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Myocarditis

Myocarditis. Howard Sacher, D.O. Long Island Cardiology and Internal Medicine. Acute Myocarditis. Focal or Diffuse inflammation of the myocardium Most Commonly 2 nd to infectious agents Viral Bacteria Rickettsia Spirochete Fungal Parasitic

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Myocarditis

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  1. Myocarditis Howard Sacher, D.O. Long Island Cardiology and Internal Medicine

  2. Acute Myocarditis • Focal or Diffuse inflammation of the myocardium • Most Commonly 2nd to infectious agents • Viral • Bacteria • Rickettsia • Spirochete • Fungal • Parasitic • Toxins, Drugs and immunologic disorders has also been implicated

  3. Infectious Myocarditis • Often follows an URI • May present with chest pain or signs of HF • ECG may show sinus tachycardia or non specific repolarization changes • Can be just about any rhythm • Echocardiogram shows cardiomegaly and contractile dysfunction • Myocardial biopsy although not sensitive, usually reveals an inflammatory process

  4. General Consideration • Viral myocarditis is most common • Cox B • Richettsial myocarditis • Scrub typhus • Rocky Mountain Spotted fever • Q-fever • Diphtheritic myocarditis is 2nd to an endotoxin that manifests as conduction abnormalities and HF

  5. Chagas’ Disease is caused by T. Cruzi, a protozoan. Most commonly in South America  always ask travel about Hx • S/S appears about a decade after exposure • AIDS Myocarditis • HIV-1 and 2

  6. Clinical Findings • S/S: • Patient usually presents several weeks post an acute febrile illness, URI or wit HF without prior symptoms • Pleural or pericardial chest pain is common • Tachycardia • S3 gallop • Evidence of HF • +/- evidence of conduction defect

  7. NSSTTW changes • +/- PVC • Usually cardiomegaly on CXR • Echocardiography – evaluate cardiac function at bedside • Gallium-67 body scan to look for infectious process. • Will usually show increased uptake of tracer in the myocardium • Biopsy – shows an inflammatory process with round cells with necrosis

  8. Treatment and Prognosis • Organism Specific antimicrobials • Immunosuppressive therapy in the acute phase  only if Bx revealed an inflammatory process with no organisms • Treatment is largely directed to preserving cardiac function • Many cases resolves spontaneously • Some deteriorates to dilated cardiomyopathies – which is usually the end stage of unresolved viral myocarditis

  9. Illicit drugs Cocaine is MC Doxorubicin Other cytotoxic agents Emetine Catecholamine excess from a Pheo Phenothiazines Li Chloroquine Disopyramide Antimony-containing compounds Arsenic Those Rx that causes hypersensitivity rxn’s Radiation Drug Induced and Toxic Myocarditis

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