In the acute phase, supportive therapy, including bed rest, is indicated. After viral entry acute injury of the myocytes, induced by virus replication leads to myocyte necrosis, exposure. Viral myocarditisincidence, diagnosis and management. Acute pericarditis causes chest pain, which may be very difficult to discern from pain caused by acute myocardial infarction. Because many cases of myocarditis are not clinically obvious, a high degree of suspicion is required to identify acute myocarditis.
There are various causes but it is usually caused by a virus. The outlook for a diagnosed case of myocarditis caused by a viral infection is excellent, with many cases healing themselves spontaneously. In human myocarditis, there is evidence for viral and autoimmune mechanisms, acting in individuals with or without a genetic predisposition familial or sporadic cases, respectively. Myocarditis is defined as inflammation of the myocardium. Myocarditis and cardiomyopathy are leading causes of heart transplants in the u. Acute myocarditis is one of the most challenging diagnosis in cardiology. The presentation pattern of viral myocarditis can range from nonspecific symptoms of fatigue and shortness of breath to more aggressive symptoms that mimic acute coronary syndrome. For example, coxsackievirus a9 is a selflimiting myocarditis, whereas coxsackievirus b3 causes severe myocarditis resulting in a high mortality rate.
Depending on the cause and severity, symptoms and possible problems can range from no symptoms at all, to lifethreatening heart failure. Myocarditis is the term used to indicate acute infective, toxic or autoimmune inflammation of the heart. After completing this article, readers should be able to. Acute myocarditis is one of the most challenging diseases to diagnose and treat in cardiology. Survival and left ventricular function changes in fulminant versus nonfulminant acute myocarditis. Currentstateofknowledgeonaetiology,diagnosis, management, and. Circulating levels of plasma tumour necrosis factor and various interleukins are elevated 12. Recognition and initial management of fulminant myocarditis. The myocarditis foundation myocarditis you can help, please. Myocarditis definition myocarditis is an inflammatory disease of the heart muscle myocardium that can result from a variety of causes. Chest pain, dyspnea, and syncope are principal symptoms. Myocarditis foundation pediatric myocarditis you can. At present, no diagnostic gold standard is generally accepted, due to the insensitivity of traditional. Acute pericarditis has a number of potential etiologies including infection, acute myocardial infarction, medication use, trauma to the thoracic cavity, and systemic diseases, such as rheumatoid.
Fortunately, most patients have mild symptoms consistent with viral syndromes, and they recover with simple supportive care on an outpatient basis, including with slow rehabilitation and the implementation of evidencebased medical therapy. Myocarditis is an inflammatory disease of the myocardium with many different etiologies, most of which are infectious. Ribavarin and interferon alpha improved survival in mice with acute myocarditis when administered at the time of virus inoculation. In viral myocarditis, viral isolates differ in tissue tropism and virulence. Treatment of myocarditis depends on the cause and severity. Because this disease may be mild or may be extreme and cause serious arrhythmias, the prognosis varies. The case report also discusses clinical criteria for endomyocardial biopsy. Myocarditis caused by insectborne chagas disease can be prevented by using effective insecticides in latin american countries where the illness is common. Acute myocarditis and pericarditis in children american. In a study investigating individuals suspected of myocarditis from 670.
Disproportionate thickening, increased echogenicity, and dyskinesis of the inferolateral wall relative to the septum. It can be an acute, subacute, or chronic disorder, and may present with focal or diffuse involvement of the myocardium. Jan 24, 2017 myocarditis is an inflammation of the heart muscle. A rare and particularly deadly form of myocarditis called, giant cell. Echocardiographic findings in fulminant and acute myocarditis. Autoimmune myocarditis histological myocarditis with negative viral pcr, with or without. Myocarditis can affect your heart muscle and your hearts electrical system, reducing your hearts ability to pump and causing rapid or abnormal heart rhythms arrhythmias. Myocarditis and giant cell myocarditis brochure pdf, 250 kb pediatric myocarditis brochure pdf, 285 kb be alert to myocarditis in children. Acute myocarditis should be suspected whenever a patient, especially a young male, presents with otherwise unexplained cardiac abnormalities of new onset, such as heart failure, myocardial infarction, cardiac arrhythmias, or conduction disturbances.
During the following years, however, the prevalence of the enteroviruses. Recognize clinical signs and symptoms of myocarditis and pericarditis. Recognition and diagnosis pdf, 265 kb myocarditis and sudden death fact sheet pdf, 117 kb the myocarditis foundation pdf, kb emergency. Acute myocarditis is a potentially lifethreatening inflammatory disorder of the myocardium, most commonly caused by viral pathogens such as coxsackie a and b, as well as influenza viruses and other enteroviruses, but an array of infections and autoimmune etiologies have been described.
