DOCSLIB.ORG

Severe Acute Mitral Valve Regurgitation in a COVID-19-Infected Patient

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Severe Acute Mitral Valve Regurgitation in a COVID-19-Infected Patient Case report BMJ Case Rep: first published as 10.1136/bcr-2020-239782 on 18 January 2021. Downloaded from Severe acute mitral valve regurgitation in a COVID- 19- infected patient Ayesha Khanduri, Usha Anand, Maged Doss, Louis Lovett Graduate Medical Education, SUMMARY damage leading to pulmonary oedema and respira- WellStar Health System, The ongoing SARS- CoV-2 (COVID-19) pandemic has tory failure secondary to congestive heart failure. In Marietta, Georgia, USA presented many difficult and unique challenges to the these patients, a broader differential for pulmonary medical community. We describe a case of a middle- aged oedema and respiratory failure must be considered Correspondence to to ensure timely and appropriate treatment. Dr Ayesha Khanduri; COVID-19- positive man who presented with pulmonary ayesha. khanduri@ wellstar. org oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. CASE PRESENTATION Accepted 3 December 2020 Later in the hospital course, his pulmonary oedema and A middle-aged man presented to the emergency respiratory failure worsened as result of severe acute department with progressively worsening short- mitral valve regurgitation secondary to direct valvular ness of breath, a non-productive cough and hypox- damage from COVID-19 infection. The patient underwent emia. His medical history was significant for atrial emergent surgical mitral valve replacement. Pathological flutter status post ablation in 2017. The patient evaluation of the damaged valve was confirmed to be is a lifelong non- smoker who bikes 2 miles daily. secondary to COVID-19 infection. The histopathological At that time in 2017, an echocardiogram revealed findings were consistent with prior cardiopulmonary mild mitral valve regurgitation with a normal left autopsy sections of patients with COVID-19 described ventricular ejection fraction (LVEF >55%). He also in the literature as well as proposed theories regarding had a history of hypertension, asthma and chronic ACE2 receptor activity. This case highlights the potential sinusitis. He was diagnosed with COVID-19 3 days of SARS- CoV-2 causing direct mitral valve damage prior to presentation to the emergency room at a resulting in severe mitral valve insufficiency with local testing site. Vital signs on admission were as subsequent pulmonary oedema and respiratory failure. follows: respiratory rate of 29 breaths per minute, heart rate of 99 beats per minute, blood pressure of 132/80 mm Hg, temperature of 37.2°C and an oxygen saturation of 87% on room air. Initial BACKGROUND physical examination revealed that the patient was This novel organism which is a single- stranded in mild respiratory distress. The lung examination http://casereports.bmj.com/ enveloped virus, SARS- CoV-2, is highly virulent, revealed decreased breath sounds in the right lung contagious and deadly with a high mortality rate 1 with scattered wheezes. On cardiac examination, in the USA. This respiratory virus can also cause no appreciable murmurs or gallops were noted. cardiovascular, gastrointestinal, renal, haemato- There was no lower extremity oedema. logic and neurological organ system dysfunction. Laboratory studies on admission demonstrated a Research shows that patients with underlying normal white blood cell count (8.0x10³/L), mildly cardiovascular disease were more likely to exhibit elevated terminal pro B-type natriuretic peptide elevated troponin T (Tn- T) levels and have more levels (625 pg/mL) and normal Tn- T (<0.01 ng/ frequent complications such as acute respiratory mL). Electrocardiography revealed sinus tachy- distress syndrome (ARDS), acute coagulopathy, cardia with left ventricular hypertrophy. Chest on September 25, 2021 by guest. Protected copyright. 2 malignant dysrhythmias and acute kidney injury. radiography confirmed patchy right lower lobe The pathophysiological mechanisms underlying opacities and peribronchial cuffing. 