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Hypersensitivity Myocarditis

Myocarditis Due to Hypersensitivity State


Presentation

  • Abstract A 13-month-old boy presented with acute onset of complete atrioventricular block and wide complex tachycardia but normal hemodynamics.[ncbi.nlm.nih.gov]
  • A 39-year-old African American male with hypertension presented to Rush Presbyterian St. Luke's Medical Center with a 1-month history of progressive dyspnea on exertion, orthopnea, and dependent edema.[ncbi.nlm.nih.gov]
  • Case Presentation: We present a case of a 59 year old male with tetanus of the generalized type with an unusual presenting complaint of heart failure, preceding the classic muscle spasms associated with tetanus infection.[herdin.ph]
  • Histologically, the heart presented diffuse eosinophilic infiltrates located around perivascular structures and focal myocyte necrosis with numerous interstitial eosinophils admixed with histiocytes.[ncbi.nlm.nih.gov]
  • A 68-year-old woman presented with acute chest pain mimicking acute coronary syndromes, but the coronary angiography was normal.[ncbi.nlm.nih.gov]
Trismus
  • Trismus, commonly known as lockjaw is the most common presenting sign.[herdin.ph]
Heart Disease
  • A comprehensive and exhaustive reference of fundamental and clinical aspects of heart disease in infancy and childhood.[books.google.com]
  • diseases and sudden-unexpected deaths.[books.google.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]
  • I51.5 Myocardial degeneration I51.8 Other ill-defined heart diseases I51.81 Takotsubo syndrome I51.89 Other ill-defined heart diseases I51.9 Heart disease, unspecified I52 Other heart disorders in diseases classified elsewhere I60 Nontraumatic subarachnoid[icd10data.com]
  • Congenital Heart Disease, 6, 499-503. [Context Link] Rupani A., Amonkar G., & Deshpande J. (2010). Eosinophillic myocarditis and coronary arteritis in a fatal case of asthma. Indian Journal of Pathology and Microbioly, 53, 790-792.[nursingcenter.com]
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]
  • Her pulse was weak and thready, and she had an enlarged, tender liver, cardiomegaly, and S 3 and S 4 gallops.[nejm.org]
  • […] should always be considered in the differential diagnosis of children who present with a viral prodrome and nonspecific respiratory or abdominal symptoms associated with tachycardia, hypotension, or cardiac rhythm abnormalities, even in the absence of cardiomegaly[ahcmedia.com]
Systolic Murmur
  • She had a systolic murmur at the apex. Her chest auscultation was normal. Abdominal examination was unremarkable.[pmj.bmj.com]
  • Systolic murmurs of mitral regurgitation and tricuspid regurgitation may be present in patients with ventricular enlargement. Sudden cardiac death due to a fatal arrhythmia is sometimes the presenting feature.[merckmanuals.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.com]
Akathisia
  • After stopping treatment with haloperidol, risperidone, and biperiden, which were ineffective and burdened the patient with severe akathisia, clozapine therapy was started.[the-medical-dictionary.com]

Workup

Cardiomegaly on Chest X-ray
  • […] on chest x-ray." 20 Diagnostic Evaluation Electrocardiogram (ECG).[ahcmedia.com]
Gram-Positive Rods
  • Symptoms are caused by the tetanus-causing bacteria, Clostridium tetani, an anaerobic, gram-positive, rod-shaped bacterium. Trismus, commonly known as lockjaw is the most common presenting sign.[herdin.ph]
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]

Treatment

  • He had a history of treatment-resistant chronic schizophrenia. A complete immunohistochemical study was performed on heart specimens.[ncbi.nlm.nih.gov]
  • Hypersensitivity myocarditis is known to be a cardiac manifestation of a delayed-type hypersensitivity response caused by drug treatment. In heart transplantation candidates the incidence is elevated.[ncbi.nlm.nih.gov]
  • Endomyocardial biopsy was performed in order to establish or exclude a clear-cut relationship between cardiac dysfunction and clozapine, and was crucial to establish a correct diagnosis and appropriate treatment.[ncbi.nlm.nih.gov]
  • With no treatment, the rhythm disturbance resolved within days of onset. Our patient's presentation and self-limited illness is unique. To our knowledge, this is only the second reported case of eosinophilic myocarditis in a young child or infant.[ncbi.nlm.nih.gov]
  • Early recognition, instrumental diagnosis, and related specific treatment made this patient's course favorable.[the-medical-dictionary.com]

