Presentation
ECG Commonly sought due to the clinical presentation, but demonstrates poor sensitivity. [radiopaedia.org]
Some presentations of myocarditis, especially those related to parvovirus B19, present like an acute lateral wall myocardial infarction. [intechopen.com]
Dermatomyositis : Degeneration ; Loss of striation ; Vacuolization and necrosis of muscle fibres may be seen ; Interstitial edema may be present ; Inflammatory infiltrate composed of mainly lymphocytes and histiocytes is present interstitially or perivascularly [histopathology-india.net]
The present case highlights the Neutrophilic Myocarditis as a rare fatal diagnosis made on autopsy. [ispub.com]
The term myocarditis describes the presence of inflammatory cells in the myocardium and implies that the presenting clinical phenotype is attributable to myocardial inflammation. [accessmedicine.mhmedical.com]
Entire Body System
- Disability
Manifested cardiac and general symptoms, a severe course and serious complications until the disability. Often is a complication of a viral or microbial infections. [mybodypain.com]
"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". [en.wikipedia.org]
Eosinophilic myocarditis can be a manifestation of eosinophilia-myalgia syndrome, which is a multisystem disease, caused by ingestion of contaminants in L-tryptophan containing products [ 185 ], characterized by peripheral eosinophilia and generalized disabling [intechopen.com]
- Leg Swelling
or neck veins Small amounts of urine If you have symptoms like these, your doctor will check you for an abnormal or rapid heartbeat, fluid in your lungs, or leg swelling. [webmd.com]
A physical exam may detect fluid in the lungs and swelling in the legs in older children. There may be signs of infection, including fever and rashes. A chest x-ray can show enlargement (swelling) of the heart. [medlineplus.gov]
Respiratoric
- Pleural Effusion
low voltage (low R-wave with poor progression) Imaging Chest x-ray and CT : cardiac enlargement, pulmonary congestion, pleural effusions Echocardiography Findings often unremarkable Ventricles: dilation, diffuse hypokinesia, reduced ejection fraction [amboss.com]
Pleural effusion. Viral or Chagas' serology may be helpful occasionally, as may autoantibodies (to screen for systemic autoimmune disease - eg, scleroderma) [ 5 ]. [patient.info]
may show pulmonary venous congestion, interstitial infiltrates, pleural effusions Echocardiography: Evaluates cardiac chamber size and wall thickness Assess systolic and diastolic function Rule out other causes of cardiac failure such as valvular heart [pathologyoutlines.com]
CT scans can show tree-in-bud opacities, pleural effusions, nodular lesions, or consolidation occasionally with cavitation. [clinicaladvisor.com]
[…] disease (pericarditis and tamponade) Accounts for 15-20% of moderate to large pleural effusions Mets - Lung, Breast, Hodgkin’s metastases Primary - Mesotheliomas and lipomas 17. SLE- pericardial involvement in up to 50% Rheumatoid Arthritis [slideshare.net]
Cardiovascular
- Heart Disease
Chapters cover the approach to the autopsy heart, ischemic heart disease, myocarditis, sudden death, valvular disease, transplant pathology, cardiomyopathy, cardiac neoplasia and congenital heart disease with a clear analysis of diagnostic criteria (macroscopic [books.google.de]
Cooper, Jr., 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]
Heart Inflammatory heart disease Infective myocarditis Topic Completed: 1 May 2014 Revised: 25 February 2019 Copyright: 2014-2019, PathologyOutlines.com, Inc. [pathologyoutlines.com]
Heart failure in Chagas heart disease is usually biventricular and commonly presents with fatigue. [intechopen.com]
disease, and evaluate for the presence or absence of a pericardial effusion (and potential tamponade physiology). [radiopaedia.org]
- Tachycardia
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]
Tachypnea and tachycardia are common. Tachycardia is often out of proportion to fever. Cyanosis may occur as well. The apex impulse may be diffuse and laterally displaced suggesting cardiomegaly. [intechopen.com]
[…] fluid is present around the heart Electrocardiogram (ECG or EKG): To assess the heart rhythm to determine the size and function of the atria and ventricles (upper and lower chambers of the heart) Stethoscope examination: To listen for a rapid heartbeat (tachycardia [utswmedicine.org]
