Edit concept Question Editor Create issue ticket

Toxic Myocarditis

Acut Toxic Myocar Dis


Presentation

  • Our patient presented with cardiocirculatory shock, necessitating the use of inotropes and mechanical ventilation.[ncbi.nlm.nih.gov]
  • Myocarditis can be difficult to diagnose in the Emergency Department (ED) due to the lack of classic symptoms and the wide variation in presentations.[ncbi.nlm.nih.gov]
  • Our patient presented with cardio-circulatory shock, necessitating the use of inotropes and mechanical ventilation.[link.springer.com]
  • A 66-year-old woman presented with new-onset complete left bundle branch block and congestive heart failure.[ncbi.nlm.nih.gov]
  • Key information is presented in tabular format wherever possible. A companion website will offer the fully searchable text and an image bank"--Provided by publisher.[books.google.de]
Congestive Heart Failure
  • We report the case of a 32-year-old man, admitted to cardiac care unit with congestive heart failure, caused by a reduced global cardiac function four months after oral hydrofluoric acid ingestion while attempting suicide.[ncbi.nlm.nih.gov]
  • A 66-year-old woman presented with new-onset complete left bundle branch block and congestive heart failure.[ncbi.nlm.nih.gov]
  • An approach used only with a patient's consent, this procedure may also confirm acute myocarditis, allowing close monitoring of potential congestive heart failure.[encyclopedia.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]
  • Cardiac symptoms usually require additional medication, including amiodarone for arrhythmias or beta blockers for congestive heart failure.[amboss.com]
Dull Chest Pain
  • The patient may have vague, dull chest pain, weight loss, night sweats, cough, and dyspnea. Physical findings in all three types of pericarditis depend on how much exudate accumulates in the pericardial space (See Table P-1 and Table P-2).[atsu.edu]
Streptococcal Pharyngitis
  • Epidemiology In 0.3-3% cases of untreated streptococcal pharyngitis, infection induces the host’s immune system to produce antibodies that damage host tissue and elicit the symptoms of acute rheumatic fever.[atsu.edu]
Heart Disease
  • They include: rheumatic heart disease, congenital heart disease (i.e., bicuspid aortic valve, ventricular septal defect, coarctation of the aorta, tetralogy of Fallot), mitral valve prolapse, degenerative heart disease (e.g., calcific aortic valve disease[atsu.edu]
  • Familial and senile amyloid heart disease are related to the overproduction of transthyretin. Myocardial amyloid heart disease is confirmed by EMB.[clevelandclinicmeded.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]
  • A great deal of information about the pathogenesis of myocarditis has been gained from experimental models in rodents using heart disease induced by infection using coxsackievirus B3 or by immunization with cardiac myosin.[journals.lww.com]
  • Heart Inflammatory heart disease Infective myocarditis Topic Completed: 1 May 2014 Revised: 25 February 2019 Copyright: 2014-2019, PathologyOutlines.com, Inc.[pathologyoutlines.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]
  • […] 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]
  • Myocarditis should be suspected when shock is accompanied by cardiomegaly or pulmonary edema. A number of metabolic and genetic diseases are associated with cardiomyopathy, and may cause similar signs and symptoms of myocardial dysfunction.[clinicaladvisor.com]
  • Diagnostic Modalities The chest x-ray typically demonstrates cardiomegaly and increased pulmonary vascular markings, indicating pulmonary oedema.[jpma.org.pk]
  • Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires).[clevelandclinicmeded.com]
Gallop Rhythm
  • All patients presented with tachypnoea, tachycardia, sweating, gallop rhythm, pulmonary wheezing, rales and hepatomegaly.[bestbets.org]
  • 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]
  • A gallop rhythm, produced by the third or fourth heart sound is best heard at the apex.[jpma.org.pk]
  • The patient may also manifest symptoms of congestive heart failure (tachypnea, orthopnea, jugular venous distention, rales, hepatomegaly, a gallop rhythm, and peripheral swelling and edema) or pericarditis (see symptoms in pericarditis section above).[atsu.edu]
  • rhythm, persistent jugular venous distention, systemic hypotension, peripheral vascular disease Laboratory findings Hyponatremia, persistently elevated B-type natriuretic peptide and A-type natriuretic peptide levels, elevated norepinephrine and renin[clevelandclinicmeded.com]
Heart Murmur
  • In infants, symptoms may also include bluish skin, heart murmurs, and a poor appetite.[healthcentral.com]
  • Carditis is most commonly detected when a new heart murmur has been auscultated or when tachycardia out of proportion to the fever is observed.[atsu.edu]
S3 Gallop
  • A S3 gallop indicates left-sided congestive heart failure.[atsu.edu]
Bone Pain
  • Chest pain, typically behind the sternum ( breast bone pain ) Palpitations Rapid and/or irregular heart rate Fever (infectious and sometimes immune-mediated causes) Shortness of breath Fatigue Leg swelling Additional symptoms may be related to the underlying[healthhype.com]

