The Intersection of Tuberculosis and Cardiovascular Disease: A Systematic Review





Background:Tuberculosis is one of the oldest infectious diseases known to affect every organ and tissue of the human body and the heart is no exception. However,cardiac manifestations of tuberculosis (TB) are not given enough attention in clinical practice in developing countries where intersection of the two epidemics are observed.

Objectives: The goal of this clinical review is assess the cardiovascular manifestations of TB and to restore awareness among clinicians to promote high index of suspicion for early diagnosis and thereby timely management of various forms of cardiovascular tuberculosis.

Materials and Methods:Literature search for published evidence on cardiovascular complications of tuberculosis was conducted on MEDLINEandCochrane collaboration and the Cochrane Register of Controlled Trials (inclusive from 1980-2017). The following search terms were used:Disseminated tuberculosis, tuberculous pericarditis, intracardiactuberculoma, tuberculous endocarditis, myocardial TB, tuberculosis of blood vessels, Takayasu arteritis (TA)

Results and Discussion: The spectrum of cardiovascular complications of TB include pericarditis, myocardial involvement, intracardiactuberculoma, and involvement of the blood vessels including coronary arteries with various manifestations ranging from no symptoms to sudden cardiac death.

Conclusion:Although TB can involve the heart and the blood vessels including coronaries, the diagnosis of cardiovascular TB remains challenging without high index of suspicion.The treatment of cardiovascular TB is primarily antituberculous chemotherapy and surgical intervention is rarely required.There is no robust evidence as to the potential association between TB and TA.


Key words: Tuberculosis, pericarditis, myocarditis, intracardiactuberculoma, endocarditis,Takayasu arteritis





Global tuberculosis report 2017. Geneva: World Health Organization; 2017. Licence: CC BY-NCSA 3.0 IGO.

Swaminathan S, RekhaB.Pediatric Tuberculosis: Global Overviewand Challenges.Clinical Infectious Diseases 2010; 50(S3):S184–S194

Mengistu AD. The Emerging Concern of Cardiovascular Complications in Children with Human Immunodeficiency Virus Infection in Sub-Saharan Africa: A Systematic Review. ARC Journal of AIDS 2017; 2(2):20–28.

Mocumbi AH, Ferreira MB. Neglected Cardiovascular Diseases in Africa. J Am Coll Cardiology 2010;55(7):680–7

HuamanMA, David Henson D, Eduardo Ticona E etal.Tuberculosis and cardiovascular disease:linking the epidemics.Travel Medicine and Vaccines ,2015; 1:10DOI 10.1186/s40794-015-0014-5

Rajesh S, Sricharan K.N, JayaprakashK , Francis N P Monteiro.Cardiac involvement in patients with pulmonary tuberculosis.Journal of Clinical and Diagnostic Research. 2011 ;5(3): 440-442

Liberti A, Altman DG,Tetzlaff J et al. PRISMA statement for reporting systematic reviews

andMetanalyses of studies theta evaluate health careinterventions:explanationand elaboration Br Med J 2009; 339:b2700

Mayosi BM, Burgess LJ, DoubellAF.TuberculousPericarditis.Circulation. 2005; 112: 3608-3616.)

Cegielski JP, Lwakatare J, Dukes CS et al.Tuberculous pericarditis in Tanzanian patients with and without HIV infection.Int J Tuber Lung Dis.1994 ;75(6):429-34

Syed FF,Mayosi BM. Pericardial disease: an evidence- based approach to clinical management. In: Yusuf S,Cairns JA, CammAJ,FallenEL,Gershbj(Editors) .Evidence-Based Cardiology ,Wiley Blackwell,BMJ books,3rd edition,2010;pp:850-853

Imazio M, Adler Y. Management of pericardial effusion.European Heart Journal ,2013; 34, 1186–1197

Cherian G. Diagnosis of tuberculous aetiology in pericardial effusions. Postgrad Med J 2004;80:262–266

Adler Y,CharronP,MassimoImazio M et al. Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Guidelines on the diagnosis and management of pericardial diseases. European Heart Journal ,2015;36, 2921–2964

Geske JB, Anavekar NS, Rick A. Nishimura RA,Oh JK, GershBJ.Differentiation of Constrictionand Restriction. J Am CollCardiol 2016; 68:2329–47.