Findings include: sinus tachycardia non-specific, most common overall electrocardiographic manifestation concave, diffuse ST segment elevation interventricular conduction delays right bundle branch block common in acute Chagas myocarditis prolongation [radiopaedia.org]
A number of tests may be used to confirm the diagnosis: With a stethoscope, doctors can listen for a rapid heartbeat (called tachycardia). Blood tests to check for recent infection or signs of inflammation in the body. [texasheart.org]
- Cardiomegaly
When it occurs quickly cardiomegaly, severe cardiac arrhythmias, and circulatory failure progresses rapidly comes death. [mybodypain.com]
CXR: Normal cardiac silhouette but pericarditis or overt clinical congestive heart failure is associated with cardiomegaly. Vascular redistribution. Interstitial and alveolar oedema. Pleural effusion. [patient.info]
[…] 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]
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]
Red blood cell casts Heart murmur is present at some times during the disease but is generally not constant. [atsu.edu]
- Gallop Rhythm
Heart sounds - soft S1 or S4 gallop rhythm. Signs of heart failure. Aetiology Infection Viral infection is the most common cause of acute myocarditis [ 2 ]. [patient.info]
However, clinically evident cardiac manifestations like dyspnea, muffled heart sounds, gallop rhythm or cardiac dilatation are much less common, occurring in 10 to 25 % of all patients with diphtheria [ 103 ]. [intechopen.com]
Workup
Microbiology
- Candida
Umbilical catheter cultures grew Candida parapsilosis. At laparotomy, there was a large ileal perforation with peritonitis, he was treated with amphotericin, antibiotics and had an ileostomy. [casereports.bmj.com]
Candida spp. parasites, e.g. [radiopaedia.org]
Examples include: Viral: Coxsackie B virus, enterovirus, adenovirus, influenza, and many others Bacterial: Streptococci, meningococci, clostridia, Corynebacterium, mycobacteria, and many others Fungal and parasites: Candida, aspergillosis, Cryptococcus [medicinenet.com]
Yeast infections, such as candida; molds, such as aspergillus; and other fungi, such as histoplasma, often found in bird droppings, can sometimes cause myocarditis, particularly in people with weakened immune systems. [mayoclinic.org]
T Wave
- T Wave Inversion
Physical agents Electric shock Hyperpyrexia Radiation/radiotherapy Investigations ECG: changes may include ST-segment elevation/depression, T-wave inversion, atrial arrhythmias, transient atrioventricular (AV) block. [patient.info]
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]
Left ventricular hypertrophy, inverted T waves, Q waves, and nonspecific ST-T changes have also been reported [ 215 ]. Recurrence in a subsequent pregnancy has been reported. [intechopen.com]
Other Pathologies
- Myocardial Fibrosis
[…] contraction 心筋収縮 myocardial damage 心筋障害 myocardial degeneration 心筋変性 myocardial disease 心筋疾患 myocardial dysfunction syndrome 心筋不全症候群 myocardial failure 心筋不全 myocardial fibrosis 心筋線維症/心筋線維化 myocardial infarction 心筋梗塞 MI myocardial injury 心筋傷害/心筋損傷 myocardial [jpeds.or.jp]
Associated with myocardial infarction. 21. Acute pericarditis - most often of viral origin. Acute pericarditis - heal by resolution or by pericardial fibrosis ranging from a thick, pearly, nonadherent epicardial plaque, to thin delicate adhesion to [slideshare.net]
Pleura
- Pleural Effusion
low voltage (low R-wave with poor progression) Imaging Chest x-ray and CT : cardiac enlargement, pulmonary congestion, pleural effusions Echocardiography Findings often unremarkable Ventricles: dilation, diffuse hypokinesia, reduced ejection fraction [amboss.com]
Pleural effusion. Viral or Chagas' serology may be helpful occasionally, as may autoantibodies (to screen for systemic autoimmune disease - eg, scleroderma) [ 5 ]. [patient.info]
may show pulmonary venous congestion, interstitial infiltrates, pleural effusions Echocardiography: Evaluates cardiac chamber size and wall thickness Assess systolic and diastolic function Rule out other causes of cardiac failure such as valvular heart [pathologyoutlines.com]
