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Bacterial Myocarditis

Bacterial myocarditis is an inflammatory condition of the heart, caused by a bacterial infection. It is an uncommon occurrence in the western world and is mostly diagnosed as a complication of sepsis or a specific syndrome involving a bacterial infection.


Presentation

Bacterial myocarditis, as every other type of myocarditis, features extremely variable clinical manifestations, with the symptoms ranging from none to an acute cardiac shock and heart failure [1]. Due to the fact that it is caused by a bacterial infection, known or unknown to the patient, the symptoms that predominate in the clinical picture at first are those pertaining to the preceding infection. Depending on the type of infection, a patient may experience fever, sweating, chills, tachycardia, weakness, abdominal pain and other symptoms; at this time, although a bacterial inflammation of the myocardium may exist, the cardiac condition is considered still asymptomatic.

At the onset of substantial myocardial inflammation, symptoms originating from the cardiovascular system include angina pectoris, mild or profound arrhythmia, thoracic pain, dyspnea upon exertion, palpitations or an acute decompensation of heart failure, with no preceding risk [2]. Bacterial myocarditis that is caused by a group A streptococcal infection (rheumatic fever), will lead to the patient experiencing additional symptoms, such as polyarthralgia, and subcutaneous nodules, chorea and/or erythema marginatum will be observed.

