Disproportionate tachycardia and tachypnea in pulmonary tuberculosis: A marker of concurrent cardiac dysfunction

Cardiovascular involvement in tuberculosis is not uncommon. Cardiac dysfunction is a clinical presentation due to direct or indirect affection due to tuberculosis. Cardiac dysfunction is possible without structural cardiac disease. In this case report, a 32-year-old male presented with constitutional symptoms for 6 months with acute deterioration with tachycardia and tachypnea with hypoxia 2 weeks before hospitalization. Radiological investigations documented conglomerated miliary tuberculosis and confirmed by sputum smear microscopy and Gene Xpert MTB/Rif. Cardiac investigations revealed sinus tachycardia in electrocardiogram, raised cardiac enzymes in laboratory evaluation, and "global left ventricular hypokinesia" with reduced ejection fraction in echocardiography. We have started Anti-tuberculosis treatment as per National guidelines for 6 months with steroids backup for four weeks. We have documented cardiac function improvement in one month post treatment, bacteriological cure after 2 months of ATT and near complete radiological resolution after 6 months. We recommend cardiac workup in all pulmonary tuberculosis cases with disproportionate tachycardia and tachypnea with or without hypoxia.