CardiologyTier 2Topic overview

Cardiovascular manifestations of systemic and chronic disease, such as amyloidosis, diabetes mellitus, HIV, renal disease, rheumatoid arthritis, systemic lupus erythematosus, and thyroid disease

Framing

Umbrella topic for cardiac involvement in systemic/chronic disease not primarily cardiac in origin

Cardiac amyloidosis
Diabetes mellitus - accelerated coronary atherosclerosis, diabetic cardiomyopathy (diastolic dysfunction independent of coronary disease, from microvascular disease and metabolic/fibrotic changes), silent ischaemia (autonomic neuropathy blunts angina symptoms)
HIV - accelerated atherosclerosis (chronic inflammation and some antiretroviral effects), HIV-associated cardiomyopathy, pericardial effusion (opportunistic infection or malignancy in advanced disease)
Renal disease - uraemic cardiomyopathy/LVH, accelerated vascular calcification, uraemic pericarditis, markedly elevated cardiovascular mortality at every CKD stage
Rheumatoid arthritis - accelerated atherosclerosis (independent inflammatory cardiovascular risk, comparable to diabetes), pericarditis, rarely myocarditis
SLE - Libman-Sacks (non-bacterial thrombotic) endocarditis, pericarditis (most common cardiac manifestation), myocarditis, accelerated atherosclerosis (compounded by antiphospholipid syndrome)
Thyroid disease - hyperthyroidism (AF, high-output heart failure), hypothyroidism (bradycardia, pericardial effusion, accelerated atherosclerosis from dyslipidaemia)

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