Myocarditis acute

Picornavimses are small, nonenveloped RNA vimses. Members of this family include rhino- and enteroviruses, which are responsible for a variety of human diseases (viral respiratory infection, viral meningitis, myocarditis, pericarditis, encephalitis, chronic meningoencephalitis, herpangina, otitis media, neonatal enteroviral disease, and acute exacerbations of asthma). 

Increased oxygen demand secondary to increased heart rates and blood pressure has been hypothesized to lead to myocardial infarction (especially in patients with fixed coronary disease) and/or ventricular arrhythmias. In patients with no history of cardiac disease, cocaine is thought to induce acute isehemie complications via vasospasm of the coronaries (Ascher et al. 1988). In addition, Virmani et al. (1988) have reported a 20 percent incidence of myocarditis thought to be secondary to accumulated microvascular injuries. 

Acute decompensated heart failure, myocarditis, or severe myopathy... 

Acute myocarditis and depression of myocardial contractility following cardiac arrest and prologed cardiac surgery also the causes of cardiogenic shock. 

Yanagawa et al Infusion of adrenomedullin improves acute myocarditis via attenuation of myocardial inflammation and edema. Cardiovasc Res 2007 76 110. [PMID 17599815]... 

Fatal Aspergillus myocarditis, probably related to shortterm administration of glucocorticoids, has been described in a 58-year-old man, who had an acute exacerbation of his chronic obstructive pulmonary disease and received oxygen, bronchodilators, omeprazole, co-amoxiclav, and intravenous methylprednisolone 40 mg 8-hourly he died 5 days later and postmortem examination showed a fungal myocarditis (337). 

Chagas disease in humans can be divided in two main phases the acute phase and the chronic phase. The acute phase may have no symptoms or have very mild symptoms. When present, the symptoms can include diarrhea, vomiting, headache, fever, edema, rashes, swollen lymph glands, enlarged liver or spleen, and myocarditis and/or meningoencephalitis. This phase is characterized by the presence of the protozoa in the patient s blood and can be severe and /or fatal in infants, children, and in people with weakened immune systems. In this phase, morbidity and clinical symptoms are directly associated with the parasitemia level. Chagas disease manifestations in the acute form are very common when T. cruzi is acquired by via the oral route. 

The first scientific report of an orally transmitted outbreak of Chagas disease in Brazil was made in 1968 (Nery-Guimaraes et ah, 1968). This occurred in the district of Teutonia, municipality of Estrela (Rio Grande do Sul state) in the year 1965, between March 13 and March 22. Seventeen people from an Agricultural School (workers, students, and lecturers that usually had meals there) fell sick. The initial unconfirmed diagnosis was typhoid fever. Other possible diagnoses like infectious hepatitis, toxoplasmosis, infectious mononucleosis, and food poisoning were also discarded. Then, some of the infected people presented with clinical symptoms of acute myocarditis, and, based on clinical observations,... 

The main dose-limiting toxicity of all anthracyclines is myelosuppression, with neutropenia more commonly observed than thrombocytopenia. In some cases, mucositis is dose-limiting. Two forms of cardiotoxicity are observed. The acute form occurs within the first 2-3 days and presents as arrhythmias or conduction abnormalities, other electrocardiographic changes, pericarditis, and myocarditis. This form is usually transient and is asymptomatic in most cases. The chronic form results in a dose-dependent, dilated cardiomyopathy associated with heart failure. The chronic cardiac toxicity appears to result from increased production of free radicals within the myocardium. This effect is rarely seen at total doxorubicin dosages below 500-550 mg/m2. Use of lower weekly doses or continuous infusions of doxorubicin appear to reduce the incidence of cardiac toxicity. In addition, treatment with the iron-chelating agent dexrazoxane (ICRF-187) is currently approved to prevent or reduce anthracycline-induced cardiotoxicity in women with metastatic breast cancer who have received a total cumulative dose of doxorubicin of 300 mg/m2. All anthracyclines can produce "radiation recall reaction," with erythema and desquamation of the skin observed at sites of prior radiation therapy. 