3 acute myocardial injury are not well understood. The patient was admitted to the medical floor, Theories on endothelial cell infection across placed on 2 L of oxygen via nasal cannula and vascular beds may explain the broad variety of started on hydroxychloroquine, azithromycin, thia- clinical manifestations of COVID-19. They include mine, vitamin C and zinc. On the second night of hypercoagulability, cytokine storm, stroke, myocar- admission, the rapid response team was activated ditis, acute renal failure and chilblains (COVID-19 because of the patient’s worsening respiratory 4 toes) among others. condition. Arterial blood gas revealed a pH of 7.47, We describe a unique case of a middle-aged PaCO2 of 23, PaO2 of 69 and HCO3 of 17 on 4 COVID-19- positive man who presented with non- L nasal cannula. Over the next several days, chest © BMJ Publishing Group productive cough and progressive dyspnoea. One Limited 2021. No commercial radiography demonstrated increased peribronchial re-use . See rights and month into hospitalisation, the patient developed wall thickening, new bilateral infiltrates, bilateral permissions. Published by BMJ. severe acute mitral valve regurgitation requiring pleural effusions and increased cardiac silhouette. emergent cardiac catheterisation and surgical mitral CT angiogram of the chest ruled out a pulmonary To cite: Khanduri A, Anand U, Doss M, et al. BMJ valve replacement. The postsurgical histopatho- embolism and confirmed patchy consolidative Case Rep 2021;14:e239782. logical analysis of the mitral valve was consistent airspace disease in a bronchovascular distribution doi:10.1136/bcr-2020- with COVID-19 infection. This case highlights the bilaterally with bilateral pleural effusions. The 239782 potential for COVID-19 infection causing valvular patient was treated with diuretics and started on Khanduri A, et al. BMJ Case Rep 2021;14:e239782. doi:10.1136/bcr-2020-239782 1 Case report BMJ Case Rep: first published as 10.1136/bcr-2020-239782 on 18 January 2021. Downloaded from Video 1. The left ventricular systolic function is normal with an ejection fraction of 60–65%. There is severe wide- open mitral valve regurgitation due to torn chordae and flail posterior leaflet with 1.2 cm coaptation gap measured. Figure 1 Chest radiography demonstrates left atrial enlargement with a double density sign (arc) and a straight left heart border (arrow). methylprednisolone 80 mg every 8 hours. On the fourth night of Cardiomegaly present. admission, the patient was found to be in rapid atrial fibrillation. Chest radiography confirmed progression of bilateral infiltrates. artery capillary wedge pressure of 52 mm Hg, minimal coronary He was placed on 15 L high flow oxygen and transferred to the disease with only 40% stenosis of the proximal right coronary intensive care unit. Over the next several days, he was started artery and moderate pulmonary hypertension with a pulmonary on anticoagulation for suspicion of pulmonary microthrombi, artery pressure of 42 mm Hg. Intraoperatively, he was found to received convalescent plasma and was maintained on diuretics. have wide- open mitral regurgitation, with a flail posterior leaflet Eventually, his oxygenation improved, he was transferred back and torn chordae, along with annular calcifications. Subsequently, to the medical floor and over the next few weeks his oxygen requirements decreased to 4 L nasal cannula. One month into his hospitalisation, the patient reported acute onset dizziness, intermittent chest pain and developed acute hypotension. His electrocardiogram confirmed atrial fibrillation. Tn- T levels remained <0.01. An echocardiogram was performed http://casereports.bmj.com/ showing a normal LVEF of 60%–65%, wide- open mitral valve regurgitation with torn chordae and a flail posterior leaflet (video 1). There was severe, wide-open/torrential mitral regur- gitation (video 2). CXR revealed worsening bilateral pulmonary oedema. The left atrium was noted to be enlarged both on chest imaging and echocardiogram (figure 1). The patient was transferred to the coronary care unit for further haemodynamic evaluation and stabilisation. An intra- aortic balloon pump was placed due to preoperative cardiogenic shock. on September 25, 2021 by guest. Protected copyright. He underwent both left and right heart catheterisation which confirmed severe mitral valve regurgitation with a pulmonary Figure 2 Tissue sections reveal valvular tissue with patchy chronic lymphohistiocytic inflammation (H&E- stained section, top left). A CD3 immunostain highlights the T-cell predominant infiltrate (top right) that is composed exclusively of a CD4 T helper subset (middle left). CD68 highlights tissue macrophages (middle right). A special stain for iron demonstrates haemosiderin deposition largely within macrophages Video 2. There is severe, wide -open torrential mitral regurgitation. (bottom middle). 2 Khanduri A, et al. BMJ Case Rep 2021;14:e239782. doi:10.1136/bcr-2020-239782 Case report BMJ Case Rep: first published as 10.1136/bcr-2020-239782 on 18 January 2021. Downloaded from the patient underwent surgical mitral valve replacement with a asymptomatic prior to hospitalisation and no audible murmur biosynthetic prosthesis and a left atrial appendage exclusion with was heard on physical examination, therefore we believe his an atrial clip was placed. mitral valve was intact and more durable prior to COVID-19. Histopathological evaluation of the valve revealed myxo- However, the murmur can be subtle due to rapid equalisation of matous degeneration. There was an inflammatory infiltrate
