Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review

Abstract

Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.

Keywords: aortitis; cardiotoxicity; cardiovascular involvement; myocarditis; pericarditis; tuberculosis.

Figure 1

Cardiovascular involvement in TB.

Figure 2

Stages of constrictive pericarditis (adapted after [105]).

Figure 3

Multimodal imaging evaluation in tuberculous pericarditis (adapted after [111]).

Figure 4

Multimodal imaging evaluation of patients with pericardial effusion, constrictive pericarditis, and restrictive cardiomyopathy (adapted after [114]).

Figure 5

Therapeutic management of TB (adapted after [134]).