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Myocarditis due to Radiation

Myocarditis Caused by Radiation


Presentation

  • A rationalisation of the 1350 boxes used throughout the book gives a simpler and clearer presentation of the various categories.[books.google.com]
  • 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]
  • A pericardial friction rub from pericarditis may be present. Ewart’s sign is dullness to percussion at the left lung base due to compressive atelectasis from a large pericardial effusion.[healio.com]
Fever
  • […] shift of mos devices due to radiation in the low - dose range 低劑量輻照條件下的mosfet因輻照導致的閾值電壓漂移的模擬 Only a few patients, especially those who have received large dosage of radiation at a time, may have some side effects, such as, headache, naupathia, vomit, fever[dict.site]
  • Adult patients are commonly asymptomatic or present with nonspecific symptoms, including fever, fatigue, and weakness.[amboss.com]
  • Bacterial/rickettsial : C. diphtheriae, C. perfringens, Mycoplasma pneumoniae, S. pyogenes (toxin-mediated, acute rheumatic fever ), S. pneumoniae, N. meningitidis, N. gonorrhoeae, Salmonella, H. influenzae, Brucella, S. aureus, Listeria, Legionella,[hopkinsguides.com]
  • Symptoms of myocarditis may start as fatigue, shortness of breath, fever and aching of the joints, all characteristic of a flu-like illness.[medical-dictionary.thefreedictionary.com]
  • Patients with myocarditis may present with the following signs and symptoms: Mild symptoms of chest pain (in concurrent pericarditis), fever, sweats, chills, dyspnea In viral myocarditis: Recent history ( 1-2 wk) of flulike symptoms of fevers, arthralgias[emedicine.medscape.com]
Congestive Heart Failure
  • 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]
  • Congestive heart failure is when the heart is unable to pump enough blood throughout the body. Chemotherapy can cause mild or severe damage to the heart. If severe, congestive heart failure or other life-threatening problems can occur.[nccn.org]
  • 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]
  • Cardiac symptoms usually require additional medication, including amiodarone for arrhythmias or beta blockers for congestive heart failure.[amboss.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]
Physician
  • New ‘In Adolescence’ boxes recognise the fact that many chronic disorders begin in childhood and become the responsibility of physicians practising adult medicine.[books.google.com]
  • College of Emergency Physicians Disclosure: Nothing to disclose.[emedicine.medscape.com]
  • *Medscape Business of Medicine Academy Survey, September 2015 Learn from Experienced Professionals Courses were developed especially for physicians by business health experts and experienced physicians.[medscape.org]
  • Search Physicians View All Physicians Your Visit Your Visit We want your visit to go smoothly.[heart.phoenixchildrens.org]
  • It also requires well-trained people, from physician specialists and physician’s assistants to nurse practitioners, obstetrical nurses and other health care professionals.[excelahealth.org]
Surgical Procedure
  • If symptoms progressively worsen and can not be controlled through these measures, surgical procedures may be necessary.[columbiasurgery.org]
  • Radiation-induced fibrosis of surrounding structures generally makes surgical procedures more difficult, 19 and inclusion of the internal mammary artery or internal thoracic artery in the radiation field may result in stenosis of these vessels, rendering[mdedge.com]
Lymphedema
  • […] skin that is radiated gets red, itchy and may blister (like a sun burn) breast or chest wall tenderness or mild pain tiredness or fatigue (some women feel a little light-headed) are swelling or edema (usually slight, see section below about avoiding lymphedema[aboutcancer.com]
Common Cold
  • These viruses typically cause other less serious diseases, such as gastrointestinal problems and the common cold.[bcm.edu]
  • Many viruses are commonly associated with myocarditis, including the viruses that cause the common cold (adenovirus); hepatitis B and C; parvovirus, which causes a mild rash, usually in children (fifth disease); and herpes simplex virus.[mayoclinic.org]
  • Viral infections – such as the viruses that cause the common cold, flu, chickenpox, glandular fever, German measles, gastrointestinal (‘stomach’) infections and adenovirus (lung infections).[cardiomyopathy.org]
  • The Coxsackie virus is one of the most frequently implicated in viral myocarditis in Western Europe and North America, but many other viruses can trigger myocarditis, including: Parvovirus B-19 (fifth disease) Adenovirus ( common cold ) Influenza virus[ada.com]
Pulmonary Disorder
  • Offers a complete overview including basic cardiopulmonary anatomy and physiology, the pathophysiology of commonly encountered cardiac and pulmonary disorders, diagnostic tests and procedures, therapeutic interventions, pharmacology, physical therapy[books.google.com]
Painful Cough