Prognosis

  • However, whether HSM at the time of HTx affects long-term prognosis, including acute cellular rejection (ACR) and antibody-mediated rejection (AMR), after HTx remains unclear.[ncbi.nlm.nih.gov]
  • 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]
  • This review covers the clinical and pathological characteristics, prognosis, and histological differential diagnosis of HSM.[ci.nii.ac.jp]
  • 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]
  • The prognosis is poor, with some cases requiring heart transplantation. Not uncommonly, incidental myocarditis that shows a focal lymphocytic process is seen at autopsy.[emedicine.medscape.com]

Etiology

  • 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]
  • Antiviral therapy has not been shown to be helpful in the treatment of viral etiologies. Bacterial etiologies may be treated with antibiotics, but this has not been shown to be effective except possibly in the acute infectious phase.[merckmanuals.com]
  • Kounis syndrome is a hypersensitivity-induced coronary syndrome that shares nearly similar etiology, symptomatology, cardiac manifestations, and laboratory findings with two other hypersensitivity cardiac diseases including eosinophilic arteritis and[nursingcenter.com]
  • Table 1 reviews the various infectious and non-infectious etiologies of myocarditis. Pathophysiology The pathogenesis of myocarditis is poorly understood due to the complex nature of the disease and its various etiologies ( see Figure 2 ).[ahcmedia.com]
  • How can infectious etiologies be tested for on autopsy? A: In general, the heart looks pretty normal in patients with myocarditis by the naked eye.[myocarditisfoundation.org]

Epidemiology

  • […] eosinophilic and giant cell myocarditis (GCM) Terminology GCM has been termed idiopathic GCM, pernicious myocarditis, Fiedler myocarditis, acute idiopathic interstitial myocarditis, giant cell granulomatous myocarditis, and granulomatous myocarditis Epidemiology[pathologyoutlines.com]
  • Grist NR, Reid D (1993) Epidemiology of viral infections of the heart. In: Banatvala JE (ed) Viral infections of the heart. Arnold, London, pp 23–31 Google Scholar 13.[link.springer.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]
  • […] catecholamine-induced injury and reperfusion injury) Pathologic classification is complicated, however, because tissue biopsies often are not obtained, and a presumptive clinical diagnosis must sometimes be confirmed by means of indirect methods such as serology. [1] Epidemiology[emedicine.medscape.com]
  • Epidemiological context This case was the only one found in a series of 1141 autopsies performed during one year (2011) in a Medico-Legal Institution that serves a territorial area of 29.206 Km 2 with a population of 2.595.540 inhabitants.[omicsonline.org]
Sex distribution
Age distribution

Pathophysiology

  • This entity can also complicate Churg-Strauss syndrome and seems to share the same pathophysiology with type I variant of Kounis syndrome.[nursingcenter.com]
  • […] myocarditis, Fiedler myocarditis, acute idiopathic interstitial myocarditis, giant cell granulomatous myocarditis, and granulomatous myocarditis Epidemiology Incidence difficult to determine as most cases are believed to be subclinical or underdiagnosed Pathophysiology[pathologyoutlines.com]
  • The pathophysiology of myocarditis remains a subject of research.[merckmanuals.com]
  • Pathophysiology The pathogenesis of myocarditis is poorly understood due to the complex nature of the disease and its various etiologies ( see Figure 2 ).[ahcmedia.com]

Prevention

  • Página 487 - Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory Committee (ACIP). ‎[books.google.es]
  • Despite causality assessment being difficult, prompt therapy must be given as soon as possible to prevent fatal outcomes. Delayed corticosteroid treatment, which is necessary regardless of the underlying cause, can result in heart failure and death.[link.springer.com]
  • Survival after heart transplantation is not impaired, and postoperative steroid therapy may prevent EM.[journals.lww.com]
  • […] and Atkins KA described that in developed countries infectious causes of heart muscle inflammation are uncommon in immunocompetent individuals. [3] Patients with Acquired immunodeficiency syndrome ( AIDS ), transplant associated immunosupression to prevent[ispub.com]
  • How can drug hypersensitivity syndrome be prevented? Patients who develop drug hypersensitivity syndrome must avoid taking the causative medicine/s again.[dermnetnz.org]

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