Load more

Recommended publications
  • Cardiac Involvement in COVID-19 Patients: a Contemporary Review
    Review Cardiac Involvement in COVID-19 Patients: A Contemporary Review Domenico Maria Carretta 1, Aline Maria Silva 2, Donato D’Agostino 2, Skender Topi 3, Roberto Lovero 4, Ioannis Alexandros Charitos 5,*, Angelika Elzbieta Wegierska 6, Monica Montagnani 7,† and Luigi Santacroce 6,*,† 1 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Coronary Unit and Electrophysiology/Pacing Unit, Cardio-Thoracic Department, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] 2 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Cardiac Surgery, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] (A.M.S.); [email protected] (D.D.) 3 Department of Clinical Disciplines, School of Technical Medical Sciences, University of Elbasan “A. Xhuvani”, 3001 Elbasan, Albania; [email protected] 4 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Clinical Pathology Unit, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] 5 Emergency/Urgent Department, National Poisoning Center, Riuniti University Hospital of Foggia, 71122 Foggia, Italy 6 Department of Interdisciplinary Medicine, Microbiology and Virology Unit, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70124 Bari, Italy; [email protected] 7 Department of Biomedical Sciences and Human Oncology—Section of Pharmacology, School of Medicine, University of Bari “Aldo Moro”, Policlinico University Hospital of Bari, p.zza G. Cesare 11, 70124 Bari, Italy; [email protected] * Correspondence: [email protected] (I.A.C.); [email protected] (L.S.) † These authors equally contributed as co-last authors. Citation: Carretta, D.M.; Silva, A.M.; D’Agostino, D.; Topi, S.; Lovero, R.; Charitos, I.A.; Wegierska, A.E.; Abstract: Background: The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) Montagnani, M.; Santacroce, L.
    [Show full text]
  • Myocarditis and Cardiomyopathy
    CE: Tripti; HCO/330310; Total nos of Pages: 6; HCO 330310 REVIEW CURRENT OPINION Myocarditis and cardiomyopathy Jonathan Buggey and Chantal A. ElAmm Purpose of review The aim of this study is to summarize the literature describing the pathogenesis, diagnosis and management of cardiomyopathy related to myocarditis. Recent findings Myocarditis has a variety of causes and a heterogeneous clinical presentation with potentially life- threatening complications. About one-third of patients will develop a dilated cardiomyopathy and the pathogenesis is a multiphase, mutlicompartment process that involves immune activation, including innate immune system triggered proinflammatory cytokines and autoantibodies. In recent years, diagnosis has been aided by advancements in cardiac MRI, and in particular T1 and T2 mapping sequences. In certain clinical situations, endomyocardial biopsy (EMB) should be performed, with consideration of left ventricular sampling, for an accurate diagnosis that may aid treatment and prognostication. Summary Although overall myocarditis accounts for a minority of cardiomyopathy and heart failure presentations, the clinical presentation is variable and the pathophysiology of myocardial damage is unique. Cardiac MRI has significantly improved diagnostic abilities, but endomyocardial biopsy remains the gold standard. However, current treatment strategies are still focused on routine heart failure pharmacotherapies and supportive care or cardiac transplantation/mechanical support for those with end-stage heart failure. Keywords cardiac MRI, cardiomyopathy, endomyocardial biopsy, myocarditis INTRODUCTION prevalence seen in children and young adults aged Myocarditis refers to inflammation of the myocar- 20–30 years [1]. dium and may be caused by infectious agents, systemic diseases, drugs and toxins, with viral infec- CAUSE tions remaining the most common cause in the developed countries [1].
