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Acute Chagas Disease with Myocarditis

Acute Chagas' Disease with Myocarditis


Presentation

  • Usually intermittent, can be prolonged. [8] Most of the patients present with fever. [7] Fever in acute Chagas disease is often self-limiting. [8] Myalgia [1,6] This is a non-specific complain, but many patients present with this symptom. [7] Headache[explainmedicine.com]
  • Diastolic filling pressures are often elevated and a small pericardial effusion may be present.[clinicaladvisor.com]
  • Critical Essential Core Tested Community Questions (2) (M2.ID.4691) A 45-year-old woman presents to clinic for an employment physical. She has no current complaints.[medbullets.com]
  • Chagas disease is both vector-borne and zoonotic, and T. cruzi is very genetically diverse, presenting unique challenges to understand its epidemiology and pathogenesis and to develop effective control programs.[med.unc.edu]
  • Presentation on theme: "Cardiovascular System Infection - Myocarditis"— Presentation transcript: 1 Cardiovascular System Infection - Myocarditis 2 Definition Myocarditis is inflammation of the heart muscle (myocardium) It resembles a heart attack but[slideplayer.com]
Congestive Heart Failure
  • Cardiac symptoms usually require additional medication, including amiodarone for arrhythmias or beta blockers for congestive heart failure.[amboss.com]
  • See sections for congestive heart failure, atrial fibrillation, ventricular tachycardia. IV. Management with Co-Morbidities. A. Renal Insufficiency.[clinicaladvisor.com]
  • heart failure Immunocompromised patient with reactivation – most common presentations are meningoencephalitis, brain abscess, and acute myocarditis ARUP Lab Tests Tests generally appear in the order most useful for common clinical situations.[arupconsult.com]
  • heart failure due to viral infection. 7 Myocarditis is associated with an autoimmune reaction Streptococcal M protein and Coxsackie B virus have regions (epitopes) that are similar to cardiac protein myosin M protein is a virulence factor that can be[slideplayer.com]
  • Heart Failure Disease Obstructive Sleep Apnea and Hypertension NEUROMUSCULAR DISORDERS Duchenne Muscular Dystrophy Myotonic Dystrophy Friedreich’s Ataxia Disorders of Potassium Metabolism PENETRATING AND NONPENETRATING HEART TRAUMA Cardiac Tamponade[euro-libris.ro]
Dyspnea
  • Snapshot A 58-year-old man presents to the clinic with a 2 month history of cough, dyspnea on exertion, palpitations, and orthopnea. He immigrated from rural Bolivia when he was 25 years of age and visits Bolivia regularly.[medbullets.com]
  • 1–2 weeks ) flulike symptoms ( fever, arthralgia, myalgia, upper respiratory tract infections ) indicates possible viral cause In infants and young children: poor feeding, irritability, respiratory distress, and failure to thrive Fatigue, weakness, dyspnea[amboss.com]
  • Two months later, the patient was admitted again, this time with class IV NYHA symptoms: dyspnea at rest, ortopnea, paroxysmal nocturnal dyspnea.[tmj.ro]
  • Symptoms include dyspnea, poor exercise tolerance, chest pain, palpitations, and syncope.[clinicaladvisor.com]
  • Dilated Cardiomyopathy and Pulmonary Congestion Pulmonary Congestion or Edema of Cardiac and Other Origins Causes and Pathogenesis of Pulmonary Edema Cardiac Origins of Peripheral or Systemic Congestion or Edema Therapy for Pulmonary Edema and Paroxysmal Dyspnea[euro-libris.ro]
Chest Pain
  • Some patients also experience cardiac signs that vary in severity from chest pain and arrhythmias to heart failure or sudden cardiac death. Infants and children typically have a more severe presentation.[amboss.com]
  • Painkillers will help to ease chest pain and high temperature (fever). There is no treatment that will cure a viral infection.[patient.info]
  • In other instances, the heart may be faster at revealing its struggles, with symptoms like chest pain, shortness of breath, heart palpitations, and heart failure.[healthline.com]
  • Chest pain is a common symptom. [6] Symptoms of meningoencephalitis [1,6] Due to severe inflammatory reaction. Patients present with headache, neck pain and photophobia.[explainmedicine.com]
  • Symptoms include dyspnea, poor exercise tolerance, chest pain, palpitations, and syncope.[clinicaladvisor.com]
Heart Disease
  • Disease : acută Pericardita și Miocardita Reumatice Heart Disease : acuta valvulara Implicarea Reumatice Heart Disease : Modificări reziduale de acută reumatice cardita Reumatice Heart Disease : mitrală Stenoza : anatomie patologica Reumatice Heart Disease[euro-libris.ro]
  • In this review, we updated and summarised the current knowledge on the major heart diseases caused by protozoan and metazoan parasites, which either involve the heart directly or otherwise influence the heart adversely.[heart.bmj.com]
  • disease Acute myocarditis Megaesophagus Achalasia Strictures Esophageal cancer Megacolon Hirschsprung disease Diabetic gastroenteropathy Colonic stricture Systemic sclerosis Amyloidosis Neurologic disease Myotomic dystrophy Parkinson disease Chronic[arupconsult.com]
  • Due to these mentioned cardiac complications, Chagas disease, throughout the Americas in recent years, has emerged as one of the leading causes of heart disease in the region. According to Dr.[pphr.princeton.edu]
  • disease エンテロウイルス性心炎、Enteroviral carditis 心筋炎、Myocarditis シャーガス病、Chagas' disease リューマチ性心症、Rheumatic heart disease アフリカ型トリパノソーマ症・ローデシア種、African tripanosomiasis, Rhodesian type 中枢神経系の所見、Signs on Central nervous system 人格変化、Altered mentation アフリカ型トリパノソーマ[amda.or.jp]
Cardiomegaly
  • There are bibasilar crackles on chest exam and a chest radiograph shows cardiomegaly. Echocardiogram revealed biventricular dilatation with an EF of 25%. Serological testing was positive for Trypanosoma cruzi.[medbullets.com]
Heart Murmur
  • murmur シャーガス病、Chagas' disease リューマチ性心疾患、Rheumatic heart disease エンテロウイルス性心炎、Enteroviral carditis 心筋炎、Myocarditis シャーガス病、Chagas' disease リューマチ性心症、Rheumatic heart disease アフリカ型トリパノソーマ症・ローデシア種、African tripanosomiasis, Rhodesian type 中枢神経系の所見、Signs on Central[amda.or.jp]
Systolic Murmur
  • Cardiogenic shock in fulminant cases Auscultation findings Brief systolic murmurs Heart failure S3 (and S4) gallops Pericarditis pericardial friction rub The clinical manifestation of myocarditis is very heterogenous and nonspecific, ranging from asymptomatic[amboss.com]
Neglect
  • As a WHO-recognized Neglected Tropical Disease, if receives disproportionately little attention and funding despite that fact that it infects upwards of 6 million people and causes more mortality and morbidity than any other parasitic infection in the[med.unc.edu]

