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Fungal Myocarditis


Presentation

  • Srinivas Ananth Narayan, Elizabeth Ann Orchard Department of Cardiology, The John Radcliffe Hospital, Oxford, Oxfordshire, UK Correspondence to Dr Elizabeth Ann Orchard, elizabethorchard{at}hotmail.com Summary A male infant born at 25 weeks gestation presented[casereports.bmj.com]
  • This reference guide will be the must-have of any internist or medical professional, as it takes a vast quantity of data across a sweeping grid of disorders, diseases, and presentations, and boils them down to individual parts, facilely indexed, and located[books.google.de]
  • ECG Commonly sought due to the clinical presentation, but demonstrates poor sensitivity.[radiopaedia.org]
  • 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]
Chronic Fatigue Syndrome
  • Kradin has a number of clinical interests including Chronic Fatigue Syndrome, Interstitial Lung Disease, Multiple Chemical Sensitivity and Pulmonary Immunology. He also holds an Associate Professor position of Pathology at Harvard Medical School.[books.google.com]
Abdominal Distension
  • distension, was transferred to our institution for surgical management following suspected bowel perforation with severe sepsis.[casereports.bmj.com]
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]
  • ., 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]
  • disease, and evaluate for the presence or absence of a pericardial effusion (and potential tamponade physiology).[radiopaedia.org]
  • Children with congenital heart disease, including valve disorders, have a greater risk for developing endocarditis. This infection is not common in kids with healthy hearts.[uchicagokidshospital.org]
Cardiomegaly
  • 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]
  • When it occurs quickly cardiomegaly, severe cardiac arrhythmias, and circulatory failure progresses rapidly comes death.[mybodypain.com]
  • […] 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 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]
Pulsus Alternans
  • Once heart dysfunction sets in, signs of cardiac failure may manifest, such as pulmonary edema (fluid accumulation in the lungs), peripheral oedema, hypoxemia, pulsus alternans, etc.[medindia.net]
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]

Workup

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]
Myocardial Fibrosis
  • 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 oxygen consumption 心筋酸素消費量 myocardial tumor 心筋腫瘍 myocarditis 心筋炎 myoclonia/myoclony ミオクロニー myoclonic encephalopathy of childhood 小児期ミオクロニー脳症/Kinsbourne症候群 myoclonic[jpeds.or.jp]
  • .  Loeffler endocarditis:  This is characterized by endo-myocardial fibrosis with large mural thrombi and is found in temperate zone.  Eosinophilic infiltration is seen in multiple organs including the heart.  There may be associated peripheral eosinophilia[slideshare.net]
Left Ventricular Hypertrophy
  • Serial echocardiograms revealed a patent ductus arteriosus (PDA), but also demonstrated increasing left ventricular hypertrophy and the development of bright areas within the septal myocardium.[casereports.bmj.com]
Ventricular Hypertrophy
  • Serial echocardiograms revealed a patent ductus arteriosus (PDA), but also demonstrated increasing left ventricular hypertrophy and the development of bright areas within the septal myocardium.[casereports.bmj.com]

Treatment

  • 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]
  • After treatment for candidal infection, there was improvement in left ventricular thickness and brightness of the echogenic lesions was reduced.[casereports.bmj.com]
  • Clinical trials often give patients access to leading-edge treatments that are not yet widely available.[utswmedicine.org]
  • If a virus is identified, there is evidence that treatment with beta-interferon may be helpful.[isarherzzentrum.de]

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]
  • .  Pericardial involvement is related to infarct size  Early stage - inflammatory etiology  Late stage  Immune mediated weeks to months out  Known as Post Cardiac Injury syndrome (PCIS) or Dressler’s syndrome  Rare in modern time due to reperfusion[slideshare.net]

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]
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]
  • .  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]

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