Fever
  • Bacterial myocarditis that is caused by a group A streptococcal infection (rheumatic fever), will lead to the patient experiencing additional symptoms, such as polyarthralgia, and subcutaneous nodules, chorea and/or erythema marginatum will be observed[symptoma.com]
  • We report an unusual case of fatal bacterial myocarditis in a seven-year-old girl, who had a history of cough for a month and fever for two days. She was given symptomatic treatment by a local physician without suspecting her clinical condition.[ncbi.nlm.nih.gov]
  • Opleiding Richtlijnen Geaccordeerde richtlijnen Congressen en cursussen Patiënten Issue: neth j crit care • volume 12 • no 6 • december 2008 Type: Case Reports Abstract: Clinical presentations of myocarditis range from nonspecific systemic symptoms, fever[nvic.nl]
  • […] the diagnosis, prognosis, and treatment of nonspecific and specific myocarditis in separate chapters devoted to such major idiopathic clinical entities as cardiac sarcoidosis, giant cell myocarditis, eosinophilic myocarditis, Chagas disease, rheumatic fever[books.google.com]
  • Glandular fever (Epstein-Barr virus) . German measles (rubella) . Chickenpox (varicella) . Mumps . Measles . Parvoviruses . Yellow fever. Dengue fever. Polio (poliomyelitis). Rabies. Viruses that cause hepatitis A and hepatitis C .[patient.info]
Congestive Heart Failure
  • If the heart is unable to pump enough blood to meet the body’s needs, symptoms of congestive heart failure will occur.[mottchildren.org]
  • An approach used only with a patient's consent, this procedure may also confirm acute myocarditis, allowing close monitoring of potential congestive heart failure.[medical-dictionary.thefreedictionary.com]
  • Myocarditis can lead to cardiomyopathy and congestive heart failure. It has been most commonly associated with enterovirus.[bmcinfectdis.biomedcentral.com]
  • Myocarditis may be suspected whenever chest pain or arrhythmia symptoms suggestive of congestive heart failure occur during the course of an infectious illness, especially a viral one.[healthcentral.com]
Chills
  • Depending on the type of infection, a patient may experience fever, sweating, chills, tachycardia, weakness, abdominal pain and other symptoms; at this time, although a bacterial inflammation of the myocardium may exist, the cardiac condition is considered[symptoma.com]
  • […] get myocarditis, you're at greater risk if you: Have a weak or compromised immune system Are exposed to agents known to cause myocarditis (such as cocaine) Have previously had myocarditis Myocarditis Symptoms Myocarditis symptoms include: Fever and chills[everydayhealth.com]
  • When to Contact Your Doctor or Health Care Provider: Fever of 100.5 F (38 C), chills, sore throat (possible signs of infection).[chemocare.com]
  • Five days prior to the onset of chest pain, he developed bloody diarrhea, fever and chills. Creatine kinase (CK) and CK-MB were elevated to 289 U/L and 28.7 μg/L. Troponin I was 30.2 μg/L.[bmcinfectdis.biomedcentral.com]
  • Most patients who present with myocarditis complain about: Palpitations ; Chest pain (with characters like heart pain or angina); Fatigue; Fever, and other signs of infection: myalgia, headache, hoarseness, diarrhea, skin rash, chills; Pain or swelling[heartupdate.com]
Constitutional Symptom
  • In most cases, Viral Myocarditis is usually heralded by traditional constitutional symptoms associated with infection such as fever. In most cases myocarditis is subclinical, rapidly resolves, and is self-limited.[pathwaymedicine.org]
Heart Disease
  • diseases and sudden-unexpected deaths.[books.google.de]
  • Kawasaki disease (KD) is an acute febrile illness and systemic vasculitis of unknown etiology that predominantly afflicts children Public Health Relevance Kawasaki Disease (KD) is the leading cause of acquired heart disease among children.[grantome.com]
  • ., MD, and a panel of leading clinical and scientific experts comprehensively review both advances in basic scientific understanding and current clinical knowledge of inflammatory heart disease.[books.google.com]
  • Hypertensive heart disease — High blood pressure resulting in a disease of the heart. Ischemic heart disease — Insufficient blood supply to the heart muscle (myocardium).[encyclopedia.com]
  • Heart Failure: A Companion to Braunwald's Heart Disease . 3rd ed. Philadelphia, PA: Elsevier; 2016:chap 26. Park MK. Cardiovascular infections. In: Park MK, ed. Park's Pediatric Cardiology for Practitioners . 6th ed.[medlineplus.gov]
Tachycardia
  • Depending on the type of infection, a patient may experience fever, sweating, chills, tachycardia, weakness, abdominal pain and other symptoms; at this time, although a bacterial inflammation of the myocardium may exist, the cardiac condition is considered[symptoma.com]
  • Myocarditis should be suspected in patients with a history of flulike symptoms and new evidence of ECG abnormalities, such as sinus tachycardia or concave ST-segment elevations.[amboss.com]
  • .  Tachycardia, hypotension, gallop rhythm, and cardiac murmur.  Associated findings may include a rash or evidence of end organ involvement such as hepatitis or aseptic meningitis. 8.[slideshare.net]
  • Myocarditis can also be associated with abnormal heart rhythms including atrial flutter, atrial fibrillation, heart block, and ventricular tachycardia.[mottchildren.org]
  • In addition the patient may experience arrhythmias or conduction disturbances such as ventricular tachycardia or second or third degree heart block.[inmo.ie]
Cardiomegaly
  • Cardiomegaly and diminished systolic function occur due to myocardial damage. Typical signs of CHF occur which may progress to shock,arrythmias and sudden death. 6.[slideshare.net]
  • […] supraventricular and ventricular arrhythmias can occur in patients with myocarditis The presence of Q waves or a new left bundle branch block (LBBB) are associated with higher rates of cardiac death or heart transplantation Radiology description Chest Xray: cardiomegaly[pathologyoutlines.com]
  • Cardiomegaly and severe congestive heart failure typically appear after the first week of illness.[intechopen.com]
  • Chest x-ray may reveal cardiomegaly with or without pulmonary congestion.[inmo.ie]
  • Cardiomegaly j. Pulmonary congestion k.[atsu.edu]
Heart Murmur
  • Other signs may include: Difficulty breathing Cyanosis (bluish appearance of the skin, lips and/or fingernails) or paleness Development of a heart murmur Fluid retention or swelling To confirm or rule out the presence of endocarditis, a cardiologist may[uchicagokidshospital.org]
  • There may be a heart murmur (sound made by abnormal backward flow through the mitral valve) or other extra heart sounds, and the liver may be enlarged.[mottchildren.org]
  • In infants, symptoms may also include bluish skin, heart murmurs, and a poor appetite.[healthcentral.com]
  • Red blood cell casts Heart murmur is present at some times during the disease but is generally not constant.[atsu.edu]
Systolic Murmur
  • Cardiac findings include, gallop rhythm, and an apical systolic murmur of mitral insufficiency. In patients with associated pericardial disease, a rub may be noted.[slideshare.net]
  • 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
  • The interest in cardiovascular pathology, neglected for years in many countries, is increasing worldwide and we are witnessing the revitalization of a discipline, which, in collaboration with clinicians, is making great contributions to the fight against[books.google.de]

