DOCSLIB.ORG

Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions Journal of Cardiovascular Translational Research https://doi.org/10.1007/s12265-020-09996-1 REVIEW ARTICLE Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions Riccardo Vio1 & Alessandro Zorzi1 & Domenico Corrado1 Received: 3 October 2019 /Accepted: 24 March 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Myocarditis is as an important cause of sudden cardiac death (SCD) among athletes. The incidence of SCD ascribed to myocarditis did not change after the introduction of pre-participation screening in Italy, due to the transient nature of the disease and problems in the differential diagnosis with the athlete’s heart. The arrhythmic burden and the underlying mechanisms differ between the acute and chronic setting, depending on the relative impact of acute inflammation versus post-inflammatory myocardial fibrosis. In the acute phase, ventricular arrhythmias vary from isolated ventricular ectopic beats to complex tachy- cardias that can lead to SCD. Atrioventricular blocks are typical of specific forms of myocarditis, and supraventricular arrhyth- mias may be observed in case of atrial inflammation. Athletes with acute myocarditis should be temporarily restricted from physical exercise, until complete recovery. However, ventricular tachycardia may also occur in the chronic phase in the context of post-inflammatory myocardial scar. Keywords Myocarditis . Athletes . Sport . Ventricular ARVC Arrhythmogenic right ventricular cardiomyopathy tachycardia . Ventricular fibrillation . Atrial fibrillation . Atrioventricular block . Sudden death Introduction Abbreviations Myocarditis is an inflammatory disease of the heart muscle AM Acute myocarditis most often caused by infectious agents (infective myocar- SCD Sudden cardiac death ditis), autoimmune conditions, or pharmacological and en- EMB Endomyocardial biopsy vironmental toxins (non-infective myocarditis) [1]. LGE Late gadolinium enhancement Infective myocarditis due to viral agents (coxsackievirus, CMR Cardiac magnetic resonance adenovirus, parvovirus, and herpes virus) is fairly the most AV Atrioventricular common form of the disease and is usually characterized LV Left ventricular by a benign prognosis [2]. The majority of patients with AF Atrial fibrillation acute myocarditis (AM) have a mild and transient cardiac VF Ventricular fibrillation involvement, most often mimicking the clinical features of VT Ventricular tachycardia acute coronary syndromes, and a favorable clinical course ICD Implantable cardioverter defibrillator with a complete clinical recovery; acute heart failure and sudden cardiac death (SCD) are less common clinical pre- Associate Editor Domingo A. Pascual-Figal oversaw the review of this sentations [1, 3, 4]. Post-inflammatory myocardial article sequelae are not so rare and consist of repair subepicardial-midmural myocardial fibrosis which occurs * Domenico Corrado [email protected] as a result of the healing process of a previous acute myo- cardial lesion [5]. There is growing evidence that non- 1 Department of Cardiac, Thoracic, Vascular Sciences and Public ischemic myocardial scar, either post-myocarditis or due Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy to other myocardial diseases, may act as a substrate of J. of Cardiovasc. Trans. Res. life-threatening ventricular arrhythmias and arrhythmic Challenges in the Diagnosis of Acute Myocarditis cardiac arrest, mostly in young people and athletes [6]. in the Athlete The present article reviews the etiology, pathogenesis, clin- ical manifestations, risk stratification, and management of Definitive diagnosis of AM relies on histologic demonstration myocarditis occurring in the athlete, with particular reference of myocardial inflammatory infiltrates and myocyte degener- to the different arrhythmogenic substrates and mechanisms ation and death on endomyocardial biopsy (EMB). However, acting in the acute and chronic disease settings. the use of EMB is uncommon in the routine clinical practice and according to current guidelines the invasive approach for histologic examination of myocardial samples is reserved to Myocarditis in the Athletes selected clinical scenarios that do not include most common benign and self-limiting presentation [26]. In the absence of Although definite evidence is lacking, athletes may be EMB confirmation, the clinical diagnosis of myocarditis is at higher risk of