Severe complications connected with cholera (or combined) immunization are extremely rare and the causal relation is always doubtful. However, when they do occur they constitute a contraindication to further administration. There are occasional reports of neurological and psychiatric reactions (SED-8, 706) (SEDA-1, 246), Guillain-Barre syndrome (SEDA-1, 246), myocarditis (154,155), myocardial infarction (SEDA-3, 261), a syndrome similar to immune complex disease (156), acute renal insufficiency accompanied by hepatitis (157), and pancreatitis (158). 

Driehorst J, Laubenthal F. Akute Myocarditis nach Choleraschutzimpfung. [Acute myocarditis after cholera vaccination.] Dtsch Med Wochenschr 1984 109(5) 197-8. 

The application of antibodies in cardiovascular targeting in vivo originated with the experimental demonstration of the feasibility of using radiolabeled antimyosin antibody for diagnosis of acute myocardial infarction in 1976. Since then, the use of antibodies in the cardiovascular system has encompassed imaging of myocarditis,heart transplant rejection, dilated cardiomyopathy, alcohol induced cardiomyopathy,adriamycin cardiotoxicity, various other cardiomyopathies, vascular clots, atherosclerotic lesions,and even certain cancers such as soft tissue sarcomas.f Yet the best characterized and studied antibody for cardiovascular diagnostic targeting is monoclonal antimyosin Fab for its exquisite specificity... 

Narula, L. Khaw, B.A. Yasuda, T. Antimyosin imaging for acute myocarditis. In Monoclonal Antibodies in Cardiovascular Diseases Khaw, B.A., Narula, J., Strauss, H.W., Eds. Lee Febiger Philadelphia, 1994 67. 

Cardiac glycosides are contraindicated in conditions in which there is obstruction to ventricular outflow, for example hypertrophic obstructive cardiomyopathy, constrictive pericarditis, and cardiac tamponade. Acute myocarditis may also increase the risk of toxicity. 

Advisory Committee (ADRAC) there were 15 cases of myocarditis (five fatal) and 8 of cardiomyopathy (one fatal) associated with clozapine. All cases of myocarditis occurred within 3 weeks of starting clozapine. Cardiomyopathy was diagnosed up to 36 months after clozapine had been started. There were no confounding factors to account for cardiac illness. Necropsy results showed mainly eosinophilic infiltrates with myocytolysis, consistent with an acute drug reaction. 

Cocaine abuse is a risk factor for myocardial ischemia, infarction, and dysrhythmias, as well as pulmonary edema, ruptured aortic aneurysm, infectious endocarditis, vascular thrombosis, myocarditis, and dilated cardiomyopathy (32). Acutely, cocaine suppresses myocardial contractility, reduces coronary caliber and coronary blood flow, induces electrical abnormalities in the heart, and increases heart rate and blood pressure. These effects can lead to myocardial ischemia (33,34). However, intranasal cocaine in doses used medicinally or recreationally does not have a deleterious effect on intracardiac pressures or left ventricular performance (35). 

Cardiovascular adverse effects of interferon beta include isolated reports of severe Raynaud s phenomenon (SEDA-22, 374) and acute myocarditis (SEDA-21, 374). 

Acute myocarditis after vaccination against smallpox has been reported (22). Fatal myocarditis is rare, but electrocardiographic evidence of myocarditis has been found more frequently this adverse effect is probably not always noticed (23-25). Pericarditis after smallpox vaccination has also been described (26). 

The pathology of the infection is associated with inflammatory reactions in infected tissues. These can lead to acute myocarditis and destruction-specific ganglia. Parasite enzymes may also cause cell and tissue damage. In the absence of parasites, an autoimmune pathological process seems to be mediated by T lymphocytes (CD4+) (see Chapter 8) and by the production of certain cytokines these in-... 

The changes of serum CK and its MB isoenzyme following a myocardial infarction are discussed in Chapter 44. Other cardiac conditions have been reported to increase serum CK and CK-MB in serum. These conditions include cardioversion, cardiopulmonary bypass and coronary artery bypass surgery, cardiac transplantation, myocarditis, pericarditis, and pulmonary embolism. Despite improvements, in the diagnostic performance and practicality of CK and CK-MB assays, there is no controlled cUnicai impact trial showing that these tests are effective for decisions to send a patient home or to the appropriate level of care of admission for patients with suspected acute cardiac ischemia, either as one-time or serial tests.For diagnosis of acute myocardial infarction, it is now advantageous to use more cardiac-specific nonenzymatic tests, such as cardiac troponin I orT. 

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