    [Show full text]
  • Myocarditis, Pericarditis and Other Pericardial Diseases
    Heart 2000;84:449–454 Diagnosis is easiest during epidemics of cox- GENERAL CARDIOLOGY sackie infections but diYcult in isolated cases. Heart: first published as 10.1136/heart.84.4.449 on 1 October 2000. Downloaded from These are not seen by cardiologists unless they develop arrhythmia, collapse or suVer chest Myocarditis, pericarditis and other pain, the majority being dealt with in the primary care system. pericardial diseases Acute onset of chest pain is usual and may mimic myocardial infarction or be associated 449 Celia M Oakley with pericarditis. Arrhythmias or conduction Imperial College School of Medicine, Hammersmith Hospital, disturbances may be life threatening despite London, UK only mild focal injury, whereas more wide- spread inflammation is necessary before car- diac dysfunction is suYcient to cause symp- his article discusses the diagnosis and toms. management of myocarditis and peri- Tcarditis (both acute and recurrent), as Investigations well as other pericardial diseases. The ECG may show sinus tachycardia, focal or generalised abnormality, ST segment eleva- tion, fascicular blocks or atrioventricular con- Myocarditis duction disturbances. Although the ECG abnormalities are non-specific, the ECG has Myocarditis is the term used to indicate acute the virtue of drawing attention to the heart and infective, toxic or autoimmune inflammation of leading to echocardiographic and other investi- the heart. Reversible toxic myocarditis occurs gations. Echocardiography may reveal segmen- in diphtheria and sometimes in infective endo-
    [Show full text]
  • Myocarditis and Mrna Vaccines
    Updated June 28, 2021 DOH 348-828 Information for Clinical Staff: Myocarditis and mRNA Vaccines This document helps clinicians understand myocarditis and its probable link to some COVID-19 vaccines. It provides talking points clinicians can use when discussing the benefits and risks of these vaccines with their patients and offers guidance on what to do if they have a patient who presents with myocarditis following vaccination. Myocarditis information What are myocarditis and pericarditis? • Myocarditis is an inflammation of the heart muscle. • Pericarditis is an inflammation of the heart muscle covering. • The body’s immune system can cause inflammation often in response to an infection. The body’s immune system can cause inflammation after other things as well. What is the connection to COVID-19 vaccination? • A CDC safety panel has determined there is a “probable association” between myocarditis and pericarditis and the mRNA COVID-19 vaccines, made by Moderna and Pfizer-BioNTech, in some vaccine recipients. • Reports of myocarditis and pericarditis after vaccination are rare. • Cases have mostly occurred in adolescents and young adults under the age of 30 years and mostly in males. • Most patients who developed myocarditis after vaccination responded well to rest and minimal treatment. Talking Points for Clinicians The risk of myocarditis is low, especially compared to the strong benefits of vaccination. • Hundreds of millions of vaccine doses have safely been given to people in the U.S. To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email [email protected].
    [Show full text]
  • Currentstateofknowledgeonaetiol
    European Heart Journal (2013) 34, 2636–2648 ESC REPORT doi:10.1093/eurheartj/eht210 Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases Downloaded from Alida L. P. Caforio1†*, Sabine Pankuweit2†, Eloisa Arbustini3, Cristina Basso4, Juan Gimeno-Blanes5,StephanB.Felix6,MichaelFu7,TiinaHelio¨ 8, Stephane Heymans9, http://eurheartj.oxfordjournals.org/ Roland Jahns10,KarinKlingel11, Ales Linhart12, Bernhard Maisch2, William McKenna13, Jens Mogensen14, Yigal M. Pinto15,ArsenRistic16, Heinz-Peter Schultheiss17, Hubert Seggewiss18, Luigi Tavazzi19,GaetanoThiene4,AliYilmaz20, Philippe Charron21,andPerryM.Elliott13 1Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padua, Padova, Italy; 2Universita¨tsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik fu¨r Kardiologie, Marburg, Germany; 3Academic Hospital IRCCS Foundation Policlinico, San Matteo, Pavia, Italy; 4Cardiovascular Pathology, Department of Cardiological Thoracic and Vascular Sciences, University of Padua, Padova, Italy; 5Servicio de Cardiologia, Hospital U. Virgen de Arrixaca Ctra. Murcia-Cartagena s/n, El Palmar, Spain; 6Medizinische Klinik B, University of Greifswald, Greifswald, Germany; 7Department of Medicine, Heart Failure Unit, Sahlgrenska Hospital, University of Go¨teborg, Go¨teborg, Sweden; 8Division of Cardiology, Helsinki University Central Hospital, Heart & Lung Centre,
    [Show full text]
  • COVID 19 Vaccine for Adolescents. Concern About Myocarditis and Pericarditis