Workup

  • Echocardiogram and cardiac MRI are the main imaging tests used in the workup of myocarditis.[clinicaladvisor.com]
Right Bundle Branch Block
  • bundle branch block, complete heart block, AV block Rule out myocardial infarction : loss of R wave and pathological Q wave specific to myocardial infarction, not found in myocarditis Pericardial effusion : low voltage (low R-wave with poor progression[amboss.com]
  • Bundle Branch Block by Permanent Selective His Bundle Pacing Kataoka T,Miyazaki S,Tsuji T,Shimizu T,Miyoshi M,Sato Y,Shiomi Y,Tama N,Hasegawa K,Fukuoka Y,Ikeda H,Morishita T,Ishida K,Kaseno K,Amaya N,Uzui H,Tada H 第65回日本不整脈心電学会学術大会 2018年07月 Right Coronary[t-profile.ad.u-fukui.ac.jp]
Myocardial Fibrosis
  • Chronic Chagas' Disease: The dominant factor in the chronic stages of Chagas' disease is almost always some degree of myocardial fibrosis. Many patients report a previous acute attack.[histopathology-india.net]

Treatment

  • There are two approaches to therapy of Chagas disease: antiparasitic treatment and symptomatic treatment. Antiparasitic treatment Antiparasitic treatment is most effective when given early, however acute Chagas disease often goes undetected.[dermnetnz.org]
  • There is no treatment that will cure a viral infection. However, for most people with viral myocarditis, the virus clears away on its own without any treatment, often within a week or so.[patient.info]
  • […] treat fluid overload antibiotic therapy Treatment depends on the source and severity of the myocardial inflammation.[healthline.com]
  • “Emerging pharmacologic targets and treatments for myocarditis”. Pharmacology & Therapeutics. vol. 161. 2016. pp. 40-51. (This paper covers newer case reports and trials of immunomodulatory treatments.) Magnani, JW, Dec, GW.[clinicaladvisor.com]
  • Ultimately, if the diagnosis is unclear, a biopsy may be indicated to help determine treatment.[amboss.com]