Workup

The extremely variable clinical presentation of bacterial myocarditis, further complicated by the symptoms associated with the initial infection, renders the diagnosis a challenging task. Even though a set of diagnostic criteria has been established, the final diagnosis is set after a biopsy result, consistent with a bacterial infiltration of the myocardium [3] [4].

Bacterial myocarditis is suspected when a priorly confirmed or suspected bacterial infection is followed by an arrhythmia or acute heart failure. The complete workup encompasses a plethora of tests, such as an electrocardiogram (ECG), cardiac enzyme laboratory tests, echocardiography, cardiac magnetic resonance imaging scans (MRI) and, eventually, a biopsy.

  • ECG

May reveal an atrioventricular or bundle branch block, arrhythmias of a ventricular or supraventricular origin, ST or T wave abnormalities and irregular Q waves. The electrocardiographic evaluation may mislead the physician to diagnose an ischemic phenomenon.

  • Laboratory blood tests

Enzymes associated with myocardial ischemia may be elevated, such as troponins or CK-MB.

  • Echocardiography

May illustrate pericardial effusion, LV (left ventricular) or RV (right ventricular) dysfunction, dilatation and thrombi, located intracardially. The findings are non-pathognomonic of bacterial myocarditis and echocardiography is primarily employed in order to eliminate other conditions, such as valvular disease, from the differential diagnosis [5]

  • Cardiac MRI scan

It's wider availability has greatly contributed to the diagnosis, as it can help to evaluate the heart both from a functional and morphological aspect while retaining the advantage of a non-invasive technique [6] [7] [8]. It can aid in the assessment of necrotic or fibrotic changes, pericardial effusion, edema or functional irregularities.
In symptomatic patients, myocarditis is suspected in the clinical setting when 1 clinical indication and 1 diagnostic indication is present. Thoracic pain, acute or chronic heart failure and arrhythmia, including syncope, palpitations and sudden cardiac death, constitute the clinical indications. The diagnostic indications encompass abnormal ECG findings, elevated cardiac enzymes or echocardiographic abnormalities. The final and assertive diagnosis of bacterial myocarditis is established after a biopsy histological examination reveals inflammation of the myocardium, with a culture that is positive for a specific pathogen.

Atrioventricular Dissociation
  • After hospitalization, she showed myocardial infarction, atrioventricular dissociation, and cardiac dysfunction, and finally she passed away despite intensive care.[ncbi.nlm.nih.gov]
T Wave Inversion
  • The ECG may demonstrate non-specific changes such as ST segment depression or elevation, T wave inversion or the presence of pathological Q waves.[inmo.ie]
  • The electrocardiogram (ECG) showed T wave inversion in the lateral and inferior leads. The chest pain resolved within 24 hours of admission. The patient had a completely normal ECG stress test.[bmcinfectdis.biomedcentral.com]
  • Markers of myocardial damage ( troponin or creatine kinase cardiac isoenzymes) are elevated. [10] The ECG findings most commonly seen in myocarditis are diffuse T wave inversions; saddle-shaped ST-segment elevations may be present (these are also seen[en.wikipedia.org]
  • In one report, either ST-segment elevation or T-wave inversion was present as the most sensitive ECG criterion in 26 ]. A gradual increase in the width of the QRS complex may be a sign of exacerbation of myocarditis.[intechopen.com]
Myocardial Fibrosis
  • fibrosis Myocarditis NOS Type 1 Excludes acute or subacute myocarditis ( I40.- ) virus, viral I40.0 bacterial I40.0 (acute) infective I40.0 pneumococcal I40.0 septic I40.0 staphylococcal I40.0 suppurative I40.0 ICD-10-CM Codes Adjacent To I40.0 I36.9[icd10data.com]