  • Cough Fatigue Swelling (edema) in the legs, feet, and face Pediatric myocarditis can be hard to diagnose because the signs and symptoms often mimic those of other heart and lung diseases, or a bad case of the flu.[medlineplus.gov]
Vomiting
  • […] voltage shift of mos devices due to radiation in the low - dose range 低劑量輻照條件下的mosfet因輻照導致的閾值電壓漂移的模擬 Only a few patients, especially those who have received large dosage of radiation at a time, may have some side effects, such as, headache, naupathia, vomit[dict.site]
  • Ingested material should be removed promptly by induced vomiting or by washing out the stomach if exposure is recent.[rarediseases.org]
  • Initial symptoms: lack of appetite, anxiety and night, the screams of the child, the attacks of cyanosis (bluing) and shortness of breath, nausea and vomiting.[qsota.com]
  • vomiting after exposure 2–6 h 1–2 h 10–60 min 10 min Minutes Duration of nausea and vomiting 24 h 24–48 h 48 h 48 h N/A (patients die in 48 h) Severity and incidence of diarrhea None None to mild ( 10%) Moderate to Severe ( 10%) Severe ( 95%) Severe[merckmanuals.com]
  • […] 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, nausea, vomiting[amboss.com]
Failure to Thrive
  • Fred Ferri’s popular "5 books in 1" format provides quick guidance on menorrhagia, Failure to Thrive (FTT), Cogan’s syndrome, and much more.[books.google.com]
  • Symptoms may include: Anxiousness Failure to thrive or poor weight gain Feeding difficulties Fever and other symptoms of infection Listlessness Low urine output (a sign of decreasing kidney function) Pale, cool hands and feet (a sign of poor circulation[medlineplus.gov]
  • […] or persistent myocarditis Preceding ( 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[amboss.com]
Chest Pain
  • However, acute pericarditis is more likely if inspiration and supine position worsens the chest pain, and sitting upright and leaning forward alleviates the chest pain; the pain in STEMI is unaffected by position.[ecgwaves.com]
  • Myocarditis care at Mayo Clinic Symptoms If you have a mild case of myocarditis or are in the early stages, you might have no symptoms or mild ones, such as chest pain or shortness of breath.[mayoclinic.org]
  • When To Call a Professional Call your doctor immediately if you have chest pain, even if you think that you are too young to be having heart problems.[drugs.com]
  • If chest pain, trouble breathing, or swelling have gotten worse since you were told you have myocarditis, call 911 or go to the hospital. Treatment If you have myocarditis, your doctor will treat its cause, if possible.[webmd.com]
Suggestibility
  • Access full-color images and 65 online-only topics at Expert Consult, as well as online-only contents including EBMs, Suggested Reading, Patient Teaching Guides, and additional algorithms.[books.google.com]
  • Recent studies suggest that in most cases, damage from anthracycline chemotherapy drugs is likely to appear within the first post-treatment year.[blog.dana-farber.org]
  • Examples include: ACE inhibitors Calcium channel blockers Diuretics Your doctor will also probably suggest rest or reduced activity for at least 6 months. He’ll probably also put you on a low-salt diet to keep fluid from building up.[webmd.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]
  • Electrical testing ( EKG ) can suggest irritation of heart muscle and document irregular beating of the heart. Nuclear heart scan testing can show irregular areas of heart muscle.[rxlist.com]
Headache
  • Simulating threshold voltage shift of mos devices due to radiation in the low - dose range 低劑量輻照條件下的mosfet因輻照導致的閾值電壓漂移的模擬 Only a few patients, especially those who have received large dosage of radiation at a time, may have some side effects, such as, headache[dict.site]
  • […] night while lying down Abnormal heartbeat, which causes fainting in rare cases Light-headedness A sharp or stabbing chest pain or pressure, which may spread to your neck and shoulders Fatigue Signs of infection, such as Fever Muscle aches Sore throat Headache[webmd.com]
  • If symptoms occur, they may include: Chest pain that may resemble a heart attack Fatigue or listlessness Fever and other signs of infection including headache, muscle aches, sore throat, diarrhea, or rashes Joint pain or swelling Leg swelling Pale, cool[stlukes-stl.com]
Stroke
  • A new chapter specifically on Stroke Disease recognises the emergence of Stroke Medicine as a distinct clinical and academic discipline.[books.google.com]
  • Clots can form in your heart, leading to a stroke or heart attack. Treatment for myocarditis depends on the cause.[mayoclinic.org]
  • Symptoms of dilated cardiomyopathy range from none to possibly including the following: Heart failure Stroke Arrhythmias Sudden cardiac death.[ada.com]
  • Increased risk of stroke – this is because when the heart is not able to pump effectively, blood can pool in the chambers of the heart and form blood clots. These clots can get trapped in blood vessels and could cause a heart attack or stroke.[cardiomyopathy.org]
  • Critical Care Our emergency medicine physicians and nurses who are dedicated to the care of patients with broken arms and “broken” hearts to stroke or sudden pain and more.[excelahealth.org]