Workup

Rickettsia Typhi
  • typhi (typhus fever) Fungi like Candida Protozoa Trypanosoma cruzi (Chagas disease) Toxoplasmosis Helminths like trichinosis Immune In these instances the body’s immune system targets the heart muscle and causes inflammation due to one or more trigger[healthhype.com]
Coxiella Burnetii
  • Evidence of endocardial involvement by positive echocardiogram OR new regurgitant murmur Positive Q fever serology (antiphase I IgG 1:800), or single blood culture positive for Coxiella burnetii Predisposing heart disease or injection drug use Fever 38[atsu.edu]
Complete Left Bundle Branch Block
  • A 66-year-old woman presented with new-onset complete left bundle branch block and congestive heart failure.[ncbi.nlm.nih.gov]

Treatment

  • Supportive therapy is paramount in the treatment of this condition.[ncbi.nlm.nih.gov]
  • Acetaminophen overdose is common and typically leads to liver failure requiring supportive treatment and emergency liver transplantation. Toxic myocarditis is an extremely rare complication of acetaminophen overdose.[ncbi.nlm.nih.gov]
  • Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Hum Exp Toxicol 2005;24(4):215–218. PubMed CrossRef Google Scholar 8. Uriel N, Kaluski E, Hendler A, et al.[link.springer.com]
  • Treatment The treatment goal is to relieve symptoms of heart failure and there is no effective proven treatment for myocarditis. Usually medications for heart failure are recommended.[nhcs.com.sg]
  • Depending on the cause, treatment may be antiviral or immunosuppressive. Endomyocardial biopsy is proving of value in determining cause and deciding future therapy.[journals.lww.com]

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.[medicinenet.com]
  • Anecdotal evidence suggests an excellent long term prognosis. Links: myocarditis[gpnotebook.co.uk]
  • 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]
  • Although the prognosis of patients who develop heart failure after viral myocarditis is poor, not all patients with viral myocarditis will develop a weakened heart.[nhcs.com.sg]

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.de]
  • (See Etiology, Clinical, and Workup.)[emedicine.medscape.com]
  • Causes of myocarditis Even though a broad spectrum of etiologies has been implicated as causes of myocarditis, viral myocarditis still represents the prototype for the study of this disease and its evolution.[news-medical.net]
  • 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]
  • Therefore, the concurrent viral etiology of intussusceptions and myocarditis in this child might explain the presence of two distinct diseases in autopsy.[synapse.koreamed.org]

Epidemiology

  • Seite 69 - Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems. ‎[books.google.de]
  • 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]
  • Epidemiology Forced exercise, pregnancy, use of steroids or nonsteroidal anti-inflammatory agents, use of ethanol, and nutritional deficiencies are factors that predispose a patient to symptomatic myocarditis.[atsu.edu]
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]
  • Further studies of the pathophysiology of myocarditis would lead to improved diagnostic criteria, which would facilitate future research . Read the full abstract... Background: This is an update of a previous review .[cochrane.org]
  • Journal Circulation 115:5-8 (2007) DOI: 10.1161/CIRCULATIONAHA.106.670554 Reference PMID: 12439638 Authors Pankuweit S, Portig I, Maisch B Title Pathophysiology of cardiac inflammation: molecular mechanisms.[genome.jp]
  • 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

  • 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]
  • Deterrence and prevention Vaccination should reduce the incidence of myocarditis caused by measles, rubella, mumps, poliomyelitis, and influenza. The development of vaccines for other cardiotropic viruses may prevent viral myocarditis in the future.[emedicine.medscape.com]
  • 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]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!