Treatment

  • She was given symptomatic treatment by a local physician without suspecting her clinical condition. Her condition rapidly deteriorated and she was brought in dead to the hospital.[ncbi.nlm.nih.gov]
  • The management of bacterial myocarditis consists of aggressive and early antibiotic or anti-toxin treatment, appropriate hemodynamic support, and treatment of arrhythmias or mechanical complications.[ncbi.nlm.nih.gov]
  • Accordingly, the appropriate workup, diagnosis and treatment remain unclear. Our patient represents the first reported case of ventricular rupture due to methicillin-resistant S. aureus-associated bacterial myocarditis.[ncbi.nlm.nih.gov]
  • In this application we will identify novel mechanisms underlying IL-1-mediated vasculitis, aortic aneurysm formation as well as myocarditis associated with KD, which will lead to new avenues for both prevention and treatment of cardiovascular complications[grantome.com]
  • On the clinical side they discuss the diagnosis, prognosis, and treatment of nonspecific and specific myocarditis in separate chapters devoted to such major idiopathic clinical entities as cardiac sarcoidosis, giant cell myocarditis, eosinophilic myocarditis[books.google.com]

Prognosis

  • On the clinical side they discuss the diagnosis, prognosis, and treatment of nonspecific and specific myocarditis in separate chapters devoted to such major idiopathic clinical entities as cardiac sarcoidosis, giant cell myocarditis, eosinophilic myocarditis[books.google.com]
  • However, if damage to the heart muscle becomes chronic and/or progressive, the prognosis for the patient declines. Those who develop severely weakened heart muscle cardiomyopathy have a poorer prognosis.[medicinenet.com]
  • Prognosis The prognosis of symptomatic myocarditis:  in newborns is poor and 75% mortality has been reported.  The prognosis is better for children and adolescents.  Recovery of ventricular function has been reported in 10-50% of patients. 14.[slideshare.net]
  • […] with a high rate of spontaneous improvement without sequelae Patients with fulminant viral myocarditis and hemodynamic compromise at presentation have an excellent long term prognosis and are more likely to experience complete recovery if aggressive[pathologyoutlines.com]

Etiology

  • Kawasaki disease (KD) is an acute febrile illness and systemic vasculitis of unknown etiology that predominantly afflicts children Public Health Relevance Kawasaki Disease (KD) is the leading cause of acquired heart disease among children.[grantome.com]
  • Each chapter includes eight to ten gross and microscopic photographs with legends highlighting the pathologic features of the disease, as well as succinct text covering etiology, clinical aspects, and differential diagnosis.[books.google.com]
  • In general, the histomorphology of the affected cardiac tissue is dependent on the particular etiology. Viral Etiologies A variety of viruses can result in myocarditis although Group B Coxsackie Viruses are by far the most common.[pathwaymedicine.org]
  • Applicable To Septic myocarditis Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol 1995; 75:378-382 Chapter 9 SPECIFIC PERICARDIAL DISORDERS Congenital malformations and acquired diseases 1. ‎[books.google.es]

