The heart in inflammatory bowel disease

Abstract

SUMMARY
Cardiovascular involvement in inflammatory bowel disease
(IBD) has been occasionally reported, mainly in the form
of case reports. Endocardium derangement in IBD involves
endocarditis and subendocardial abscess. Endocarditis may
occur as a result of septicemia or due to the prolonged use
of total parental nutrition (TPN) catheters or/and immunosuppression.
The cause of endocarditis may be bacterial
or fungal and require surgery in several cases. Prophylaxis
for endocarditis in selected IBD patients is discussed. Myocarditis
or perimyocarditis in IBD is reported as an autoimmune
phenomenon during bowel disease excacerbations
or as a side-effect of 5-aminosalicylic acid (5-ASA)
formulations. Ulcerative colitis (UC) patients seem to be
at a higher risk for this complication compared to Crohn�s
disease (CD) patients. Myocardial infarctions, selenium deficiency
during TPN, the role of prolonged steroid use and
the association with giant cell myocarditis are topics which
need further analysis. Pericardium involvement seems to
be the most frequent type of cardiovascular complication
in IBD caused by drugs (5-ASA, azathioprine, cyclosporine),
pericardio-colonic fistulas or unknown causes (idiopathic)
and it may occasionally be the disease presenting symptom.
Coronary artery status and other factors for cardiovascular
risk, such as smoking, hyperlipidemia and exercise are
also discussed. Electrocardiogram and ultrasonographic
changes are not so uncommon and cardiogenic sudden death
in IBD is reviewed. Intracavitary coagulation abnormalities,
amyloidosis, heart failure and aortitis syndrome are topics included and discussed in this review. A list of tables
contributes to a more systemic overview of this current
knowledge.
Key Words: heart, inflammatory bowel disease, ulcerative
colitis, Crohn�s diseas