Myocarditis: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 32: | Line 32: | ||
*[[Chest pain]] | *[[Chest pain]] | ||
*Pericardial friction rub | *Pericardial friction rub | ||
*Flu like | *[[Flu-like symptoms]] | ||
**Fever, fatigue, myalgia, nausea and vomiting | **[[Fever], [[fatigue]], [[myalgia]], [[nausea and vomiting]] | ||
**Tachycardia (out of proportion to fever) | **[[Tachycardia]] (out of proportion to fever) | ||
**Tachypnea | **[[Tachypnea]] | ||
*New onset [[congestive heart failure]] | *New onset [[congestive heart failure]] | ||
*Pediatric patients: | *Pediatric patients: | ||
| Line 42: | Line 42: | ||
**Ronchi | **Ronchi | ||
*Infants may have fulminant syndrome | *Infants may have fulminant syndrome | ||
**Fever | **[[Fever]] | ||
**Cyanosis | **Cyanosis | ||
**Respiratory distress | **[[Shortness of breath (peds)|Respiratory distress]] | ||
**Tachycardia | **[[Tachycardia]] | ||
**Heart failure | **[[Heart failure]] | ||
**Ventricular dysrhythmias | **[[Ventricular dysrhythmias]] | ||
*Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids | *Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids | ||
| Line 57: | Line 57: | ||
==Evaluation== | ==Evaluation== | ||
*[[ECG]] | *[[ECG]] | ||
**Sinus tachycardia | **Sinus [[tachycardia]] | ||
**Low voltages | **[[low voltage ECG|Low voltages]] | ||
**[[Prolonged QTc]] | **[[Prolonged QTc]] | ||
**AV block | **[[AV block]] | ||
**ST | **[[ST elevation]]s (Usually >1 vessel distribution) | ||
*Elevated troponin | *Elevated [[troponin]] | ||
* | *[[Echocardiography]] | ||
**Decreased LVEF | **Decreased LVEF | ||
**Global hypokinesis | **Global hypokinesis | ||
| Line 81: | Line 81: | ||
*Chronic phase | *Chronic phase | ||
**Treatment for CHF symptoms | **Treatment for CHF symptoms | ||
**Ventricular Assist Devices (VAD) | **Ventricular Assist Devices ([[LVAD|VAD]]) | ||
**Cardiac transplant | **Cardiac transplant | ||
| Line 94: | Line 94: | ||
==Complications== | ==Complications== | ||
*Ventricular dysrhythmias | *[[Ventricular dysrhythmias]] | ||
*LV | *[[LV aneurysm]] | ||
*[[CHF]] | *[[CHF]] | ||
Revision as of 15:54, 25 September 2019
Background
- Inflammatory (dilated) cardiomyopathy caused by necrosis of myocytes
Causes
- Infectious agents
- Enterovirus (Coxsackie B) and adenovirus most common
- Influenza A and B
- Hepatitis B
- Beta-hemolytic streptococcus
- Mycoplasma
- Mumps
- CMV
- Toxoplasma
- Chagas (most common cause worldwide
- Trichinosis
- Diphtheria
- Lyme disease
- Drugs
Phases
- Acute
- Viral cytotoxicity and focal necrosis
- Subacute
- Host's humoral/immune response leading to further cell injury
- Chronic
- Diffuse myocardial fibrosis and cardiac dysfunction
Clinical Features
- Typically young patients (20 - 50 years) with few risk factors for CAD
- Chest pain
- Pericardial friction rub
- Flu-like symptoms
- [[Fever], fatigue, myalgia, nausea and vomiting
- Tachycardia (out of proportion to fever)
- Tachypnea
- New onset congestive heart failure
- Pediatric patients:
- Grunting
- Retractions
- Ronchi
- Infants may have fulminant syndrome
- Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids
Differential Diagnosis
Consider other causes of CHF
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Evaluation
- ECG
- Sinus tachycardia
- Low voltages
- Prolonged QTc
- AV block
- ST elevations (Usually >1 vessel distribution)
- Elevated troponin
- Echocardiography
- Decreased LVEF
- Global hypokinesis
- Regional wall motion abnormalities
- Contrast MR
- Nuclear Study
- Widespread uptake indicating myocyte necrosis
- Viral titres
- Endocardial biopsy: Gold standard, but rarely used
Management
- Acute phase
- Antiviral agents (Pleconaril/Ribavirin) may be effective
- Subacute phase
- Studies have not shown efficacy of immunosupressants
- Pediatric patients may receive high-dose IVIG
- Chronic phase
- Treatment for CHF symptoms
- Ventricular Assist Devices (VAD)
- Cardiac transplant
Disposition
- If CHF is present, admit to monitored bed
- If hemodynamically unstable, admit to ICU
Prognosis
- Fulminant myocarditis has best prognosis
- Mortality: 20% 1 yr/ 50% 5 yr
- Children with 70% survival rate at 5 yrs