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The association between pneumonia and acute cardiac events was of considerable clinical interest in the early 20th century (when pneumonia was routinely treated with digitalis). Houston researchers have reassessed the association using today’s more precise diagnostic tools.
Of 170 patients with culture-confirmed pneumococcal pneumonia treated from 2001 through 2005 at a single Veterans Affairs hospital, 33 (19%) presented with 46 acute cardiac problems on admission: MI was diagnosed in 12 (7%), a new arrhythmia (most commonly atrial fibrillation) in 10 (6%), and new or worsening congestive heart failure in 24 (14%). Thirty-one of the 33 patients had severe pneumonia. Mortality rates varied from 40% in MI patients to 0% in those with new arrhythmias; the overall mortality rate of 27% in pneumonia patients with cardiac complications contrasted with the 9% mortality rate in those without.
Interestingly, all 12 patients with acute MI had at least two cardiac risks, but in 8 patients, these risks had not been identified before admission.
Musher DM et al. The association between pneumococcal pneumonia and acute cardiac events. Clin Infect Dis 2007 Jul 15; 45:158-65.
Comment
Acute bacterial pneumonia might be considered nature’s little stress test. Although this study doesn’t prove a causal relation, it makes sense that pneumonia might worsen preexisting cardiac problems and bring new ones to light. Here’s yet another reason to endorse the pneumococcal vaccine: It also may reduce the likelihood of cardiac decompensation.