CT scans can show tree-in-bud opacities, pleural effusions, nodular lesions, or consolidation occasionally with cavitation. [clinicaladvisor.com]
[…] disease (pericarditis and tamponade) Accounts for 15-20% of moderate to large pleural effusions Mets - Lung, Breast, Hodgkin’s metastases Primary - Mesotheliomas and lipomas 17. SLE- pericardial involvement in up to 50% Rheumatoid Arthritis [slideshare.net]
Treatment
Clinical trials often give patients access to leading-edge treatments that are not yet widely available. [utswmedicine.org]
Treatment [ edit ] Treatment of myocarditis differs between cases, and depends on the severity of each condition. [en.wikibooks.org]
If a virus is identified, there is evidence that treatment with beta-interferon may be helpful. [isarherzzentrum.de]
What is the treatment for myocarditis? Often, myocarditis improves on its own without treatment with complete recovery. [medicinenet.com]
More severe cases of pericarditis may require interventional or surgical treatment. Pediatric Heart Related Articles [uchicagokidshospital.org]
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 of Myocarditis The prognosis varies with the type of myocarditis. Many studies have been done to predict the outcome of disease, but no reliable markers are available thus far. [medindia.net]
Complications Congestive cardiac failure Pulmonary oedema Cardiogenic shock Dilated cardiomyopathy Dysrhythmias Recurrent myositis Prognosis The prognosis for patients with acute myocarditis can be very good but depends on clinical presentation, LVEF [patient.info]
Etiology
Inflammation from viral etiologies is thought to be caused both by direct cellular damage by the infectious agent and also from involvement by the host's immune system. Etiology Infectious etiologies viral (most common etiology): e.g. [radiopaedia.org]
The descriptive diagnosis of myocarditis encompasses a wide spectrum of etiologically different diseases that share, as unique criterion, the presence of myocardial inflammation. [accessmedicine.mhmedical.com]
MYOCARDIAL INFARCTION ETIOLOGY: Chylamydia pneumoniae, a Gram -, pleomorphic, obligate intracellular parasite. [atsu.edu]
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]
Currently, the etiology of peripartum cardiomyopathy (PPCM) remains unclear. [intechopen.com]
Epidemiology
References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Epidemiology The exact incidence of myocarditis is unknown. One study suggested that myocarditis is the cause of sudden cardiac death in 8.6% of cases and is identified in up to 9% of routine post-mortem examinations [ 1 ]. [patient.info]
[…] 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]
[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]
There are few population-based, epidemiologic studies which have defined the presenting symptoms of acute myocarditis; this is due to the absence of a safe and sensitive noninvasive test that can confirm the diagnosis. [intechopen.com]
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]
Based on pathophysiology there are three major groups : 1.Dilated ; 2.Hypertrophic ; 3.Restrictive. Dilated type - Hypertrophy & dilation of left ventricle with normal left atrium. ; Hypertrophic type -Thick left ventricle with small cavity [slideshare.net]
Prevention
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]
He’ll also try to take the extra load off your heart, if needed, and take steps to prevent or control complications. Usually, you’ll be prescribed medicines to help your heart work better. [webmd.com]
Prevention The best thing you can do to prevent myocarditis is to avoid infections known to cause the condition: Take normal precautions against germs, such as properly washing your hands and avoiding sick people. Practice safe sex. [innerbody.com]
[…] showing that exercise increases the risk of mortality by 45% with those infected with Coxsackie virus. [9] With this evidence shown, exercise at moderate intensity is highly recommended once the heart muscle has recovered as it will assist in further preventing [en.wikibooks.org]
[…] heart is infected (rare) Myocarditis Treatments Treatments for myocarditis include: Analgesics or anti-inflammatory drugs to relieve pain Antibiotics to treat bacterial infection Diuretics to remove fluid from the lungs and legs Low-salt diet to help prevent [utswmedicine.org]