    Opinion COVID 19 Vaccine for Adolescents. Concern about Myocarditis and Pericarditis Giuseppe Calcaterra 1, Jawahar Lal Mehta 2 , Cesare de Gregorio 3 , Gianfranco Butera 4, Paola Neroni 5, Vassilios Fanos 5 and Pier Paolo Bassareo 6,* 1 Department of Cardiology, Postgraduate Medical School of Cardiology, University of Palermo, 90127 Palermo, Italy; [email protected] 2 Department of Medicine, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA; [email protected] 3 Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; [email protected] 4 Cardiology, Cardiac Surgery, and Heart Lung Transplantation Department, ERN, GUAR HEART, Bambino Gesu’ Hospital and Research Institute, IRCCS Rome, 00165 Rome, Italy; [email protected] 5 Neonatal Intensive Care Unit, Department of Surgical Sciences, Policlinico Universitario di Monserrato, University of Cagliari, 09042 Monserrato, Italy; [email protected] (P.N.); [email protected] (V.F.) 6 Department of Cardiology, Mater Misericordiae University Hospital and Our Lady’s Children’s Hospital Crumlin, University College of Dublin, School of Medicine, D07R2WY Dublin, Ireland * Correspondence: [email protected]; Tel.: +353-1409-6083 Abstract: The alarming onset of some cases of myocarditis and pericarditis following the adminis- tration of Pfizer–BioNTech and Moderna COVID-19 mRNA-based vaccines in adolescent males has recently been highlighted. All occurred after the second dose of the vaccine. Fortunately, none of Citation: Calcaterra, G.; Mehta, J.L.; patients were critically ill and each was discharged home. Owing to the possible link between these de Gregorio, C.; Butera, G.; Neroni, P.; cases and vaccine administration, the US and European health regulators decided to continue to Fanos, V.; Bassareo, P.P.
    [Show full text]
  • Basic Mechanisms of Myocarditis KIRK U
    Basic Mechanisms of Myocarditis KIRK U. KNOWLTON, M.D. INTERMOUNTAIN MEDICAL CENTER, SALT LAKE CITY, UTAH UNIVERSITY OF CALIFORNIA, SAN DIEGO Major mechanisms that contribute to myocarditis Infection Virus Bacteria Parasites Immune activation against infectious pathogens Innate immunity Adaptive immunity Primary immune mechanisms Myocyte injury Antigen mimicry Hypersensitivity reactions Causes of Myocarditis Checkpoint inhibitors Are there common questions between viral myocarditis and checkpoint-inhibitor mediated myocarditis? Low incidence of myocarditis in patients treated with checkpoint inhibitors A very small percentage of patients that receive checkpoint inhibitors develop myocarditis- 0.09% or 0.27% of patients treated single checkpoint inhibitors or combination checkpoint inhibitors, respectively. Low incidence of myocarditis in patients infected with viruses that are known to cause myocarditis While many patients are infected with common viruses such as Coxsackievirus, adenovirus, parvovirus, herpes virus, Epstein-Barr virus, only a very small percentage actually develop myocarditis Why? Potential genetic variants/ mutations Innate immunity Adaptive immunity Sarcolemmal membrane integrity Other factors Underlying infection Nutrition Age Pregnancy Hormones The incidence of disease is likely affected by a combination of multiple influences Therefore, Review mechanisms that have been shown to cause myocarditis And, those that increase susceptibility to myocarditis SCIENCE VOL 291 12 JANUARY 2001 Nature
    [Show full text]
  • Histopathological Characterization of Mitral Valvular Lesions from Patients with Rheumatic Heart Disease
    Artigo Original Caracterização Histológica das Lesões da Valva Mitral de Pacientes com Cardiopatia Reumática Histopathological Characterization of Mitral Valvular Lesions from Patients with Rheumatic Heart Disease Nayana F. A. Gomes,1 Marcelo A. Pascoal-Xavier,1 Livia S. A. Passos,1 Thiago Mendonça Nunes Paula,1 João Marcelo de Souza Aguiar,1 Felipe Vieira Guarçoni,1 Maria Cecília Landim Nassif,1 Claudio Leo Gelape,1 Renato Braulio,1 Paulo Henrique N. Costa,1 Luiz Guilherme Passaglia,1 Raquel Braga Martins,1 Walderez O. Dutra,1 Maria Carmo P. Nunes1 Universidade Federal de Minas Gerais,1 Belo Horizonte, MG - Brasil Resumo Fundamentos: Os mecanismos subjacentes pelos quais a doença cardíaca reumática (DCR) levam à disfunção valvar grave não são totalmente compreendidos. Objetivo: O presente estudo avaliou as alterações histopatológicas nas valvas mitrais (VM) buscando uma associação entre o padrão de disfunção valvar predominante e os achados histopatológicos. Métodos: Em 40 pacientes submetidos à troca da VM devido a DCR e em 20 controles submetidos a transplante cardíaco, foram analisados os aspectos histológicos da VM excisada. Dados clínicos e ecocardiográficos também foram coletados. As análises histológicas foram realizadas usando coloração com hematoxilina-eosina. Determinou-se inflamação, fibrose, neoangiogênese, calcificação e metaplasia adiposa. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados: A idade média dos pacientes com DCR foi de 53±13 anos, sendo 36 (90%) do sexo feminino, enquanto a idade média dos controles foi de 50±12 anos, semelhante aos casos, sendo a maioria do sexo masculino (70%). O endocárdio valvar reumático apresentou espessura maior que os controles (1,3±0,5 mm versus 0,90±0,4 mm, p=0,003, respectivamente), e infiltrado inflamatório mais intenso no endocárdio (78% versus 36%; p=0,004), com predominância de células mononucleares.
