प्रणालीगत रोग में हृदय

A wide variety of systemic diseases may affect the heart by a number of different mechanisms, including increasing demands on the heart, causing arrhythmias, affecting the structure of the heart or promoting cardiovascular disease and therefore coronary heart disease.

Common cardiac associations with systemic disease include:

• अंतःस्रावी और चयापचय:
  

  • मधुमेह: coronary artery disease, cardiomyopathy, congestive heart failure.

  • हाइपरथायरायडिज्म: supraventricular tachycardia, atrial fibrillation, hypertension.

  • हाइपोथायरायडिज्म: bradycardia, dilated cardiomyopathy, heart failure, pericardial effusion.

  • Malignant carcinoid: tricuspid and pulmonary valve disease, right heart failure.

  • फेयोक्रोमोसाइटोमा: hypertension, tachycardia, congestive heart failure.

  • एक्रोमेगली: heart failure.

  • हीमोक्रोमैटोसिस: heart failure, arrhythmias, heart block.

  • एंडरसन-फैब्री रोग: arrhythmias, coronary artery disease, heart failure.

• Nutrition:
  

  • कुपोषण: dilated cardiomyopathy, heart failure.

  • Thiamine deficiency: high-output heart failure, dilated cardiomyopathy.

  • Hyperhomocysteinaemia: premature atherosclerosis.

  • मोटापा: cardiomyopathy, heart failure.

• Multisystem diseases:
  

  • रूमेटाइड आर्थराइटिस: pericarditis, pericardial effusion, coronary arteritis, myocarditis, valvulitis.

  • सेरोनेगेटिव आर्थ्रोपैथीज़: aortitis, aortic and mitral insufficiency, conduction abnormalities.

  • सिस्टेमिक ल्यूपस एरिथेमेटोसस (एसएलई): pericarditis, Libman-Sacks endocarditis, myocarditis, thrombosis (arterial and venous).

  • एमाइलॉइडोसिस: heart failure, restrictive cardiomyopathy, valvular regurgitation, pericardial effusion.

  • सारकॉइडोसिस: heart failure, dilated or restrictive cardiomyopathy, ventricular arrhythmias, heart block.

  • मार्फन का सिंड्रोम: aortic aneurysm and dissection, aortic insufficiency, mitral valve prolapse.

  • एहलर्स-डानलोस सिंड्रोम: aortic and coronary aneurysms, mitral valve prolapse.

• एचआईवी संक्रमण: myocarditis, dilated cardiomyopathy, pericardial effusion.

हृदय विफलता

हृदय विफलता may be caused or precipitated by any condition that puts a greater demand on the heart - eg, fever, severe anaemia, thyrotoxicosis and pregnancy.

एथेरोस्क्लेरोसिस

• Coronary arteries may be involved in कावासाकी रोग and, very rarely, in late सिफलिस.

• The association between coronary heart disease and diabetes is as well known. It is also well known to be associated with abnormalities of lipid metabolism, including the मेटाबोलिक सिंड्रोम.¹

• There is also a strong relationship between coronary heart disease and rheumatoid arthritis.²

उच्च रक्तचाप

Any cause of secondary उच्च रक्तचाप, such as renal disease (eg, ग्लोमेरुलोनेफ्राइटिस, पॉलीआर्टेराइटिस नोडोसा, सिस्टेमिक स्क्लेरोसिस, chronic pyelonephritis, or polycystic kidneys), or endocrine disease (eg, कुशिंग सिंड्रोम, Conn's syndrome, फियोक्रोमोसाइटोमा, एक्रोमेगली, हाइपरपैराथायरॉइडिज्म), may cause hypertensive heart disease, which may lead to left ventricular hypertrophy.

Lung disease

Disease of the lungs can also lead to right ventricular hypertrophy and strain.

• क्रॉनिक ऑब्सट्रक्टिव पल्मोनरी डिजीज (सीओपीडी), including that due to the general disease of cystic fibrosis.

• पुनरावर्ती फुफ्फुसीय एम्बोलिज्म.

• Primary फुफ्फुसीय उच्च रक्तचाप.

रूमेटिक बुखार

रूमेटिक बुखार is now very uncommon in Western Europe, although it is still seen in other parts of the world, especially Africa.³

• Rheumatic fever may cause disease of the mitral valve and/or the aortic valve. This is usually mitral stenosis or aortic stenosis but mitral regurgitation or aortic regurgitation may occur alone or in combination.

• Acute rheumatic fever is also associated with myocarditis, which can be severe. A soft, rumbling, mid-diastolic murmur, called the Carey Coombs' murmur, may be heard during active disease. Severe disease is associated with a greater risk of recurrence.

Other causes of valvular heart disease

As rheumatic fever appears to be confined to history, at least in the UK, other causes of disease of heart valves take importance. Many are congenital heart disease.

• एंकिलोसिंग स्पॉन्डिलाइटिस may be associated with aortic regurgitation.

• Incompetent valves, including mitral valve prolapse may occur with a number of the hypermobility syndromes, including एहलर्स-डानलोस सिंड्रोम, मार्फन का सिंड्रोम, डाउन सिंड्रोम and joint hypermobility syndrome.

• मार्फन का सिंड्रोम may cause aortic regurgitation and even aortic aneurysm at the root.