Prognosis

  • […] is dependent on the adequacy of the residual left ventricular function, patients with severe left ventricular dysfunction having higher mortality rates. 25 In this case the early prognosis was favorable, but on the long term, the prognosis still remains[tmj.ro]
  • Prognosis and Patient Counseling. Prognosis varies quite a bit depending on the acuity and cause of the myocarditis as well as the patient’s ejection fraction at presentation.[clinicaladvisor.com]
  • 急性冠症候群患者におけるCHADS2並びにSYXTAXスコアの予後予測因子としての有用性 森下 哲司 第27回日本心血管インターベンション治療学会学術集会 2018年08月 心室中隔欠損症に感染性心内膜炎が合併した一例 向井 萌,汐見 雄一郎,福岡 良友,森下 哲司,長谷川 奏恵,石田 健太郎,絈野 健一,宮﨑 晋介,宇隨 弘泰,夛田 浩 日本超音波医学会第39回中部地方会学術集会 2018年10月 The importance of cachexia in heart failur patients prognosis[t-profile.ad.u-fukui.ac.jp]
  • 旋回するマクロリエントリー性心房粗動の1例, カテーテルアブレーション関連大会2017, 札幌市, 20170707 4.三好 真智子,掛橋 昇太,清水 智弘,宮永 大,佐藤 裕介,汐見 雄一郎,長谷川 奏恵,池田 裕之,玉 直人,福岡 良友,森下 哲司, 石田 健太郎,絈野 健一,天谷 直貴,宇随 弘泰,夛田 浩: 経皮的冠動脈形成術を施行した急性冠症候群患者におけるSYNTAXスコアの予後予測の有用性についての検討, 第26回日本心血管インターベンション治療学会;CVIT2017学術集会, Prognosis[fukui-u-cardio.jp]

Etiology

  • Etiology Infectious Viral Most commonly implicated: Coxsackie B1-B5 ( picornavirus ), parvovirus B19, human herpesvirus 6 ( HHV-6 ), adenovirus, HCV, HIV, EBV, CMV, Echovirus, H1N1 influenza A Bacterial β-hemolytic Streptococcus group A (acute rheumatic[amboss.com]
  • Tabs Content Clinical Overview Diagnosis Indications for Testing Residency in endemic area Recent travel to endemic area Cardiomyopathy or prototypical gastrointestinal disease without obvious etiology Laboratory Testing Trypanosomiasis diagnosis (CDC[arupconsult.com]
  • We performed tridimensional (3D) transthoracic echocardiography to study the etiology of MR.[tmj.ro]
  • Drug-induced myocarditis is another etiology and is provoked by either a direct toxic effect or a hypersensitivity reaction leading to an eosinophilic infiltrate in the heart.[clinicaladvisor.com]

Epidemiology

  • A comprehensive, and profusely illustrated description of the common and uncommon images which will be found in a wide range of tropical diseases, correlated with the clinical and laboratory findings, and the epidemiology and pathology.[books.google.com]
  • Chagas disease is both vector-borne and zoonotic, and T. cruzi is very genetically diverse, presenting unique challenges to understand its epidemiology and pathogenesis and to develop effective control programs.[med.unc.edu]
  • References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • […] restrictive (grade III) pattern History and etymology Named after Carlos Justiniano Ribeiro Chagas (1879-1934), a Brazilian physician who completely described this infectious disease: the pathogen, the vector, the host, the clinical manifestations and its epidemiology[radiopaedia.org]
  • Strictures Esophageal cancer Megacolon Hirschsprung disease Diabetic gastroenteropathy Colonic stricture Systemic sclerosis Amyloidosis Neurologic disease Myotomic dystrophy Parkinson disease Chronic opiate ingestion Severe hyperthyroidism Background Epidemiology[arupconsult.com]
Sex distribution
Age distribution

Pathophysiology

  • Principal Sites of Embolism from Left Artial Thrombosis Rheumatic Heart Disease: Mitral Stenosis: Thromboembolic Complications: Mitral Balloon Valvuloplasty Rheumatic Heart Disease: Mitral Regurgitation Rheumatic Heart Disease: Mitral Regurgitation: Pathophysiology[euro-libris.ro]
  • Left ventricular aneurysms: pathophysiologic observations and standard resection. Sem Thorac Cardiovasc Surg 1997;9:113-22. 9. Grieco JG, Montoya A, Sullivan HJ, et al. Ventricular aneurysm due to blunt chest injury.[tmj.ro]
  • The pathophysiology of this disease involves direct cardiac myocyte injury followed by activation of cell-mediated immunity and cytokines leading to further destruction of myocytes.[clinicaladvisor.com]

Prevention

  • Other preventive measures include spraying infested dwellings with residual insecticides, using bed nets treated with insecticides, wearing protective clothing, and using insect repellant.[dermnetnz.org]
  • According to the Center for Disease Control and Prevention (CDC), it is estimated that as many as 8 million people suffer from this disease worldwide, many of whom are unaware of their condition.[pphr.princeton.edu]
  • Centers for Disease Control and Prevention Definition (NCI_CDISC) A parasitic infection caused by Trypanosoma cruzi and transmitted by the reduviid bug.[fpnotebook.com]
  • There are no steps to definitely prevent myocarditis, but avoiding serious infections may help.[healthline.com]
  • Centers for Disease Control and Prevention. Infection with protozoa of the genus trypanosoma causes diseases including african sleeping sickness and chaga's disease in humans, and nagana and surra in animals.[icd10data.com]

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