    [Show full text]
  • Inflammation and Your Heart: Endocarditis, Pericarditis and Myocarditis
    Inflammation and your heart: Endocarditis, pericarditis and myocarditis Types of inflammation Myocarditis When you see the letters ‘itis’ at the end of a What causes myocarditis? Will I need treatment? word, it means inflammation. Myocarditis is inflammation of the myocardium Myocarditis is often mild and goes unnoticed, but – the heart muscle. It is usually caused by a viral, you may need to take medicines to relieve your Myocarditis, pericarditis and bacterial or fungal infection. Sometimes the cause is symptoms such as non-steroidal anti-inflammatories endocarditis refer to inflammation unknown – or ‘idiopathic’. and sometimes antibiotics. around or in the heart. If the myocarditis it is causing a problem with What are the symptoms? how well your heart pumps, you may develop the • Myocarditis – inflammation of the myocardium The symptoms of myocarditis usually include a (the heart muscle) symptoms of heart failure which you will need to pain or tightness in your chest which can spread to take several different types of medicines for. In very • Pericarditis – inflammation of the pericardium other parts of your body, shortness of breath and extreme cases where there is severe damage to the (the sac which surrounds tiredness. You may also have flu like symptoms, such heart you may be considered for a heart transplant. the heart) as a high temperature, feeling tired, headaches and aching muscles and joints. • Endocarditis – inflammation of the Inflammation of the heart often causes chest pain, endocardium (the inner lining of the heart) What tests will I need? and you may feel like you are having a heart attack. If you have not been diagnosed with one of You may need to have an electrocardiogram (ECG), these conditions and you have chest pain, or any echocardiogram (a scan of your heart similar to an of the symptoms we describe below, call 999 ultrasound) and various blood tests.
    [Show full text]
  • Case Reports NSTEMI in a 28-Year-Old Female with Recent Myocarditis
    Case Reports NSTEMI in a 28-year-old female with recent myocarditis Rachel Barkley, B.S.1 & Logan Kinney, M.D.2 Introduction 1Wake Forest School of Medicine, Myocarditis and acute coronary syndrome (ACS) have similar clinical presentations Winston-Salem, NC 1 and can be hard to differentiate. Myocarditis is an inflammatory disease of cardiac 2Department of Anesthesiology, muscle and has a variety of noninfectious and infectious etiologies. The cause of Wake Forest School of Medicine, acute coronary syndrome is a mismatch between the myocardial oxygen demand and Winston-Salem, NC myocardial oxygen consumption. While the source of this mismatch in ST-segment Address Correspondence To: elevation myocardial infarction (STEMI) is almost always coronary plaque rupture, Rachel Barkley, B.S. there are several potential causes of this mismatch in non-ST-segment elevation Department of Anesthesiology myocardial infarction (NSTEMI). Non-coronary injury to the heart such as cardiac Wake Forest School of Medicine contusion, presence of cardiotoxic substances, and even myocarditis can produce Medical Center Boulevard NSTEMI.2 Also, conditions such as hypotension, hypertension, tachycardia, aortic Winston-Salem, NC, 27157 [email protected] stenosis, and pulmonary embolism, though seemingly unrelated to the coronary arteries or myocardium, can lead to NSTEMI because the increased oxygen demand of the heart cannot be met.3,4 Unsurprisingly, acute myocarditis is more common than ACS in younger patients aged 18–29 years, but the risk of myocardial infarction (MI) subsequently increases.2 Additionally, risk factors such as hypercholesterolemia, diabetes, and hypertension predict MI regardless of age and gender. Although many factors go into diagnosing myocarditis and MI, distinguishing between the two is crucial because the short and long term management and prognosis is largely different.