The acute viremic stage, which typically occurs over the first 4 days of. Currently, parvovirus b19 and adenoviruses are most frequently identified in endomyocardial biopsies. In virus myocarditis, the acute phase of the disease is triggered by the entry and proliferation in the myocardium of the causative virus. Figure 2 pathophysiology of viral myocarditis pathophysiology of viral myocarditis. Although acute viral myocarditis is frequently subclinical. Myocarditis can be produced by a variety of infectious and noninfectious causes. The pathogenesis of viral myocarditis is both caused by direct injury mediated by viral infection and secondary to the immune response of the host. Viruses are the most important cause of acute myocarditis, especially in developed countries. Autoimmune myocarditis histological myocarditis with negative viral. Currentstateofknowledgeonaetiology,diagnosis, management. The diagnoses of myocarditis and pericarditis are often delayed because they are uncommon diseases in pediatrics and because symptoms in the early stages may be overlooked in the context of current or recent viral illnesses or other systemic diseases. Many infants and children with myocarditis present with fulminant features such as rapid and labored breathing, wheezing, grunting, low blood pressure.
At the cellular and tissue levels, the pathological progression of viral myocarditis consists of 3 stages. They range from mild flulike symptoms to sudden death. Utility of virus serology in patients with suspected myocarditis unproven costly and. The incidence, clinical manifestations, and diagnosis of myocarditis in children are. In people with symptoms, digoxin and diuretics may help. Recognize the context in which myocarditis and pericarditis arise in a differential diagnosis. Pdf acute myocarditis is one of the most challenging diagnosis in cardiology. Key difference myocarditis vs pericarditis myocarditis and pericarditis are fairly common diseases of the blood circulatory system, and they can be defined as the inflammation of the myocardium and inflammation of the pericardium respectively. The manifestations of myocarditis described above often suggest the clinical diagnosis. In this case report, seasonality of enteroviruses is examined, as well as additional factors which may contribute to sporadic cases during winter months. Longterm outcome of fulminant myocarditis as compared with acute nonfulminant myocarditis.
Current state of knowledge on aetiology, diagnosis, management. Viral myocarditis may have various clinical presentations, sometimes mimicking acute myocardial infarction or ischaemia. Acute viral myocarditis european heart journal oxford academic. While most cases are produced by a viral infection, an inflammation of the heart muscle may also be instigated by toxins, drugs, and hypersensitive immune reactions. Acute viral myocarditis a death associated with anaesthesia w. Myocarditis is inflammation of the myocardium, the cardiac muscle. Virus myocarditis an overview sciencedirect topics. Acute viral myocarditis european heart journal oxford. An outofseason case of coxsackie b myocarditis with. Acute myocarditis is an inflammatory disease of the heart muscle that may progress to dilated cardiomyopathy and chronic heart failure. Affected patients can present with a broad clinical spectrum of signs and symptoms ranging from subclinical disease to cardiogenic shock, arrhythmias, and sudden death. About 20 viruses have been associated with myocarditis and dilated cardiomyopathy. What causes pediatric myocarditis clinical manifestations of acute viral myocarditis are usually nonspecific and highly variable. Jul 09, 2008 viruses are the most important cause of acute myocarditis, especially in developed countries.
At present, no diagnostic gold standard is generally. The chest pain in acute pericarditis may be severe and the patient may also experience cold sweats, tachycardia and anxiety. Modern techniques have improved the ability to diagnose specific viral pathogens in the myocardium. Patients with fm experience a greater degree of recovery in contractile function if they survive to recovery relative to those with acute myocarditis. It can lead to infectious dilated cardiomyopathy, a disease frequently requiring cardiac transplantation. An outofseason case of coxsackie b myocarditis with severe. The presentation, diagnosis and course of the disease is discussed. At present, no diagnostic gold standard is generally accepted.
Difference between myocarditis and pericarditis compare. Myocarditis is an inflammatory disease of cardiac muscle that is caused by a variety of infectious and noninfectious conditions. In very rare cases, myocarditis can lead to sudden death. In developed countries, viral infections commonly cause myocarditis. A number of factors including the sex hormone testosterone, components of innate immunity, and profibrotic cytokines have been identified in animal models as important pathogenic mechanisms that increase inflammation and susceptibility to chronic dilated. Reversible toxic myocarditis occurs in diphtheria and sometimes in infective endocarditis when autoimmune mechanisms may also contribute. Acute myocarditis is most commonly caused by a viral illness.
A viral infection usually causes myocarditis, but it can result from a reaction to a drug or be part of a more general inflammatory condition. As with most viral infections, symptomatic treatment is the only form of therapy for most forms of myocarditis. Thus the difference between myocarditis and pericarditis lies in their place of inflammation. Dec 19, 2016 because many cases of myocarditis are not clinically obvious, a high degree of suspicion is required to identify acute myocarditis. For example, people with only mild viral myocarditis may be allowed to rest at home. For example, in acute paediatric myocarditis, the sensitivity of specificity of troponin t tnt were 75 and 75% when the cutoff was set at 0. Jag0 summary the death of a 35yearold woman in the immediate postoperative period as a result of undiagnosed acute viral myocarditis is described. Myocarditis, pericarditis and other pericardial diseases heart. A 21yearold woman was found to have fulminant myocarditis as a result of coxsackie b infection a virus shown to exhibit summerfall seasonality in middecember. The prognosis and treatment of myocarditis vary according to the cause, and clinical and hemodynamic data usually offer guidance on when to refer a patient to a specialist for endomyocardial biopsy. Viral myocarditis has an incidence rate of 10 to 22 per 100,000 individuals. A guide for physicians pdf, 372 kb adult myocarditis. Acute myocarditis definition of acute myocarditis by.
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