developing myocarditis than the gener- strongly suspected or highly probable in the presence of ≥ 2 al population. Sports activity can influence the suscep- criteria including compatible clinical symptoms, electrocar- tibility to infections, depending on the intensity and du- diographic abnormalities, elevation of myocardiocytolysis ration of the physical exercise. While moderate physical markers, evidence of non-ischemic morphofunctional ventric- activity may improve immunological defenses [7–9], in- ular abnormalities, and increased T2 signal for myocardial tense and prolonged training and competition lower the edema/regional late gadolinium enhancement (LGE) at cardi- immunity by reducing salivary secretory immunoglobu- ac magnetic resonance (CMR) [1]. lin A, lactoferrin, and lysozyme and altering the T cell Personal and family history, physical examination, and 12- response, all mechanisms that may increase the vulner- lead ECG are crucial in the initial evaluation of athletes with ability of athletes to viral infections [7, 8, 10–14]. Non- suspected myocarditis. Symptoms, such as chest pain, dys- infective myocarditis, i.e., immune-mediated and toxic pnea, and fatigue, possibly start after a respiratory or gastro- myocarditis, may also be favored. intestinal infection. Sports activity may also worsen the pathobiological At the electrocardiogram, repolarization abnormalities are course of AM [15–18]. Murine models of myocarditis by the most common alterations in AM, being detected in 40% of coxsackievirus B3 showed a striking augment in the viru- patients; ST segment elevation (typically concave and diffuse lence of the pathogen agents when the animals were forced without reciprocal changes) is more frequent than ST segment to swim [15]. The acceleration of coxsackie B3 myocardi- depression (6% vs 2%), and negative T waves (36%) are ob- tis course induced by exercise was also reported by Kiel served mainly in lateral leads [27]. These ECG changes are et al., who observed that exercise increased both the extent typically transient in AM [28], and even when present, their of myocardial cell necrosis and overall mortality [16]. significance might be uncertain since athletes frequently show Worsening of the myocardial pathological damage can oc- repolarization abnormalities (i.e., early repolarization) [29]. cur not only in viral myocarditis but also in autoimmune The most notable ECG feature of early repolarization is ST myocarditis as demonstrated by the increase of both hu- segment elevation, which may vary on morphology, location, moral and cellular immunities against the heart muscle in anddegree;Twaveinversioncanalsobeobservedparticular- mice exercised by treadmill [19]. ly in black athletes but confined to leads V1-V4 [30]. Myocarditis has been traditionally regarded as cause of Pathologic Q waves are reported in 13% of patients with life-threatening ventricular arrhythmias and SCD in the AM [27], whereas they are rare in athletes [31]. PR segment athletes. The incidence of SCD due to AM in the athlete depression and low voltages can reveal the existence of peri- ranges from 2 to 12% of all fatalities [20–24]. Data from cardial inflammation and effusion and tend to disappear the registry of juvenile SCD of the Veneto region of Italy throughout the healing process. Other ECG changes include showed that the mortality did not significantly change atrioventricular (AV) and bundle branch blocks. before and after the implementation of systematic pre- Electrocardiographic differential diagnosis between AM and participation screening in Italy (from 0.3/100.000 to athlete’s heart is summarized in Table 1. 0.15/100.000, p =0.42)[25]. Failure to identify athletes Biomarkers indicative of myocardial injury are usually el- with myocarditis by pre-participation screening reflects evated in myocarditis; however, the majority of healthy ath- the acute and unpredictable nature of the inflammatory letes after prolonged exercise show values of cardiac troponin process, which often is clinically silent and may lead to above the 99th percentile [32]. electrical ventricular instability and cardiac arrest in oth- Echocardiography may solve the dilemma, identifying erwise asymptomatic individuals. Furthermore, highly signs of the disease such as global left ventricular (LV) en- trained athletes tend to underestimate or hide symptoms largement and dysfunction, localized wall motion abnormali- to avoid limitations to competitive sports eligibility. ties, and relaxation alterations suggestive of the presence of J. of Cardiovasc. Trans. Res. Table 1 Electrocardiographic differential diagnosis between acute myocarditis and athlete’sheart Acute myocarditis Athlete’sheart Repolarization abnormalities - ST segment elevation Diffuse Localized (usually in the anterior leads) or diffuse - ST segment depression Possible Absent - T wave inversion Mainly in lateral or inferior leads Confined to V1-V4 in Afro-Caribbean athletes Q waves Pathological (amplitude ≥ 25% of the ensuing R wave Non-pathological (≥ 4 mm in depth but