    [Show full text]
  • Giant-Cell Myocarditis: a Rare Cause of Rapidly Evolved Stenosis of the Mitral Valve
    Hellenic J Cardiol 44: 355-359, 2003 Giant-Cell Myocarditis: A Rare Cause of Rapidly Evolved Stenosis of the Mitral Valve CHRISTOS E. CHARITOS1, MICHALIS ARGIRIOU1, DIMITRA RONTOGIANNI2, CHRISTOFOROS KOTOULAS2 1Second Cardiothoraric Surgery Department and 2Pathologoanatomic Laboratory, “Evangelismos” Hospital, Athens, Greece Key words: An aged anemic woman was operated on for mitral valve stenosis that had rapidly progressed in a few Idiopathic giant-cell months. Surgical and histological findings of the replaced valve proved the unexpected diagnosis of giant- myocarditis, mitral valve stenosis. cell myocarditis. This atypical clinical presentation of mitral stenosis associated with systemic manifestations must raise suspicions for other underlying illnesses. In such cases, a preoperative endomyocardial biopsy can be helpful. The patient succumbed few days later from low cardiac output syndrome. Repair or replacement of an infiltrated by giant-cells myocardium and mitral valve should not be attempted. Instead, combined immunosuppression or mechanical support and heart transplantation should be applied to save these patients. Manuscript received: itral valve stenosis of origin 25 years ago, for which she was receiving December 11, 2003; other than rheumatic fever is a replacement therapy. There was no hi- Accepted: July 10, 2003. M rare entity. Giant-cell myo- story of rheumatic fever during childhood carditis is an extremely rare, with poor or adolescent years. The symptoms began prognosis, probably autoimmune, granu- 7 months earlier with a dyspnea on exer- Address: lomatous disease of the heart. Progres- tion, moderate fever, substernal aches, Christos E. Charitos sive congestive heart failure, intraventri- and anemia (Ht=23%). The echocar- cular conduction defects and ventricular diogram revealed normal cardiac funct- 11 Filippoupoleos St., arrhythmias, which in many cases can be ion, a well functioning mitral valve, and 171 23, Nea Smirni, fatal, are the usual manifestations of this only minor accumulation of pericardial Athens, Greece 1 e-mail: disease .
    [Show full text]
  • Lack of Seasonality in Occurrence of Pericarditis, Myocarditis, and Endocarditis
    Annals of Epidemiology 37 (2019) 77e80 Contents lists available at ScienceDirect Annals of Epidemiology Original article Lack of seasonality in occurrence of pericarditis, myocarditis, and endocarditis * Nils Skajaa, BSc a, , Erzsebet Horvath-Puh o, MSc, PhD a, Kasper Adelborg, MD, PhD a, b, Hans Erik Bøtker, MD, PhD, DMSc c, Kenneth R. Rothman, DrPH d, Henrik Toft Sørensen, MD, PhD, DMSc a a Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark b Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark c Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark d RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC article info abstract Article history: Purpose: The etiology of pericarditis, myocarditis, and endocarditis is predominantly infectious, and Received 21 November 2018 infections often show seasonal variation. Little is known, however, about seasonal patterns in these Accepted 6 July 2019 cardiopathies. Available online 10 July 2019 Methods: Using Danish health care registries, we identified all patients with a first-time hospital-based diagnosis of pericarditis, myocarditis, or endocarditis between 1994 and 2016. We estimated peak-to- Keywords: trough ratios from fitted sine curves to measure the intensity of seasonal variation in occurrence Cardiovascular inflammation during the study period. Because randomness will lead to small apparent seasonal patterns, we also Seasonal variation Peak-to-low ratios conducted a plasmode simulation to assess the degree of seasonality that randomness would produce. Random error Results: Crude peak-to-trough ratios of monthly frequencies summarized over a year were small. We estimated a peak-to-trough ratio of 1.10 (95% confidence interval [CI], 1.05e1.14) for pericarditis, 1.11 (95% CI, 1.02e1.21) for myocarditis, and 1.01 (95% CI, 1.00e1.07) for endocarditis.
    [Show full text]