Acute Viral Myocarditis Mimicking ST Elevation Myocardial Infarction: Manifestation on Cardiac Magnetic Resonance
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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]. -
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- -
Cardiovascular Disease and Rehab
EXERCISE AND CARDIOVASCULAR ! CARDIOVASCULAR DISEASE Exercise plays a significant role in the prevention and rehabilitation of cardiovascular diseases. High blood pressure, high cholesterol, diabetes and obesity can all be positively affected by an appropriate and regular exercise program which in turn benefits cardiovascular health. Cardiovascular disease can come in many forms including: Acute coronary syndromes (coronary artery disease), myocardial ischemia, myocardial infarction (MI), Peripheral artery disease and more. Exercise can improve cardiovascular endurance and can improve overall quality of life. If you have had a cardiac event and are ready to start an appropriate exercise plan, Cardiac Rehabilitation may be the best option for you. Please call 317-745-3580 (Danville Hospital campus), 317-718-2454 (YMCA Avon campus) or 317-456-9058 (Brownsburg Hospital campus) for more information. SAFETY PRECAUTIONS • Ask your healthcare team which activities are most appropriate for you. • If prescribed nitroglycerine, always carry it with you especially during exercise and take all other medications as prescribed. • Start slow and gradually progress. If active before event, fitness levels may be significantly lower – listen to your body. A longer cool down may reduce complications. • Stop exercising immediately if you experience chest pain, fatigue, or labored breathing. • Avoid exercising in extreme weather conditions. • Drink plenty of water before, during, and after exercise. • Wear a medical identification bracelet, necklace, or ID tag in case of emergency. • Wear proper fitting shoes and socks, and check feet after exercise. STANDARD GUIDELINES F – 3-5 days a week. Include low weight resistance training 2 days/week I – 40-80% of exercise capacity using the heart rate reserve (HRR) (220-age=HRmax; HRmax-HRrest = HRR) T – 20-60mins/session, may start with sessions of 5-15 mins if necessary T – Large rhythmic muscle group activities that are low impact (walking, swimming, biking) Get wellness tips to keep YOU healthy at HENDRICKS.ORG/SOCIAL.. -
Myocardial Infarction (Heart Attack)
Sacramento Heart & Vascular Medical Associates February 19, 2012 500 University Ave. Sacramento, CA 95825 Page 1 916-830-2000 Fax: 916-830-2001 Patient Information For: Only A Test Myocardial Infarction (Heart Attack) What is a myocardial infarction (MI)? Myocardial infarction (MI) is a heart attack. It happens when blood flow to a part of the heart is suddenly blocked. How does it occur? Myocardial infarction may occur at any time and often occurs without warning. As we grow older, our coronary arteries may become narrowed by the buildup of cholesterol plaque. When the arteries narrow, less blood can go through them, and less oxygen gets to the heart muscle. The process of narrowing is called atherosclerosis. The narrower the artery becomes, the more likely it is that a blood clot may form and block the artery completely, causing a heart attack. Sometimes sudden blockages can occur even in places where the artery was not narrow before. A heart attack may also occur when the heart muscle needs more oxygen than the blood vessels can provide. This might happen, for example, during hard exercise such as shoveling snow, or with a sudden increase in blood pressure. Less commonly, a heart attack can occur due to coronary spasm. Coronary spasm is a sudden and temporary narrowing of a small part of an artery that supplies blood to the heart. It may be caused by smoking or drugs such as cocaine. Risk factors for heart disease include: - cigarette smoking - a family history of heart attack - diabetes - overweight - high blood pressure - high blood cholesterol - low HDL cholesterol (that is, too little "good" cholesterol) - stress - a lifestyle that does not include much physical activity. -
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, -
Neuropsychiatric Manifestations of Infective Endocarditis: a Study of 95 Patients at Ibadan, Nigeria
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.4.325 on 1 April 1976. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry, 1976, 39, 325-329 Neuropsychiatric manifestations of infective endocarditis: a study of 95 patients at Ibadan, Nigeria 0. BADEMOSI,1 A. 0. FALASE, F. JAIYESIMI, AND A. BADEMOSI From the Departments of Medicine and Paediatrics, University College Hospital, Ibadan, Nigeria SYNOPSIS Thirty-eight percent of patients with infective endocarditis (36 of 95) had neuropsychi- atric manifestations. In 750 (27 of 36), these features were the major presenting picture. Fifteen patients (42%) presented with cerebrovascular lesions and seven (19%) with meningitis. Toxic encephalopathy (12.5%) was not uncommon. Other neurological syndromes seen included psychosis and spinal cord lesions. The mortality was high especially when the infective endocarditis was acute in onset. It is essential to search diligently for an underlying cardiac cause in patients who present with neuropsychiatric symptoms because treatment of the underlying pathology improves prognosis. Although the clinical features of infective endo- criteria: (1) repeated positive blood cultures during a Protected by copyright. carditis are well established, significant changes febrile illness in a patient with known previous have taken place in the pattern of the disease in valvular or congenital heart disease; (2) evidence of the developed countries over the last 20 years peripheral manifestations of infective endocarditis; 1951; Pankey, (3) development of a significant cardiac murmur (Horder, 1909; Cates and Christie, with features of cardiac failure in any patient 1961, 1962; Thompson, 1964; Cooper et al., admitted for an unexplained febrile illness while 1966; British Medical Journal, 1973). -