Load more

Recommended publications
  • Severe Arrhythmias in Coxsackievirus B3 Myopericarditis
    Arch Dis Child: first published as 10.1136/adc.53.2.174 on 1 February 1978. Downloaded from 174 Short reports Oh, W., and Karecki, H. (1972). Phototherapy and insensible Table Results of clinical chemistry water loss in the newborn infant. American Journal of Diseases of Children, 124, 230-232. Oh, W., Yao, A. C., Hanson, J. S., and Lind, J. (1973). Date: September Peripheral circulatory response to phototherapy in Investigation newborn infants. Acta Paediatrica Scandinavica, 62, 49-54. (normal max) 6 7 9 10 14 23 Smales, 0. R. C. (1978). Simple method for measuring Blood urea 13-2 18-6 23-0 11-2 9*5 3-9 oxygen consumption in babies. Archives of Disease in (2*7-7 5 mmol/l) Childhood, 53, 53-57. Alananine Wilcoxon, F. (1945). The signed ranks test. Biometrics aminotransferase 2562 4987 7185 Bulletin, 1, 80. (100-500 nkat/1) Wu, P. Y. K., and Berdahl, M. (1974). Irradiance in incubators Aspartate aminotransferase 8000 7935 6000 under phototherapy lamps. Journal of Pediatrics, 84, (75-400 nkat/1) 754-755. Glutamin oxalotransferase 226 68 10 (9-19 IU/1) 0. R. C. SMALES Glutamic Department of Child Health, University Hospital and phosphorotransferase 687 207 16 (5-17 IU/1) Medical School, Nottingham NG7 2UH. Creatine kinase 133 11 12 (0-1 17 IU/1) Lactic dehydrogenase 1368 691 217 (115-457 IU/1) Severe arrhythmias in Alkaline phosphatase 75 100 117 (25-103 IU/1) Coxsackievirus B3 myopericarditis Bilirubin 7 13 18 (0-22 ,umol/l) Proven viral myopericarditis onlyrarely presents with Conversion: SI to traditional units-Blood urea: 1 mmol/l 6 02 life-threatening arrhythmias.
    [Show full text]
  • An Unusual Case of Idiopathic Hypereosinophilic Syndrome Presenting with Myopericarditis and a Polypoid Cardiac Mass
    Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2014;42(3):281-284 doi: 10.5543/tkda.2014.83284 281 An unusual case of idiopathic hypereosinophilic syndrome presenting with myopericarditis and a polypoid cardiac mass Miyoperikardit ve polipoid kardiyak kitle ile ortaya çıkan nadir bir idiyopatik hipereozinofilik sendromlu olgu Özgül Uçar Elalmış, M.D., Candan Mansuroğlu, M.D., Hülya Çiçekçioğlu, M.D., Ahmet Karagöz, M.D.# Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara; #Department of Cardiology, Giresun Professor Doctor Atilla İlhan Özdemir State Hospital, Giresun Summary– Idiopathic hypereosinophilic syndrome (IHES) is Özet– İdiyopatik hipereozinofilik sendrom (İHES), çoklu a rare systemic disorder with blood eosinophilia and multiple sistem tutulumu ve eozinofili ile seyreden nadir sistemik bir system involvement. Commonly, there is endocardial fibro- hastalıktır. Genellikle altta yatan mural trombüs ile birlikte sis with overlying mural thrombus, and mitral and tricuspid endokartta fibröz mevcut olup mitral ve triküspit kapaklar valves can be involved concomitantly. Outflow tracts near eş zamanlı olarak etkilenebilir. Aort ve pulmoner kapak çı- the aortic and pulmonary valves are generally protected. We kış yolları genellikle korunmuştur. Biz burada steroit tedavi- herein describe an atypical case of IHES with a mass on the si ile regresyon gösteren sol ventrikül çıkış yolunda (LVOT) left ventricular outflow tract (LVOT), which showed regres- bir kitle ile birlikte seyreden, atipik bir idiyopatik hipereozi- sion under steroid therapy. There are two features that make nofilik sendromlu olguyu sunduk. Bu olgunun sunulmasını our case worthy of reporting: First, the mitral and tricuspid değerli kılan iki özellik vardır: Birincisi, İHES’de mitral ve valves are expected to be involved in IHES, and outflow triküspit kapak tutulumu beklenir ve aort ve pulmoner ka- tracts near the aortic and pulmonary valves are generally pak çıkış yollarında etkilenme son derece nadirdir.
