Podcast #149 - EM ID: Infections A Cardiovascular Risk Factor?

Patrick Bafuma is back with another interview this time with Dr. John Perkins from Carilion Clinic in Virginia to talk about the post-infectious period as a cardiovascular risk factor.

The idea behind this discussion is that patients are at an increased risk for a coronary event within a period of approximately a week after a recent illness.  This leads to us asking the patient, "Have you been sick recently?"

There is not a great specific number, but in general the increased risk for cardiovascular complications is approximately within a week of having the illness and the immediate time after that period.  One study was assessing a VA population with pneumonia and the NEJM had one with influenza.  There was also a very recent review article by Musher et al in the NEJM on this issue.

Dr. Perkins generally recommends that with those having recovered from an infectious disease within the last seven days having symptoms that would potentially be concerning for coronary disease, obtain two EKGs and two troponins for those who might be otherwise low risk.  Keep in mind patients with dyspnea on exertion or other concerning findings may still require even more of an evaluation.  Depending on the findings, a period of observation may be beneficial.  He is usually using aspirin and acetaminophen in combination without adding NSAIDs such as ibuprofen.  Giving medications such as clopidogrel (Plavix) has not been assessed well enough yet for a good recommendation.  Overall, the suggested approach is more with those complaining of "weakness" or CHF type symptoms.  However, the young and healthy with a clear infectious disease that is not concerning could forego this type of evaluation.

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