretio cordis) forming fibrinous tissue around of heart squeezing it. In case of calcium deposition in this tissue the picture ‘the testaceous heart ” develops.

The treatment of the tubercular patient pericarditis requires thorough attention to course of lung tuberculosis for its fast regression. Simultaneous symptomatic therapy is required of heart pathology directed to: easing of pericaditis symptoms, prevention of the heart tamponade, heart-blood insufficiency, and to prevent formation of the commissures and inosculates. At the constrictive pericarditis the surgical treatment is required.

2. Functional disturbances caused by not specific diseases of cardio-vascular system, due to lung tuberculosis.

The tubercular intoxication and hemodynamic disturbances of the pulmonary circulation system can cause heavy aggravations of tuberculosis development. The aggravations are connected to extensiveness of the lung damage by hypertension in pulmonary circulation, deformation of the chest organs, fissures development, displacement of the heart and hypoxia. One of the most important unspecific defeats, in tuberculosis is the lung heart syndrome (cor pulmonale). The increase of the proportion of the lung tuberculosis patients with cor pulmonale is explained by growth of life expectancy of the patients with the chronic far advanced tuberculosis. The diagnostic signs of chronic cor pulmonale are especially poor at compensated lung heart. Any specific symptoms indicating presence of the right ventricle are not present. Modern methods of functional diagnostics of the cardiovascular system (ultrasonic echography, computer tomography etc.) are capable to reveal a degree of defeat with high reliability.

3. Concomitant to lung tuberculosis diseases of cardiovascular system, etiologically not connected with tuberculosis.

Concomitant development of lung tuberculosis with ischemic heart disease (IHD) and hypertension are met frequently, usually in young age. At chemotherapy different side effects appear among tuberculosis patients of elderly age suffering from arteriosclerosis and hypertension. At aggravations of cardiovascular diseases concomitant of tuberculosis, it is necessary correctly to choose right drug combination, having cancelled those caused toxic side effects. Correctly choused antibacterial therapy even in acute and sub acute periods of heart attack and others cardiovascular conditions do not cause deterioration of the heart activity or increase of stenocardia.

The modern schemes of IHD and hypertension treatment are applicable to the tuberculosis patients. The effective treatment of IHD and hypertension among tuberculosis patients is achievable by application of modern medicinal means. This leads to improvement of a condition of the tuberculosis patients, to normalization of cardiovascular system function, which allows carrying out long-term anti-tuberculosis chemotherapy and promotes treatment of tuberculosis.

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