    [Show full text]
  • The Spectrum of COVID-19-Associated Myocarditis: a Patient-Tailored Multidisciplinary Approach
    Journal of Clinical Medicine Article The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach Giovanni Peretto 1,2,3,*, Andrea Villatore 3 , Stefania Rizzo 4, Antonio Esposito 2,3,5, Giacomo De Luca 2,6, Anna Palmisano 2,5, Davide Vignale 2,5, Alberto Maria Cappelletti 7, Moreno Tresoldi 8,9, Corrado Campochiaro 2,6 , Silvia Sartorelli 2,6, Marco Ripa 9,10 , Monica De Gaspari 4 , Elena Busnardo 2,11, Paola Ferro 11, Maria Grazia Calabrò 12, Evgeny Fominskiy 12 , Fabrizio Monaco 12 , Giulio Cavalli 6, Luigi Gianolli 11, Francesco De Cobelli 3,5 , Alberto Margonato 7, Lorenzo Dagna 3,6, Mara Scandroglio 12, Paolo Guido Camici 3, Patrizio Mazzone 1, Paolo Della Bella 1, Cristina Basso 4 and Simone Sala 1,2 1 Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; [email protected] (P.M.); [email protected] (P.D.B.); [email protected] (S.S.) 2 Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; [email protected] (A.E.); [email protected] (G.D.L.); [email protected] (A.P.); [email protected] (D.V.); [email protected] (C.C.); [email protected] (S.S.); [email protected] (E.B.) 3 School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; [email protected] (A.V.); [email protected] (F.D.C.); [email protected] (L.D.); [email protected] (P.G.C.) 4 Department of Cardiac Thoracic Vascular Sciences and Public Health,
    [Show full text]
  • A Case of Myopericarditis.Indd 294 30/05/12 16:14 BRAZ J INFECT DIS
    BRAZ J INFECT DIS. 2012;16(3):294-296 The Brazilian Journal of INFECTIOUS DISEASES www.elsevier.com/locate/bjid Case Report A case of myopericarditis associated to Campylobacter jejuni infection in the Southern Hemisphere Alberto Ficaa,*, Daniela Seelmannb, Lorena Portec, Daniela Eugenind, Ricardo Gallardoe aHead of the Infectious Diseases Unit, Hospital Militar de Santiago; Associate Professor, Universidad de Chile and Universidad de los Andes, Chile bDepartment of Medicine, Hospital Militar de Santiago, Chile cMicrobiology Unit, Clinical Laboratory, Hospital Militar de Santiago, Chile dCritical Care Unit, Hospital Militar de Santiago, Chile eCardiovascular Diseases Department, Hospital Militar de Santiago, Chile ARTICLE INFO ABSTRACT Article history: Myopericarditis is an infrequent complication of acute diarrheal illness due to Campylobacter Received 27 November 2011 jejuni, and it has been mainly reported in developed nations. The first case detected in Chile – an Accepted 17 February 2012 upper-middle income country –, that is coincidental with the increasing importance of acute gastroenteritis associated to this pathogen, is described. Recognition of this agent in stools Keywords: requires special laboratory techniques not widely available, and it was suspected when a young Campylobacter jejuni patient presented with acute diarrhea, fever, and chest pain combined with electrocardiogram Myocarditis (EKG) abnormalities and elevated myocardial enzymes. C. jejuni myopericarditis can easily be Infectious diarrheal disease suspected but its detection requires dedicated laboratory techniques. © 2012 Elsevier Editora Ltda. All rights reserved. Introduction Case presentation Viral infections are the leading cause of myocarditis and A 17-year-old adolescent male was admitted to the Hospital pericarditis in developed countries.1 On the other hand, parasitic Militar de Santiago, in September 2011, with a history of two diseases such as acute Chagas disease and endemic viruses days of upper abdominal pain, fever (38.5oC), and dysentery.
