Cardiovascular Changes in Children with Acute Lower Respiratory Tract Infection

Abstract

Background: Acute Lower Respiratory Tract Infections (ALRI), particularly Pneumonia and Bronchiolitis, are important causes of death in childhood in Bangladesh. The cardiovascular and respiratory systems function as a single unit and alteration in cardiorespiratory interactions, can cause significant changes in cardiac function. The objective of this study was to find out any electrical and functional changes, myocardial injury, frequency of heart failure and the outcomes in these patients with ALRIs.
 Methodology: It was a prospective observational study carried out at DMCH from January to June 2012 on 35 consecutive children admitted with ALRI, which were further diagnosed as pneumonia or bronchiolitis using operational definitions. Heart failure cases were identified and all the cases were then evaluated for any cardiovascular changes.
 Results: Most of the patients were male. ECG changes occurred in the form of tachycardia. Abnormal echocardiographic findings were noted in the form of pulmonary hypertension, left ventricular systolic (LV) dysfunction and tricuspid regurgitation. 82.9% had raised CK-MB and was significantly higher in patients with tachycardia and having abnormal echocardiographic changes. Nine patients developed heart failure, 3 of them had pulmonary hypertension along with LV systolic dysfunction and one of pulmonary hypertension and LV systolic dysfunction each. CK-MB was raised significantly in all the patients with heart failure.
 Conclusion: Raised CK-MB, tachycardia out of proportion on ECG and pulmonary hypertension with left ventricular systolic dysfunction were common findings in patients with ALRI.
 Bangladesh J Child Health 2019; VOL 43 (1) :27-34

Pulmonary Hypertension in Children with Lower Respiratory Tract Infections in the Konya Province of Turkey

“…In various studies, the incidence of CHF in children with LRTI was reported as 10 to 72%. 7,[19][20][21][22] In the present study, CHF was detected in 10% of patients with LRTI.…”

“…Considering the studies evaluating the prevalence of PH via Doppler echocardiography in children with LRTI, the prevalence of LRTI-associated PH was 33.3% in children with pneumonia and 15% in children with bronchiolitis in a study by Kabir et al, 7 and 24% in 75 infants with acute respiratory disease in a study by Bardi-Peti and Ciofu. 23 Üner et al 24 and Sreeram et al 25 reported prevalence of, respectively, 40.5% in children with pneumonia and 52.38% in children with acute bronchiolitis.…”

“…Hypoxia also depresses myocardial function, disrupts the balance between afterload and preload, and as a result, may lead to heart failure. 7 Myocarditis caused by microorganisms invading the heart muscle directly is also one of the factors causing heart failure. 8,19 In the literature, multivariable results have been reported regarding the incidence of CHF in patients with LRTI.…”

“…6 Furthermore, heart failure developed due to various causes contributes to mortality in LRTI. 7 Heart failure may develop due to direct damage to the myocardium by circulating toxins and microorganisms, disruption of the balance between right ventricular afterload and preload due to hypoxemia, and increased pulmonary artery pressure (PAP) due to pulmonary vasoconstriction (pulmonary hypertension [PH]). 8 The aim of this study was to examine the risk factors causing LRTI in children, the symptoms and physical examination findings of children with LRTI, and to investigate the frequency of PH secondary to LRTI.…”

The value of modified Ross score in the evaluation of children with severe lower respiratory tract infection admitted to the pediatric intensive care unit

“…The cardiovascular and respiratory systems function as a single unit and alteration in cardiorespiratory interactions can cause significant changes in cardiac function [ 8 ]. Studies in adult patients revealed that the presence of a cardiac event, such as congestive heart failure (CHF), is among the leading complications that increase the chances of morbidity and mortality among patients with LRTI [ 9 , 10 ].…”