obsolete cardiovascular tuberculosis

Obsolescence of Cardiovascular Tuberculosis

Cardiovascular tuberculosis (TB) has been largely eradicated in modern times, but it was once a significant concern in the past.

• Historical Context: Plombage, a treatment for TB, was practiced from the 1930s to the mid-1950s [8]. However, with the advent of potent anti-tuberculous medications, plombage became obsolete.
• Right-Sided Mediastinal Lymph Nodes Predilection: Tuberculosis has an anatomical predilection for the right-sided mediastinal lymph nodes. As a result, the right heart is the most vulnerable area due to contiguous spread [10].
• Rare Cases of Endocarditis and Pancarditis: Less than 50 cases of tuberculous endocarditis have been described in the literature, with even fewer cases of tubercular pancarditis reported [10].

The relationship between tuberculosis and cardiovascular disease (CVD) is complex. While TB has largely been eradicated, CVD rates continue to rise globally, particularly in low- and middle-income countries.

• Shared Risk Factors: Both TB and CVD share similar risk factors, which may contribute to their overlapping epidemics [12].
• Possible Pathophysiological Substrate: Research suggests that a possible pathophysiological substrate links TB and CVD, although further study is needed to fully understand this relationship [13].

In summary, cardiovascular tuberculosis was once a significant concern but has largely been eradicated with the advent of modern treatments. However, its legacy continues to influence our understanding of the complex relationships between TB and CVD.

References: [8] AA Kolkailah · 2018 · Cited by 6 [10] Various authors · [18], [19], [28] [12] López-López JP et al. · 2021 · J Am Heart Assoc [13] López-López JP et al. · 2021 · J Am Heart Assoc

Symptoms of Obsolete Cardiovascular Tuberculosis

Cardiovascular tuberculosis, also known as tuberculous pericarditis, is a rare but serious complication of tuberculosis that affects the heart and surrounding tissues. The symptoms of this condition can be subtle and may not always present with classic signs of cardiovascular disease.

• Chest pain: A dull, aching pain in the chest area is a common symptom of tuberculous pericarditis [11].
• Shortness of breath: Difficulty breathing or feeling winded even when sitting still can indicate fluid accumulation around the heart [2].
• Fatigue and weakness: Feeling extremely tired or weak due to the body's response to the infection [8][12].
• Weight loss: Unintentional weight loss is a common symptom in patients with tuberculosis, including cardiovascular forms [5][6][8].
• Night sweats: Sweating at night can be a sign of an underlying infection, including tuberculosis [5].

Less Common Symptoms

In some cases, the symptoms may not be as apparent or may be mistaken for other conditions. These include:

• Coughing up blood: Hemoptysis (coughing up blood-stained sputum) is a rare symptom in tuberculous pericarditis [6].
• Ankle edema: Swelling in the ankles and feet can occur due to fluid accumulation around the heart [2].

Important Note

It's essential to note that these symptoms can be similar to those of other cardiovascular conditions, making diagnosis challenging. A thorough medical evaluation, including imaging studies and laboratory tests, is necessary for accurate diagnosis.

References:

[1] IG Sia · 2011 · Cited by 289 [2] JM Kim · 2011 · Cited by 3 [5] [6] [8] Feb 2, 2024 [11] Nov 1, 2021

Treatment Options for Obsolete Cardiovascular Tuberculosis

Cardiovascular tuberculosis (TB) is a rare but serious condition that affects the heart and blood vessels. While it's considered an obsolete disease, there are still some treatment options available.

• Traditional Antitubercular Drugs: The traditional antitubercular drugs such as isoniazid, rifampin, pyrazinamide, and ethambutol can be used to treat cardiovascular TB (TB) [10]. These medications have been in use for decades and are still effective against the disease.
• Newer Antitubercular Drugs: Newer antitubercular drugs such as bedaquiline, delamanid, and clofazimine have shown promise in treating drug-resistant TB, including cardiovascular TB [4], [11]. These medications can be used in combination with traditional antitubercular drugs to improve treatment outcomes.
• Surgical Treatment: In some cases, surgical treatment may be necessary to remove infected tissue or repair damaged blood vessels. However, this approach is typically reserved for severe cases of cardiovascular TB and should only be considered under the guidance of a qualified healthcare professional [13].