    [Show full text]
  • A Case of Myopericarditis Caused by Neisseria Meningitidis W135
    Clinical Medicine 2018 Vol 18, No 3: 253–5 ACUTE MEDICAL CARE A c a s e o f m y o p e r i c a r d i t i s c a u s e d b y Neisseria meningitidis W135 serogroup with protracted infl ammatory syndrome A u t h o r s : A l e x J K e e l e y , A D a n i e l H a m m e r s l e y B a n d S u k h b i r S D h a m r a i t C Meningococcal pericarditis is classically divided into three separate entities: isolated meningococcal pericarditis, dissemi- nated meningococcal disease with pericarditis, and reactive (immunopathic) meningococcal pericarditis. We present the case of a 74-year-old woman with meningococcal septicaemia ABSTRACT with meningococcal myopericarditis, which demonstrates crossover features. Case presentation A 74-year-old caucasian woman with no history of immunosuppression or rheumatological disease, but with a history of paroxysmal atrial fibrillation (AF) for which she was taking flecainide but no anticoagulation, was admitted following a Baltic cruise holiday. She had fever, rigors, chest pain radiating Fig 1. 12-lead electrocardiogram showing atrial fi brillation with a rapid to the back and neck, and progressive breathlessness of several ventricular response, with subtle widespread ST segment elevation days onset. On initial examination, she was in respiratory distress with ST segment depression in leads aVR and V1. with a respiratory rate of 24 breaths/minute, oxygen saturations of 92% on 28% oxygen, tachycardia of 146 beats/minute, blood pressure of 133/73 mmHg and a temperature of 37.5°C.
    [Show full text]
  • Myocarditis and Pericarditis Following Mrna COVID-19 Vaccination: What Do We Know So Far?
    children Review Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination: What Do We Know So Far? Bibhuti B. Das 1,*, William B. Moskowitz 1, Mary B. Taylor 2 and April Palmer 3 1 Department of Pediatrics, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA; [email protected] 2 Department of Pediatrics, Division of Critical Care, University of Mississippi Medical Center, Jackson, MS 39216, USA; [email protected] 3 Department of Pediatrics, Division of Infectious Disease, University of Mississippi Medical Center, Jackson, MS 39216, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-601-984-5250; Fax: +1-601-984-5283 Abstract: This is a cross-sectional study of 29 published cases of acute myopericarditis following COVID-19 mRNA vaccination. The most common presentation was chest pain within 1–5 days after the second dose of mRNA COVID-19 vaccination. All patients had an elevated troponin. Cardiac magnetic resonance imaging revealed late gadolinium enhancement consistent with myocarditis in 69% of cases. All patients recovered clinically rapidly within 1–3 weeks. Most patients were treated with non-steroidal anti-inflammatory drugs for symptomatic relief, and 4 received intravenous immune globulin and corticosteroids. We speculate a possible causal relationship between vaccine administration and myocarditis. The data from our analysis confirms that all myocarditis and pericarditis cases are mild and resolve within a few days to few weeks. The bottom line is that the risk of cardiac complications among children and adults due to severe acute respiratory syndrome Citation: Das, B.B.; Moskowitz, W.B.; coronavirus 2 (SARS-CoV-2) infection far exceeds the minimal and rare risks of vaccination-related Taylor, M.B.; Palmer, A.
    [Show full text]
  • Myopericarditis in a Korean Young Male with Systemic Lupus Erythematosus
    CASE REPORT Print ISSN 1738-5520 / On-line ISSN 1738-5555 DOI 10.4070/kcj.2011.41.6.334 Copyright © 2011 The Korean Society of Cardiology Open Access Myopericarditis in a Korean Young Male With Systemic Lupus Erythematosus Kyu Tae Park, MD, Kyung Soon Hong, MD, Sang Jin Han, MD, Duck Hyoung Yoon, MD, Hyunhee Choi, MD, Min Young Lee, MD, Myeong Shin Ryu, MD, and Chan Woo Lee, MD Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea ABSTRACT Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids. (Korean Circ J 2011;41:334-337) KEY WORDS: Male; Pericarditis; Myocarditis; Systemic lupus erythematosus. Introduction effusion and pneumonia (Fig. 1A), and was transferred to our hospital for evaluation of the cause and treatment. His me- Myocardial involvement is not uncommon in systemic lu- dical and family histories were unremarkable. pus erythematosus (SLE). Sometimes lupus myocarditis can On examination, his blood pressure was 110/70 mmHg, pul- be a life-threatening complication of SLE. But, SLE-related se rate was 112 beats/min, respiratory rate was 24 breaths/min, myopericarditis is very rare in a young male patient. and body temperature was 38°C. Jugular veins were engorg- We report a case of SLE-associated myopericarditis in a yo- ed. On cardiac auscultation, the cardiac rhythm was regular ung male without clear evidence of viral infection based on and rapid, summation gallops were heard at the cardiac apex, viral markers in blood.