Workup

Pericardial Effusion
  • Iatrogenic pericardial effusions are common after cardiac surgery and frequently require drainage. Pericardial effusions caused by radiation therapy are less common due to the dose reduction possible today.[healio.com]
  • Treatment Complications Progression to dilated cardiomyopathy ( 15% of cases ) Concurrent pericaridits ( perimyocarditis ) that may lead to cardiac tamponade (associated with large pericardial effusions) Heart failure or sudden cardiac death : probably[amboss.com]
  • effusion (and potential tamponade physiology).[radiopaedia.org]
  • .  Common bugs  Cocksackie A and B  Echovirus  Adenovirus  Viral infections uncommon in patients presenting with pericardial effusion w/o pericarditis  Exception is HIV- frequently presents with significant effusion w/o pericarditis  seen in 7[slideshare.net]
  • The 2D echocardiography obtained in the emergency department showed a normal sized non-hypertrophic left ventricle with inferior wall hypokinesis and normal global systolic function, with no pericardial effusion.[revespcardiol.org]
Chlamydia
  • […] rickettsial : C. diphtheriae, C. perfringens, Mycoplasma pneumoniae, S. pyogenes (toxin-mediated, acute rheumatic fever ), S. pneumoniae, N. meningitidis, N. gonorrhoeae, Salmonella, H. influenzae, Brucella, S. aureus, Listeria, Legionella, Mycoplasma, Chlamydia[hopkinsguides.com]
  • Some things that can cause myocarditis include: Coxsackie B viruses Epstein-Barr virus ( EBV ) Cytomegalovirus ( CMV ) Hepatitis C Herpes HIV Parvovirus Chlamydia (a common sexually transmitted disease ) Mycoplasma (bacteria that cause a lung infection[webmd.com]
  • It may also be caused by bacterial infections such as Lyme disease, streptococcus, mycoplasma, and chlamydia.[stlukes-stl.com]
Staphylococcus Aureus
  • Corynebacterium diphtheriae, Streptococcus pyogenes, Staphylococcus aureus, Borrelia burgdorferi fungal, e.g. Candida spp. parasites, e.g.[radiopaedia.org]
Myocardial Fibrosis
  • In general, potential heart-related adverse events from immunotherapy are myocardial fibrosis, myocarditis, and acute heart failure, which have been reported among patients treated with programmed cell death protein-1 (PD-1) pathway immunotherapy, noted[medpagetoday.com]
  • Applicable To Chronic (interstitial) myocarditis Myocardial fibrosis Myocarditis NOS Type 1 Excludes Type 1 Excludes Help A type 1 excludes note is a pure excludes. It means "not coded here".[icd10data.com]
  • Aortic stiffness and interstitial myocardial fibrosis by native T1 are independently associated with left ventricular remodeling in patients with dilated cardiomyopathy. Hypertension 2014; 64: 762–8.[ecrjournal.com]
  • "For instance, the role of nuclear cardiology for assessing pericardial structures, myocardial fibrosis or valvular heart disease associated with RIHD is limited by its suboptimal spatial resolution," they wrote.[medicalphysicsweb.org]
  • Progressive fibrosis leads to impaired diastolic function, which can culminate in constrictive pericarditis (if the pericardial fibrosis dominates), restrictive cardiomyopathy (if the myocardial fibrosis dominates), or a combination of the 2 forms [ 6[omicsonline.org]