• Another cause of aneurysm of the proximal aorta with aortic regurgitation is tertiary सिफलिस.

• Heart valves may be affected in many systemic autoimmune diseases, such as रूमेटाइड आर्थराइटिस, एसएलई, antiphospholipid antibody syndrome, the seronegative spondyloarthropathies, the systemic vasculitides and स्क्लेरोडर्मा.⁴

Any damage or abnormality of the heart or valves makes them susceptible to subacute bacterial endocarditis. Acute bacterial endocarditis can occur when drug addicts inject themselves with heavily infected material.

Pericardial disease

• अलग देखें Acute Pericarditis, Chronic Pericarditis और Pericardial Effusion articles. These are often associated with systemic disease and they are often inflammatory diseases or infections.

• Constrictive pericarditis may impair adequate filling of the heart. तपेदिक is one possible cause. पेरिकार्डियल इफ्यूजन can further constrict the heart and cause cardiac tamponade.

कार्डियोमायोपैथी

Cardiomyopathy is discussed much more fully in the separate हृदय की मांसपेशियों की बीमारियाँ article. They may be primary or due to other disease. Many systemic diseases may cause cardiomyopathy, including:

• सारकॉइडोसिस.

• Metabolic: diabetes, amyloidosis, विल्सन की बीमारी, haemochromatosis, glycogen storage diseases.

• Drugs and poisons:
  

  • Around 7 or 8 units of alcohol (>80g) a day for at least five years are required to develop cardiomyopathy.⁵ However, it is probably an underdiagnosed cause and may represent 30% of dilated cardiomyopathy. Women are susceptible at a lower dose than men. High consumption of alcohol also leads to hypertension.

  • Many other substances have been implicated. Examples include cocaine, amphetamines, chemotherapy for malignancy.⁶

• Cardiomyopathy may occur in patients on long-term dialysis.

• Endocrine disease: acromegaly, phaeochromocytoma, diabetes mellitus (maternal diabetes can also have an adverse effect on the developing fetal heart),⁷ hyperthyroidism, hypothyroidism.

• Connective tissue disorders: systemic sclerosis (may cause myocarditis or pericardial effusion), rheumatoid arthritis (can cause pericardial effusion, valvulitis and myocardial fibrosis), SLE (is associated with pericarditis, hypertension, an increased risk of coronary heart disease and Libman-Sacks endocarditis).

• Infections: acute viral infection (especially Coxsackie B), South American trypanosomiasis (Chagas' disease), हेपेटाइटिस बी, HIV infection.

• Nutritional: malnutrition, vitamin B1 deficiency, obesity.

• Myopathies: ड्यूचेन मस्कुलर डिस्ट्रॉफी, बेकर की मांसपेशीय डिस्ट्रॉफी.

Malignant disease

• Metastatic spread of malignancy to the heart is far more common than primary cardiac tumours.⁸ The most common clinical presentation is from pericardial effusion, tachyarrhythmias, atrioventricular block and congestive heart failure.

• Tumours most likely to metastasise to the heart are मेलिग्नेंट मेलेनोमा, leukaemia, malignant germ cell tumours and malignant thymoma.

• हालांकि carcinoma of the lung और स्तन do not often metastasise to the heart, because of the very high numbers, they account for the greatest numbers of cardiac metastases.

• Carcinoma of the lung can also cause एट्रियल फाइब्रिलेशन in the absence of metastatic spread to the heart.

Central nervous system

• ECG abnormalities and rhythm disorders often occur in patients with सबअरेक्नॉइड हेमरेज and in cases of ischaemic stroke, intracranial haemorrhage, head trauma, neurosurgical procedures, acute meningitis, intracranial space-occupying tumours and मिर्गी.

• New-onset atrial fibrillation has been reported in up to one third of patients with acute stroke.

Renal disease

Abnormalities of renal function may affect the heart in a number of ways:

• Renal impairment may impair the clearance of drugs that are potentially cardiotoxic, such as digoxin.

• Electrolyte disturbances associated with तीव्र गुर्दा चोट या दीर्घकालिक गुर्दा रोग may cause cardiac abnormalities, particularly hypokalaemia, हाइपरकलेमिया, hypercalcaemia और hypocalcaemia. Other electrolytes, including magnesium, may also be important.

• दीर्घकालिक गुर्दा रोग may result in pericardial effusion.

• Long-term dialysis may cause cardiomyopathy.⁹

• Kidney disease may lead to hypertensive cardiac disease.

मूल्यांकन

If there is any suspicion that the heart may be involved in systemic disease, this needs to be investigated or it may become apparent on other investigations. In addition to any other investigation for the suspected underlying disease:

• Cardiovascular history and examination and clinical assessment of other systems as applicable.

• Blood tests for myocardial infarction (cardiac enzymes - particularly troponins) and/or heart failure (including brain natriuretic peptide (BNP)).

• CXR may show an enlarged heart, although it may not be clear if this is due to hypertrophy of the myocardium or dilation of the chambers. It may also indicate heart failure.

• 12-lead ECG.

• Echocardiography.

• Other investigations may be indicated - eg, cardiac catheterisation, MRI scan, Doppler flow studies, nuclear cardiology and other cardiac scans.