    [Show full text]
  • Acute Non-Rheumatic Myopericarditis: a Rare Complication of Pharyngitis
    European Journal of Case Reports in Internal Medicine Acute Non-Rheumatic Myopericarditis: A Rare Complication of Pharyngitis Rafael Silva1, Luís Puga2, Rogério Teixeira2, Carolina Lourenço2, Ana Botelho2, Lino Gonçalves2 1Serviço de Medicina Interna, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 2Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Doi: 10.12890/2018_000987- European Journal of Case Reports in Internal Medicine - © EFIM 2018 Received: 04/11/2018 Accepted: 09/11/2018 Published: 29/11/2018 How to cite this article: Silva R, Puga L, Texeira R, Lourenço C, Botelho A, Gonçalves L. Acute non-rheumatic myopericarditis: a rare complication. EJCRIM 2018;5: doi:10.12890/2018_000987. Conflicts of Interests: The Authors declare that there are no competing interests. This article is licensed under a Commons Attribution Non-Commercial 4.0 License ABSTRACT Acute non-rheumatic streptococcal myopericarditis (ANRSM) is a rare complication of an upper airway infection by streptococcus group A in developed countries. Cardiac involvement in bacterial infections must be adequately treated because it can lead to long-term complications. This case report describes recurrent ANRSM in an 18-year-old man, which illustrates how difficult and challenging the diagnosis of this disease can be. LEARNING POINTS • In developed countries, acute non-rheumatic streptococcal myopericarditis is a rare complication of an upper airway infection by streptococcus group A and can mimic acute myocardial infection with ST elevation. • The diagnosis is made on the basis of a recent upper airway infection by streptococcus group A in the absence of a rheumatic setting. • Cardiac imaging (mainly ultrasound and magnetic resonance) plays a major role in making the diagnosis.
    [Show full text]
  • Cardiotoxicity of Novel Targeted Hematological Therapies
    life Review Cardiotoxicity of Novel Targeted Hematological Therapies Valentina Giudice 1,2,* , Carmine Vecchione 1,3 and Carmine Selleri 1,4 1 Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; [email protected] (C.V.); [email protected] (C.S.) 2 Clinical Pharmacology, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy 3 IRCCS Neuromed (Mediterranean Neurological Institute), 86077 Pozzilli, Italy 4 Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy * Correspondence: [email protected]; Tel.: +39-089-672-493 Received: 9 November 2020; Accepted: 10 December 2020; Published: 11 December 2020 Abstract: Chemotherapy-related cardiac dysfunction, also known as cardiotoxicity, is a group of drug-related adverse events negatively affecting myocardial structure and functions in patients who received chemotherapy for cancer treatment. Clinical manifestations can vary from life-threatening arrythmias to chronic conditions, such as heart failure or hypertension, which dramatically reduce quality of life of cancer survivors. Standard chemotherapy exerts its toxic effect mainly by inducing oxidative stress and genomic instability, while new targeted therapies work by interfering with signaling pathways important not only in cancer cells but also in myocytes. For example, Bruton’s tyrosine kinase (BTK) inhibitors interfere with class I phosphoinositide 3-kinase isoforms involved in cardiac hypertrophy, contractility, and regulation of various channel forming proteins; thus, off-target effects of BTK inhibitors are associated with increased frequency of arrhythmias, such as atrial fibrillation, compared to standard chemotherapy. In this review, we summarize current knowledge of cardiotoxic effects of targeted therapies used in hematology.
    [Show full text]
  • Myopericarditis Associated with Parainfluenza Virus Type I Infection
    Case Reports Acta Cardiol Sin 2006;22:163-9 Myopericarditis Associated with Parainfluenza Virus Type I Infection Jien-Jiun Chen,1 Ming-Tzer Lin,1 Lung-Chun Lin,1 Chuen-Den Tseng1 and Fu-Tien Chiang1,2 Myopericarditis is not uncommon, but often under-diagnosed. In fulminant cases, it may lead rapidly to circulatory failure or malignant arrhythmia, causing mortality. In this report, we describe a 41-year-old man who had episodes of convulsion one week after an upper respiratory tract infection. His electrocardiograms (ECGs) recorded during attack showed ventricular tachycardia. He had pulmonary edema and shock in the hospitalization course. The serial ECGs showed widespread PR depression, ST elevation and T-wave inversion afterwards, typical of myopericarditis change. The patient recovered finally. A paired serology test showed fourfold elevation of Parainfluenza virus type I antibody titer, suggesting that the parainfluenza virus might be the causative agent. This case illustrates that the parainfluenza virus might have a causative role in acute myopericarditis in which the clinical course is fulminant. Key Words: Myopericarditis · Ventricular tachycardia · Parainfluenza virus INTRODUCTION ual status of health until 7 days prior to admission, when he started to have cough, rhinorrhea and mild fever. Myopericarditis is a disease with both pictures of my- While watching television at about 9 pm on the day be- ocarditis and pericarditis. The presentations are variable, fore admission, he suddenly had generalized convulsion from fatigue, dyspnea, chest pain, to sudden death.1 Patients and cyanosis, lasting for several minutes. He regained his may recover fully upon rapid diagnosis and best supportive consciousness spontaneously.