Treatment

  • Lists the latest drugs used for the treatment of cardiopulmonary disorders. Includes information on laboratory medicine and pediatrics to help you apply cardiopulmonary principles to practice.[books.google.com]
  • Your heart will likely be checked before you start treatment. This will tell your doctor about your baseline (pre-treatment) heart health.[nccn.org]
  • Therefore, cardiologists recommend heart function be tested with an echocardiogram before treatment starts and again one year following treatment.[blog.dana-farber.org]
  • As more patients are surviving cancer and living longer, knowledge about the long-term effects of treatment is expanding.[my.clevelandclinic.org]

Prognosis

  • 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.[rxlist.com]
  • 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]
  • Treatment of myocarditis The prognosis depends on the form of the disease and its severity. Myocarditis Abramov-Fiedler, septic and diphtheria myocarditis prognosis for life is poor.[qsota.com]

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]
  • etiology triggered by ipilimumab as the most likely culprit of the heart failure," the researchers stated.[medpagetoday.com]
  • (See Etiology, Clinical, and Workup.)[emedicine.medscape.com]
  • 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]
  • Importantly, the clinical presentation, as well as the cardiac magnetic resonance findings, in our case were similar to those reported in other common etiologies of myocarditis, such as Parvovirus B19 infection.[revespcardiol.org]

Epidemiology

  • References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology[brainscape.com]
  • "As the epidemiological studies do not give clues on the important mechanisms underlying RIHD, it is difficult to design preventive strategies.[medicalphysicsweb.org]
  • 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]
  • […] with nonirradiated patients, patients who have undergone chest radiotherapy have a 2% higher absolute risk of cardiac morbidity and death at 5 years and a 23% increased absolute risk after 20 years. 2 This article will review the pathophysiology and epidemiology[mdedge.com]
Sex distribution
Age distribution

Pathophysiology

  • It integrates key concepts of pathophysiology, clinical manifestations, diagnostic tests and laboratory information and findings with clinically important medical and surgical interventions and pharmacologic therapies — then applies the material to physical[books.google.com]
  • The pathophysiology remains poorly understood, but radiation "might harm virtually all cardiac tissues and the underlying pathophysiological mechanisms may be related to micro- and macrovascular damages," they explained.[medicalphysicsweb.org]
  • But endothelial cells remain sensitive to radiation, and the pathophysiology of most forms of RIHD appears to be associated with damage to endothelial cells.[mdedge.com]
  • Few studies in animal models have explored the potential of molecular imaging to detect or monitor the effectors and/or modulators of inflammation based on the ability of radiolabeled ligands to measure pathophysiological processes.[ecrjournal.com]
  • Pathophysiology Dilated cardiomyopathy represents the final common morphologic outcome of various biologic insults. The combination of myocyte injury and necrosis associated with myocardial fibrosis results in impaired mechanical function.[clevelandclinicmeded.com]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.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]
  • Ultimately, the prevention of heart problems from cancer therapy is the goal. Here, too, there are signs of hope. In 2011, British researchers were able to prevent heart failure from trastuzumab (Herceptin) using beta blockers.[health.harvard.edu]
  • 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]
  • Also, researchers are working to learn more about what causes cardiotoxicity from cancer care and how it can be better detected, treated, and prevented.[today.uconn.edu]

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