Pulmonary tuberculosis with cardiac dysfunction: An ignored combination!
More details
Hide details
MIMSR Medical College, Latur, Maharashtra, INDIA
Venkatesh Chest Hospital and Critical Care Center, Latur, Maharashtra, INDIA
NIMS Medical College, Jaipur, Rajasthan, INDIA
Online publication date: 2022-12-05
Publication date: 2023-01-01
Electron J Gen Med 2023;20(1):em437
Cardiovascular involvement is rare in tuberculosis & high index of suspicion is must in diagnosing these cases in high burden setting to have successful treatment outcome. In this case report, 26-year male, presented with constitutional symptoms for three months duration with acute deterioration with tachycardia and tachypnea with hypoxia. Radiological investigations documented conglomerated miliary tuberculosis and confirmed by sputum smear microscopy. Cardiac investigations revealed sinus tachycardia in ECG, raised cardiac enzymes, and echocardiography as ‘global left ventricular hypokinesia’ with reduced ejection fraction. Treatment initiated with steroids with anti-tuberculosis and recorded near complete radiological resolution, bacteriological cure and restored cardiac function after six months with good compliance. We recommend cardiac workup in all pulmonary tuberculosis cases with disproportionate tachycardia.
Adewole OO, Erhabor GE, Ogunrombi AB, Awopeju FA. Prevalence and patient characteristics associated with pleural tuberculosis in Nigeria. J Infect Dev Ctries. 2010;4(4):213-7. PMid:20440058.
Anders JM. Tuberculosis of the myocardium. JAMA–J Am Med Assoc. 1902;XXXIX(18):1081-6.
Mayosi BM. Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub–Saharan Africa. Heart. 2007;93(10):1176-83. PMid:17890693 PMCid:PMC2000928.
Burgos LM, Farina J, Liendro MC, et al. Neglected tropical diseases and other infectious diseases affecting the heart. The NET–Heart Project: Rationale and design. Glob Heart. 2020;15(1):60. PMid:32923353 PMCid:PMC7473196.
Ortiz HIA, Farina JM, Saldarriaga C, et al. Human African trypanosomiasis & heart. Expert Rev Cardiovasc Ther. 2020;18(12):859-65. PMid:32967478.
WHO. Global tuberculosis report 2019. World health Organization. 2020. Available at: (Accessed 10 March 2020).
WHO. Global tuberculosis control: Surveillance, planning, financing. World Health Organization. 2008. Available at: (Accessed 10 March 2020).
Bawri S, Ali S, Phukan C, Tayal B, Baruwa P. A study of sputum conversion in new smear positive pulmonary tuberculosis cases at the monthly intervals of 1, 2 & 3 month under directly observed treatment, short course (dots) regimen. Lung India. 2008;25(3):118-23. PMid:20165663 PMCid:PMC2822329.
Rose AG. Cardiac tuberculosis. A study of 19 patients. Arch Pathol Lab Med. 1987;111(5):422-6.
Liu A, Hu Y, Coates A. Sudden cardiac death and tuberculosis–how much do we know? Tuberculosis (Edinb). 2012;92(4):307-13. PMid:22405969.
Yilmaz A, Kindermann I, Kindermann M, et al. Comparative evaluation of left and right ventricular endomyocardial biopsy: Differences in complication rate and diagnostic performance. Circulation. 2010;122(9):900-9. PMid:20713901.
Patil SV, Narwade G, Gondhali G. Cardiac dysfunction in active pulmonary tuberculosis: Double trouble!! Eur Respir J. 2020;56:1604.
Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: A systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100(21):1673-80. PMid:24860005.
Imazio M, Brucato A, Barbieri A, et al. Good prognosis for pericarditis with and without myocardial involvement: Results from a multicenter, prospective cohort study. Circulation. 2013;128(1):42-9. PMid:23709669.
Syed FF, Aje A, Ntsekhe M, et al. Resolution of nodular myocardial tuberculosis demonstrated by contrast–enhanced magnetic resonance imaging. Cardiovasc J Afr. 2008;19(4):198-9.
George IA, Thomas B, Sadhu JS. Systematic review and meta–analysis of adjunctive corticosteroids in the treatment of tuberculous pericarditis. Int J Tuberc Lung Dis. 2018;22(5):551-6. PMid:29663961.