Epidemiology

  • Pagina 340 - The Framingham Study: an epidemiological investigation of cardiovascular disease. National Institutes of Health publication, 1974:74-599. ‎[books.google.it]
  • References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • […] was first introduced by Corvisart It is defined by WHO / International Society and Federation of Cardiology (ISFC) as an inflammatory disease of the heart muscle, diagnosed by established histological, immunological and immunohistochemical criteria Epidemiology[pathologyoutlines.com]
  • Giant cell myocarditis, sarcoidosis, Kawasaki disease, Crohn disease, systemic lupus erythematosus, ulcerative colitis, Wegener granulomatosis, thyrotoxicosis, scleroderma, rheumatoid arthritis Peripartum cardiomyopathy Posttransplant cellular rejection Epidemiology[emedicine.medscape.com]
  • [22] Extracorporeal membrane oxygenation may be used in those who are about to go into cardiac arrest . [24] Alternative medicine [ edit ] Studies have shown no benefit for the use of herbal medicine on all cause mortality in viral myocarditis. [25] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • […] criteria Epidemiology Postmortem data identify myocarditis in 8.6% to 12% of cases of sudden death in young adults The Myocarditis Treatment Trial reported the incidence of biopsy proven myocarditis in patients with unexplained heart failure to be 9.6% Pathophysiology[pathologyoutlines.com]
  • Discussion A diagnosis of myocarditis should be contemplated when a patient presents with unexplained congestive heart failure, or with chest pain and elevated cardiac enzyme levels in the absence of coronary disease or coronary spasm.[ 3 ] The pathophysiology[bmcinfectdis.biomedcentral.com]
  • As the pathophysiology of myocarditis involves an immune response the literature debates whether there is a role for immunosuppression in the treatment strategy.[inmo.ie]

Prevention

  • Death from bacterial myocarditis can be prevented by early diagnosis and appropriate antibiotics.[ncbi.nlm.nih.gov]
  • In this application we will identify novel mechanisms underlying IL-1-mediated vasculitis, aortic aneurysm formation as well as myocarditis associated with KD, which will lead to new avenues for both prevention and treatment of cardiovascular complications[grantome.com]
  • Diphtheria myocarditis can be prevented by undergoing diphtheria immunization, and HIV can be prevented by following safe sex practices and avoiding intravenous drug use.[drugs.com]
  • Prevention There's no specific prevention for myocarditis. However, taking these steps to prevent infections might help: Avoid people who have a viral or flu-like illness until they've recovered.[mayoclinic.org]
  • Prevention While it is difficult to prevent myocarditis, taking steps to prevent the spread of viral, bacterial and other types of infections may help to reduce the risk.[ada.com]

References

Article

  1. Dec GW. Introduction to clinical myocarditis. In: Cooper LT, ed. Myocarditis: From Bench to Bedside. Totowa, NJ: Humana Press; 2003: 257–281.
  2. Kühl E, Schultheiss HP. Myocarditis. Early Biopsy Allows for Tailored Regenerative Treatment. Dtsch Arztebl Int. 2012 May; 109(20): 361–368
  3. Haddad F, Berry G, Doyle RL, Martineau P, Leung TK, Racine N. Active bacterial myocarditis: a case report and review of the literature. J Heart Lung Transplant. 2007 Jul;26(7):745-9
  4. Richardson P, McKenna RW, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation. 1996;93(5):841–842
  5. Dennert R, Crijns HJ, Heymans S. Acute viral myocarditis. European Heart Journal. 2008;29(17):2073–2082.
  6. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. Journal of the American College of Cardiology. 2009;53(17):1475–1487.
  7. Olimulder MAGM, van Es J, Galjee MA. The importance of cardiac MRI as a diagnostic tool in viral myocarditis-induced cardiomyopathy. Netherlands Heart Journal. 2009;17(12):481–486.
  8. Bruder O, Wagner A, Lombardi M, et al. European Cardiovascular Magnetic Resonance (EuroCMR) registry—multi national results from 57 centers in 15 countries. Journal of Cardiovascular Magnetic Resonance. 2013.

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Last updated: 2018-06-22 02:13