Cold agglutinin disease (CAD) is a rare autoimmune condition in which the immune system produces autoantibodies called cold agglutinins that attack the red blood cells during cold exposure. CAD causes several symptoms, including heart disorders.
Heart involvement in CAD
During cold conditions, the cold agglutinins in CAD patients attach to the surface of the red blood cells and cause them to clump. The clumped blood cells are targeted by the immune system and die prematurely. The clumping of blood cells can clog the blood vessels, hindering blood flow and exerting excessive workload on the heart to pump blood. Moreover, the disintegrated red blood cells can make the blood more viscous, which affects flow through the blood vessels. The blood’s increased viscosity may add pressure to the heart muscles to maintain blood circulation, leading to heart problems.
Symptoms of heart involvement in CAD
Heart-associated symptoms reported in CAD patients include:
- Arrhythmia, or irregular heartbeat;
- High blood pressure;
- Heart murmurs;
- Cardiomegaly (enlarged heart);
- Acute heart failure where the heart fails to pump the amount of blood the body needs;
- Heart attack caused by blockage of the blood vessels by a blood clot or clumped blood cells, preventing blood flow to the heart;
- Cardiac arrest, where the heart stops working.
Diagnosis of heart involvement in CAD
To diagnose heart involvement in CAD, doctors usually perform a detailed review of the patient’s medical history and assess the symptoms.
Multiple conditions can cause heart problems. If CAD is suspected, blood tests can help identify the presence of autoantibodies.
An electrocardiogram may be performed to measure heart health by monitoring its electrical activity.
Treatment and management of heart problems in CAD
The management of heart involvement is specific for each patient. The doctors will review the patient’s medical history and level of autoantibodies and determine a course of action.
For mild symptoms, warm conditions may reverse the damage and alleviate symptoms.
In some cases, immunosuppressive therapy with cyclophosphamide can help alleviate heart symptoms.
In severe cases, surgery may be required to repair the damage caused to the heart.
In heart surgery, cold conditions are maintained to slow down the heart and help with the procedure. The cold temperatures can lead to venous thromboembolism — a blood clot that can plug the arteries or veins. Therefore, it is important to confirm a diagnosis of CAD with blood tests before heart surgery to take the necessary measures to prevent complications.
Last updated: Aug. 12, 2019
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