Important Considerations

When treating cardiovascular TB, it's essential to consider the following factors:

• Drug Resistance: Cardiovascular TB can develop resistance to antitubercular drugs, making treatment more challenging. Using newer antitubercular drugs or combining traditional medications with other treatments may help overcome this issue.
• Comorbidities: Patients with cardiovascular TB often have comorbid conditions such as HIV/AIDS, which can complicate treatment and require additional management strategies [15].
• Adherence to Treatment: Adhering to the prescribed treatment regimen is crucial for successful outcomes. Patients should work closely with their healthcare providers to ensure they receive proper care and support throughout the treatment process.

References

[10] Tuberculosis is a communicable disease caused by the bacillus Mycobacterium tuberculosis.It is the leading cause of mortality from an infectious disease and is among the top 10 leading causes of death worldwide, particularly in low‐ and middle‐income countries (LMIC) where it generates a significant burden of disease.

[4] by E. Solomonia N, Dzidzikashvili N, Blumberg HM. Surgical treatment of drug-resistant tuberculosis. Lancet Infect Dis 2012;12:157–66. [PMC free article] [Google Scholar]

[11] Clofazimine is the best third drug in combination with bedaquiline and pyrazinamide in a mouse model , but it has yet to find a clinical niche except in the treatment of drug-resistant tuberculosis.

[13] We note the importance of adequate history-taking and the implications of what seemingly obsolete techniques may have in contemporary practice. ... Solomonia N, Dzidzikashvili N, Blumberg HM. Surgical treatment of drug-resistant tuberculosis. Lancet Infect Dis 2012;12:157–66. [PMC free article] [Google Scholar]

[15] Owing to the high prevalence of tuberculosis (TB) and human immunodeficiency virus/AIDS, tuberculous heart disease remains an important problem in TB endemic areas. In this review, we reiterate salient aspects of the traditional understanding and approach to its management, and provide important updates on the pathophysiology, diagnosis, and treatment garnered over the past decade of focused research.

A very specific and interesting question!

Obsolete cardiovascular tuberculosis refers to an outdated medical condition where tuberculosis (TB) affects the heart, particularly in a way that was more common before modern treatments were available.

Here are some potential differential diagnoses for obsolete cardiovascular tuberculosis:

1. Rheumatic heart disease: This is a condition where rheumatic fever causes inflammation and scarring of the heart valves, leading to valve dysfunction.
2. Cardiac sarcoidosis: A rare autoimmune disorder that can cause inflammation and scarring in the heart tissue, potentially mimicking TB.
3. Fibrothorax: A rare condition characterized by fibrosis (scarring) of the pleura, which is the lining surrounding the lungs. This can lead to compression of the heart and mimic TB symptoms.
4. Pulmonary embolism with cardiac involvement: In some cases, a pulmonary embolism (blood clot in the lung) can cause cardiac complications, such as right ventricular dysfunction or myocardial infarction, which might be mistaken for TB.
5. Cardiac amyloidosis: A rare condition where abnormal proteins accumulate in the heart tissue, leading to thickening and stiffening of the heart walls, potentially causing symptoms similar to those seen in obsolete cardiovascular tuberculosis.
6. Pericarditis with effusion: Inflammation of the pericardium (the sac surrounding the heart) accompanied by fluid accumulation, which can cause cardiac dysfunction and mimic TB symptoms.
7. Cardiac metastases from other cancers: Rarely, cancer cells can spread to the heart, causing inflammation and scarring that might be mistaken for obsolete cardiovascular tuberculosis.

Please note that these differential diagnoses are not exhaustive, and a thorough medical evaluation by a qualified healthcare professional is essential to determine the correct diagnosis.