The Management of Acute Coronary Syndromes in Patients Presenting
CONCISE GUIDANCE Clinical Medicine 2021 Vol 21, No 2: e206–11 The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician Authors: Ramesh NadarajahA and Chris GaleB There have been significant advances in the diagnosis and international decline in mortality rates.2,3 In September 2020, management of non-ST-segment elevation myocardial the European Society of Cardiology (ESC) published updated infarction over recent years, which has been reflected in an Clinical Practice Guidelines for the management of ACS in patients international decline in mortality rates. This article provides an presenting without persistent ST-segment elevation,4 5 years after overview of the 2020 European Society of Cardiology Clinical the last iteration. ABSTRACT Practice Guidelines for the topic, concentrating on areas relevant The guidelines stipulate a number of updated recommendations to the general or emergency physician. The recommendations (supplementary material S1). The strength of a recommendation and underlying evidence basis are analysed in three key and level of evidence used to justify it are weighted and graded areas: diagnosis (the recommendation to use high sensitivity according to predefined scales (Table 1). This focused review troponin and how to apply it), pathways (the recommendation provides learning points derived from the guidelines in areas to facilitate early invasive coronary angiography to improve relevant to general and emergency physicians, including diagnosis outcomes and shorten hospital stays) and treatment (a (recommendation to use high sensitivity troponin), pathways paradigm shift in the use of early intensive platelet inhibition). -
Treatment of Acute Coronary Syndrome
Acute Coronary Syndrome: Current Treatment TIMOTHY L. SWITAJ, MD, U.S. Army Medical Department Center and School, Fort Sam Houston, Texas SCOTT R. CHRISTENSEN, MD, Martin Army Community Hospital Family Medicine Residency Program, Fort Benning, Georgia DEAN M. BREWER, DO, Guthrie Ambulatory Health Care Clinic, Fort Drum, New York Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States. Family physicians need to identify and mitigate risk factors early, as well as recognize and respond to acute coronary syn- drome events quickly in any clinical setting. Diagnosis can be made based on patient history, symptoms, electrocardi- ography findings, and cardiac biomarkers, which delineate between ST elevation myocardial infarction and non–ST elevation acute coronary syndrome. Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. Coupled with appropriate medical management, percutaneous coronary interven- tion can improve short- and long-term outcomes following myocardial infarction. If percutaneous coronary interven- tion cannot be performed rapidly, patients with ST elevation myocardial infarction can be treated with fibrinolytic therapy. Fibrinolysis is not recommended in patients with non–ST elevation acute coronary syndrome; therefore, these patients should be treated with medical management if they are at low risk of coronary events or if percutaneous coronary intervention cannot be performed. Post–myocardial infarction care should -
Lyme Carditis and Sudden Cardiac Death
Health Update August 6, 2018 TO: Health Care Providers FROM: Mark Levine, MD, Commissioner of Health Lyme Carditis and Sudden CardiaC Death – Please Distribute as Appropriate – Laboratory results from the Centers for Disease Control and Prevention (CDC) have confirmed that the recent death of a Franklin County resident was a result of Lyme carditis, a rare complication of Lyme disease. This is the first reported death due to Lyme carditis in Vermont. Between 1985 and 2014 there were nine deaths related to Lyme carditis reported worldwide. The Health Department issued a Health Advisory on December 13, 2013 following a CDC report about sudden cardiac death associated with Lyme carditis. Symptomatic infection of the heart is rare in recognized Lyme disease cases. Approximately 1 percent of reported cases have Lyme carditis, which is usually present with other features of Lyme disease but can be observed independently. It is more common among males than would be expected based on the gender distribution of patients with clinical manifestations of Lyme disease. • Vermont Health Advisory: http://www.healthvermont.gov/dec2013_healthadvisory • CDC report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a1.htm?s_cid=mm6249a1_w The most common cardiac manifestation is atrioventricular block (first, second, or third degree). Symptoms of atrioventricular block include lightheadedness, palpitations, shortness of breath, chest pain and syncope. Some cases might require temporary pacing, although prognosis is excellent with appropriate antibiotic therapy. Lyme disease is endemic in Vermont. Place carditis symptoms in context during the spring, summer and fall seasons. Actions Requested: • If you suspect Lyme disease, treat with antibiotics according to current treatment guidelines: https://www.cdc.gov/lyme/treatment/index.html • Ask all patients with suspected Lyme disease about cardiac symptoms. -
The Frequency of Rhythm and Conduction Abnormalities and Benefits of 24-Hour Holter Electrocardiogram on Detecting These Abnormalities
