Myocarditis overview: Difference between revisions
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===History and Symptoms=== | ===History and Symptoms=== | ||
The symptoms and the intensity of symptoms associated with myocarditis are variable. Myocarditis may be associated with no symptoms. If symptoms are present,they may be similar to the flu. Patients may present with [[chest pain]] as a result of the inflammatory process involving the myocardium or with symptoms of [[congestive heart failure]]. Patients may complain of [[palpitations]], a [[racing heart]] or [[syncope]]. In fulminant myocarditis, patients present with the abrupt onset of [[flu]]-like symptoms and the abrupt onset of [[heart failure]] symptoms. In chronic and acute myocarditis, the onset of symptoms may be more insidious. | The symptoms and the intensity of symptoms associated with myocarditis are variable. Myocarditis may be associated with no symptoms. If symptoms are present,they may be similar to the flu. Patients may present with [[chest pain]] as a result of the inflammatory process involving the myocardium or with symptoms of [[congestive heart failure]]. Patients may complain of [[palpitations]], a [[racing heart]] or [[syncope]]. In fulminant myocarditis, patients present with the abrupt onset of [[flu]]-like symptoms and the abrupt onset of [[heart failure]] symptoms. In chronic and acute myocarditis, the onset of symptoms may be more insidious. | ||
===Physical Examination=== | |||
The physical examination in patients with myocarditis may reveal [[tachycardia]], a [[cardiac gallop]], [[mitral regurgitation]] due to [[left ventricular dilation]] and [[pedal edema]] suggestive of [[cardiac failure]]. A [[pericardial friction rub]] may be noted in presence of concomitant [[pericarditis]], a condition sometimes referred to as [[myopericarditis]]. | |||
==References== | ==References== | ||
Revision as of 18:50, 10 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Varun Kumar, M.B.B.S.
Overview
Myocarditis is inflammation of the myocardium. It may present with chest pain, ST segment elevation, elevated biomarkers of myonecrosis, heart failure, and / or sudden death.
Classification
Myocarditis can be classified clinicopathologically into Fulminant myocarditis, Acute myocarditis, Chronic active myocarditis and Chronic persistent myocarditis.
Pathophysiology
During either an infection or a hypersensitivity reaction, the inflammatory response may cause myonecrosis either directly or indirectly as part of an autoimmune reaction.
Causes
The cause of myocarditis may be infectious or non-infectious. The idiopathic myocarditis is the most common type of myocarditis and is often suspected to be secondary to viral infection[1].
Giant Cell Myocarditis
Giant cell myocarditis is a rare but often fatal inflammatory process involving the myocardium. Other than cardiac transplantation, there is no known effective treatment for giant cell mycoarditis.
Differentiating Myocarditis from other Diseases
Myocarditis presents with chest pain and ST segment elevation. Myocardits must be distinguished from pericarditis and the life threatening condition of ST elevation myocardial infarction.
Epidemiology and Demographics
In developed countries, myocarditis is generally due to viral infections such as coxsackie B, enterovirus,adenovirus, parvovirus B19, hepatitis C, and herpes virus 6. In developing countries, myocarditis is generally due to HIV and rheumatic heart disease.
Natural History, Complications and Prognosis
Myocarditis is usually self limiting and is associated with a good prognosis especially if it is secondary to a viral infection. Patients rarely develop cardiac failure, pulmonary edema, arrhythmias or cardiogenic shock. In some instances, myocarditis may be associated with sudden death. Patients with fulminant myocarditis have a good long term prognosis if they survive the acute phase of the disease.[2] The prognosis of fulminant myocarditis is better than that of either acute myocarditis or giant cell myocarditis.
The presence of left bundle branch block, q waves, AV block, syncope and a left ventricular ejection fraction < 40% are associated with sudden death and cardiac transplantation.[3]
Diagnosis
History and Symptoms
The symptoms and the intensity of symptoms associated with myocarditis are variable. Myocarditis may be associated with no symptoms. If symptoms are present,they may be similar to the flu. Patients may present with chest pain as a result of the inflammatory process involving the myocardium or with symptoms of congestive heart failure. Patients may complain of palpitations, a racing heart or syncope. In fulminant myocarditis, patients present with the abrupt onset of flu-like symptoms and the abrupt onset of heart failure symptoms. In chronic and acute myocarditis, the onset of symptoms may be more insidious.
Physical Examination
The physical examination in patients with myocarditis may reveal tachycardia, a cardiac gallop, mitral regurgitation due to left ventricular dilation and pedal edema suggestive of cardiac failure. A pericardial friction rub may be noted in presence of concomitant pericarditis, a condition sometimes referred to as myopericarditis.
References
- ↑ Kühl U, Pauschinger M, Noutsias M, Seeberg B, Bock T, Lassner D; et al. (2005). "High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction". Circulation. 111 (7): 887–93. doi:10.1161/01.CIR.0000155616.07901.35. PMID 15699250.
- ↑ McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM; et al. (2000). "Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis". N Engl J Med. 342 (10): 690–5. doi:10.1056/NEJM200003093421003. PMID 10706898.
- ↑ Scartazzini R, Schneider P, Bickel H (1975). "[New beta-lactam antibiotics. Functionalisation of the cephem 3-position with sulfur or nitrogen bearing substituents (author's transl)]". Helv Chim Acta. 58 (8): 2437–50. doi:10.1002/hlca.19750580824. PMID 1194054.