Most infections, courtesy of their ability to cause fever, can cause at least a transient tachycardia. Conversely and uncommonly, however, some infections like typhoid fever, Legionnaire’s disease, chlamydia pneumonia, Sandfly fever, and Dengue fever, can cause a relative bradycardia; although not thought to be diagnostically useful (Wittesjo, 1999). There, are nonetheless, specific infectious agents that have a predisposition to cause a tachycardia. If so, which?
Some infectious agents have a predilection to infect heart tissue. Among these are the enteroviruses, particularly Coxsackie B viruses and the echoviruses. They can cause either a myocarditis, infection of the cardiac muscle, or a pericarditis, infection of the pericardium that surrounds the heart, or both. Because of that, these viruses have a propensity to cause cardiac rhythm abnormalities, including tachycardia, irrespective of any febrile response in their host. And a group from Berlin, in 2008, have discovered perhaps why.
Recall that cells, rather than lying in complete isolation, are connected by “cellular junctions” made up of intercellular protein bridges. These junctions help anchor cells to one another (the so-called adherens junctions), help cells communicate (gap junctions) or act as impermeable connections (tight junctions). The former two junctions have already been implicated with arrhythmias. Tight junctions, however, were only recently implicated with cardiac arrhythmias after Lisewski and colleague’s ground-breaking research out of Berlin in 2008. Lisewski showed that a protein involved in the tight junctions between the conduction fibres of the heart, named coxsackie-adenovirus receptor (CAR) — because the protein is utilised by those named viruses to gain access into the host cell — can also be a mechanism for tachyarrhythmias (Lisewski, 2008):
Our results indicate that CAR is not only relevant for virus uptake and cardiac remodeling but also has a previously unknown function in the propagation of excitation from the atrium to the ventricle that could explain the association of arrhythmia and Coxsackievirus infection of the heart.
Infectious agents known to cause a myocarditis include the following (Tintinalli, 2016):
Viruses
- coxsackie B
- echovirus
- adenovirus
- influenza (flu) virus
- parainfluenza virus
- parvovirus (the cause of “slapped-cheek syndrome” in children)
- cytomegalovirus (CMV)
- Epstein-Barr virus (EBV)
- HIV
- others
Bacteria
- Lyme disease
- Streptococcus
- Mycoplasma
- Chlamydia
- others
Any infection can cause a tachycardia but certain infectious agents, like coxsackie and echovirus, have a penchant to infect heart tissue. These infections are more likely than most to cause cardiac arrhythmias.
References
- Wittesjö B, Björnham A, Eitrem R. Relative bradycardia in infectious diseases. Journal of Infection. 1999;39:246-247.
- Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. Eight;8th; ed. New York: McGraw-Hill Education; 2016.
- Lisewski U, Shi Y, Wrackmeyer U, et al. The tight junction protein CAR regulates cardiac conduction and cell-cell communication. The Journal of experimental medicine. 2008; 205: 2369-2379.
Featured Image
- ECG in a case of Acute Pericarditis showing some mild ST elevation in inferiolateral leads [Wikimedia Commons]