ORIGINAL ARTICLE East J Med 24(3): 303-309, 2019 DOI: 10.5505/ejm.2019.31932 The Frequency of Rhythm and Conduction Abnormalities and Benefits of 24-Hour Holter Electrocardiogram on Detecting These Abnormalities In Patients With Acute Rheumatic Fever Serdar Epçaçan*, Yasemin Nuran Dönmez University of Health Sciences, Van Training and Research Hospital, Department of Pediatric Cardiology, Van, Turkey ABSTRACT During the acute phase of acute rheumatic fever (ARF), cardiac arrhythmias and conduction disorders may occur. Standard electrocardiogram (ECG) may be insufficient in the cases of possible paroxysmal rhythm or conduction abnormalities. The aim of this study is to evaluate arrhythmias and conduction disorders and benefits of 24-hour Holter ECG on detecting these disorders in children with ARF. Two hundred and ten patients who were diagnosed with ARF during a four-year period, were retrospectively analyzed. Demographic characteristics, clinical, laboratory, and echocardiographic findings of the patients were evaluated. Standard ECG and 24-hour Holter analysis were examined. First (47.8%), second (6.9%) and third degree (4.3%) atrioventricular (AV) blocks, bundle branch blocks (9.8%), intermittent pre-excitation (1.1%), accelerated nodal rhythm (15.2%), supraventricular (10.9%) and ventricular premature contractions (8.7%), as well as supraventricular (3.3%) and ventricular tachycardia (1.1%) were detected with 24 -hour Holter ECG. Frequency of both rhythm and conduction abnormalities were detected higher with Holter ECG than 12-lead ECG, and this was statistically significant (p<0.05). Second degree type II AV block and non-sustained supraventricular tachycardia as well as intermittent complete AV block were detected on 24-hour Holter analysis in patients with normal initial standard ECG. -
Long QT Syndrome: an Emerging Role for Inflammation and Immunity
REVIEWS IN MEDICINE published: 27 May 2015 doi: 10.3389/fcvm.2015.00026 Long QT syndrome: an emerging role for inflammation and immunity Pietro Enea Lazzerini*, Pier Leopoldo Capecchi and Franco Laghi-Pasini Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy The long QT syndrome (LQTS), classified as congenital or acquired, is a multi-factorial disorder of myocardial repolarization predisposing to life-threatening ventricular arrhyth- mias, particularly torsades de pointes. In the latest years, inflammation and immunity have been increasingly recognized as novel factors crucially involved in modulating ventricular repolarization. In the present paper, we critically review the available information on this topic, also analyzing putative mechanisms and potential interplays with the other etiologic factors, either acquired or inherited. Accumulating data indicate inflammatory activation as a potential cause of acquired LQTS. The putative underlying mechanisms are complex but essentially cytokine-mediated, including both direct actions on cardiomyocyte ion channels expression and function, and indirect effects resulting from an increased Edited by: central nervous system sympathetic drive on the heart. Autoimmunity represents another Theofilos M. Kolettis, recently arising cause of acquired LQTS. Indeed, increasing evidence demonstrates that University of Ioannina, Greece autoantibodies may affect myocardial electric properties by directly cross-reacting with Reviewed by: Luigi Venetucci, the cardiomyocyte and interfering with specific ion currents as a result of molecular University of Manchester, UK mimicry mechanisms. Intriguingly, recent data suggest that inflammation and immunity Giannis G. Baltogiannis, Cardiovascular Institute, Greece may be also involved in modulating the clinical expression of congenital forms of LQTS, *Correspondence: possibly triggering or enhancing electrical instability in patients who already are genetically Pietro Enea Lazzerini, predisposed to arrhythmias. -
Lyme Carditis Presenting As Atrial Fibrillation Treated Successfully - 08-11-2019 by Dr
Lyme carditis presenting as atrial fibrillation treated successfully - 08-11-2019 by Dr. Daniel Cameron - Daniel Cameron, MD, MPH - http://danielcameronmd.com Lyme carditis presenting as atrial fibrillation treated successfully Sunday, August 11, 2019 http://danielcameronmd.com/lyme-carditis-atrial-fibrillation-treated-successfully/ A case study published in the British Medical Journal features a 23-year-old man with a history of degenerative joint disease who presented with a sudden onset of palpitations. [2] His echocardiogram (ECG) revealed atrial fibrillation (AF) with a mildly dilated left Atrium. The patient did not recall a tick bite or a rash. And, “Although Lyme carditis was on the differential diagnoses list, it was not considered high enough due to the initial rhythm being AF and not [atrioventricular ] AV block,” writes Shabbir and colleagues. The man was treated with metoprolol and released from the hospital after his heart spontaneously reverted back to normal sinus rhythm. However, 4 days later the patient returned to the hospital. “ECG now exhibited atrioventricular (AV) mobitz-II block alternating with intermittent complete heart block (CHB) on telemetry confirmed with ECG,” writes Shabbir. He was tested for Lyme disease and treated empirically with intravenous ceftriaxone. Within 48 hours, his symptoms began to improve. Lyme disease tests came back positive. And 1 month later, after antibiotic therapy, his heart rhythm had returned to normal. The authors' key learning points include: 1. Consider the unusual initial presentation of Lyme disease as atrial fibrillation. 2. Keeping Lyme carditis in the differential diagnoses when someone from a Lyme-endemic area presents as supraventricular arrhythmia (atrial fibrillation/flutter).