Welch TD etal.Echocardiographic Diagnosis of Constrictive Pericarditis: Mayo Clinic Criteria.CircCardiovasc Imaging;2014:1-35

Bashi VV, John S, Ravikumar E et al.Early and late results of pericardiectomy in 11 8 casesof constrictive pericarditis.Thorax 1988;43:637-641

Gulati GS, Kothari SS.Diffuse infiltrative cardiac tuberculosis.Annals of Pediatric Cardiology 2011;(4 )1:87-89

Michira BN, AlkizimFO,MathekaDM.Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases.PanAfr Med J. 2015;21:118

Behr G,PalinHC,TemperleyJM.Myocardial tuberculosis.Br Med J;1977:951

Rose AG.Cardiac tuberculosis.A study of 19 patients.ArchPathol Lab Med. 1987;111(5): 422-6

Agarwal R,MalhotraP,AwasthiA,Kakkar N, Gupta D.Tuberculous dilated cardiomyopathy: an under-recognized entity?BMC Infectious Diseases 2005, 5:29

Liu A. Sudden cardiac death and tuberculosis- How much do we know? Tuberculosis 2012;92(4): 307-313

Chang B, Ha J, Kim J, Chung N, Cho S .IntracardiacTuberculomaAnnThoracSurg 1999;67:228 –31

Jeilan M, Schmitt M, McCann G. Cardiac Tuberculoma.Circulation. 2008;117:984-986

Cantinotti M, De Gaudio M, de Martino M.etal.Intracardiac left atrial tuberculoma in an elevenmonth-old infant: case report.BMC Infectious Diseases 2011, 11:359

Monga A, Arora A,MakarRP,Gupta A.A rare site for tuberculosis. Can Med Ass J 2002;167(10): 1149-1150

Al-Nasser I,Anwar AM, NosirY,et al. Bicaval obstruction complicating right atrial tuberculoma:thediagnostic value of Cardiovascular MR.Journal of Cardiovascular Magnetic Resonance 2008, 10:60

Liu A,Nicol E,Hu Y,Coates A. Tuberculous endocarditis.Int J Cardiol 2013;167(3): 640-5

AbraraA,NewsholmeW,KleinJL,ChambersJB.Tuberculous endocarditis in an immunocompetent host without military tuberculosis.Int J Tuber Lung Dis 2014;1047-1048

O"NeillPG,Rokey H ,Greenberg S, PacificoA.Resolution of Ventricular Tachycardia and Endocardial TuberculomafollowingAntituberculosis Therapy.Chest1991; 100:1467-69

Chung WS, Lin CL, Hung CT et al.Tuberculosis increases the subsequent risk of acute coronary syndrome: a nationwide population-based cohort study.Int J Tuberc Lung Dis. 2014;18(1):79-83

Canaud L, MarzelleJ,BassinetL,etal.Tuberculous aneurysms of the abdominal aorta.JVascSurg 2008;48:1012-6

PeddleaL, OttoM.Coronary artery tuberculosis: An unusual case of sudden death.Legal Medicine 2018;30: 56–58

BouuzianeZ, BoukhabrineK,LahlouZ,etal.Tuberculosis of the renal artery:a rare cause of renovascularartereialhypertension.AnnVascSurg 2009;23(6):786.e7-9

Wang SH,ChienWC,Chung CH, et al.Tuberculosis increases the risk of peripheral arterial disease: A nationwide population-based study. Respirology 2017;22(8): 1670-1676

PantelRH,Goodman BW. Takayasus Arteritis: The relationship with tuberculosis. Pediatrics 1981;67: 84-88

Aggarwal A, Chag M, Sinha N, Naik S. Takayasu’s arteritis: role of Mycobacterium tuberculosis and its 65 kDa heat shock protein. Int J Cardiol.1996; 55:49–55.




How to Cite

MENGISTU, A. D. (2019). The Intersection of Tuberculosis and Cardiovascular Disease: A Systematic Review. Ethiopian Medical Journal, 57(3). Retrieved from



Systematic review