    [Show full text]
  • An Acute Myopericarditis in a Young Adult: Consider an Acute Epstein-Barr Viral Infection
    Grand Rounds Vol 12 pages 40–43 Specialities: Cardiology; Emergency Medicine Article Type: Case Report DOI: 10.1102/1470-5206.2012.0010 ß 2012 e-MED Ltd An acute myopericarditis in a young adult: consider an acute Epstein-Barr viral infection Maurice Remmelinka, Paul Dekkersb and Paul F.M.M. van Bergenb aDepartment of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; bDepartment of Cardiology, Westfriesgasthuis, Hoorn, The Netherlands Corresponding address: Dr M. Remmelink, Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. Email: [email protected] Date accepted for publication 5 June 2012 Abstract We present a case of an uncommon viral myopericarditis in a 19-year-old man with chest pain. Electrocardiographic abnormalities and elevated cardiac enzymes were present. Myopericarditis of unknown origin was diagnosed following cardiac magnetic resonance imaging. During admission, the patient developed tonsillitis and serology tests confirmed an acute Epstein–Barr viral infection. Therefore, in acute myo(peri)carditis, we suggest early viral determination. Keywords Myopericarditis; Epstein-Barr virus; cardiac magnetic resonance imaging. Case report A 19-year-old man presented to the cardiac emergency room complaining of acute chest pain radiating to the left arm of 60 min duration, accompanied by dyspnea. The morning of presentation, he woke up at 05:00 h with a fever and sweating heavily. The day before he had muscle pains all over, and during a short period posture-dependent chest discomfort, especially when lying down. He had experienced some dyspnea, and a temperature rise to 398C. He had no medical history.
    [Show full text]
  • Myopericarditis Following Smallpox Vaccination Among Vaccinia-Naive US Military Personnel
    ORIGINAL CONTRIBUTION Myopericarditis Following Smallpox Vaccination Among Vaccinia-Naive US Military Personnel Jeffrey S. Halsell, DO Context In the United States, the annual incidence of myocarditis is estimated at 1 James R. Riddle, DVM, MPH to 10 per 100000 population. As many as 1% to 5% of patients with acute viral in- J. Edwin Atwood, MD fections involve the myocardium. Although many viruses have been reported to cause myopericarditis, it has been a rare or unrecognized event after vaccination with the Pierce Gardner, MD currently used strain of vaccinia virus (New York City Board of Health). Robert Shope, MD Objective To describe a series of probable cases of myopericarditis following small- Gregory A. Poland, MD pox vaccination among US military service members reported since the reintroduction of vaccinia vaccine. Gregory C. Gray, MD, MPH Design, Setting, Participants Surveillance case definitions are presented. The cases Stephen Ostroff, MD were identified either through sentinel reporting to US military headquarters surveillance Robert E. Eckart, DO using the Defense Medical Surveillance System or reports to the Vaccine Adverse Event Reporting System using International Classification of Diseases, Ninth Revision. The cases Duane R. Hospenthal, MD, PhD occurred among individuals vaccinated from mid-December 2002 to March 14, 2003. Roger L. Gibson, DVM, PhD Main Outcome Measure Elevated serum levels of creatine kinase (MB isoenzyme), John D. Grabenstein, RPh, PhD troponin I, and troponin T, usually in the presence of ST-segment elevation on elec- trocardiogram and wall motion abnormalities on echocardiogram. Mark K. Arness, MD, MTM&H Results Among 230734 primary vaccinees, 18 cases of probable myopericarditis af- David N.
    [Show full text]