Myocarditis

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MYOCARDITIS
DEFINITION
The definition of myocarditis varies, but the central feature is an infection of the heart, with an inflammatory infiltrate, and damage to the heart muscle, without the blockage of coronary arteries that define a heart attack (myocardial infarction) or other common non-infectious causes. Myocarditis may or may not include death (necrosis) of heart tissue. When the heart is involved in an inflammatory process, often caused by an infectious agent, myocarditis is said to be present Inflammation may involve the myocytes, interstitium, vascular elements &/or pericardium Characterized by isolated pockets of inflamed & necrotic myocardial cells Usually of sudden onset

CAUSES

Viruses. Viruses commonly associated with myocarditis include coxsackievirus B, which can cause symptoms similar to a mild case of flu; the viruses that cause the common cold (adenovirus); and parvovirus B19, which causes a rash called fifth disease. Gastrointestinal infections (echoviruses), mononucleosis (Epstein-Barr virus) and German measles (rubella) also are causes of myocarditis. Myocarditis is also common in people with HIV, the virus that causes AIDS.

Bacteria. Numerous bacteria may cause myocarditis, including staphylococcus, streptococcus, the bacteria that causes diphtheria and the tick-borne bacterium responsible for Lyme disease.

Parasites. Among these are such parasites as Trypanosoma cruzi and toxoplasma, including some that are transmitted by insects and can cause a condition called Chagas' disease.

Fungi. Some yeast infections (such as candida), molds (such as aspergillus) and other fungi (such as histoplasma, often found in bird droppings) can sometimes cause myocarditis.

Other Causes of Myocarditis may Include:

Medications or illegal drugs that may cause an allergic or toxic reaction. These include antibiotics, such as penicillin and sulfonamide drugs, some anti-seizure medications as well as some illegal substances, such as cocaine. •Other diseases. These include lupus, connective tissue disorders and rare inflammatory conditions, such as Wegener's granulomatosis.

SIGNS AND SYMPTOMS

Myocarditis vary from person-to-person depending on the cause and the severity. Symptoms may appear slowly or come on suddenly. •Flu-like complaints, including fever, fatigue, muscle pain, vomiting, diarrhea , and weakness •Rapid heart rate

Chest pain
Shortness of breath and respiratory distress
Shortness of breath and respiratory distress
Loss of consciousness
Sudden, unexpected death
Sudden, intense myocarditis can lead to congestive heart failure •Some people have no symptoms (asymptomatic).

RISK FACTORS

Immunodeficient person
Who undergone heart transplant
Heavy Smokers
Alcoholic
Obese

DIAGNOSTIC EXAMS

Cardiac enzyme levels
These levels are only elevated in a minority of patients. •Normally, a characteristic pattern of slow elevation and fall over a period of days occurs •Cardiac troponin I may be more sensitive because it is present for longer periods after myocardial damage from any cause. •Erythrocyte sedimentation rate (ESR) is elevated in 60% of patients with acute myocarditis. •Leukocytosis is present in 25% of cases.

IMAGING STUDIES

Chest radiography
An X-ray image of your chest allows your doctor to check the size and shape of your heart, as well as look for fluid in or around the heart that might indicate heartfailure.

MRI
Cardiac magnetic resonance imaging (MRI) will show your heart's size, shape and structure. This test can show signs of inflammation of the heart muscle and help make or confirm a diagnosis of myocarditis.

Electrocardiogram (ECG)
This noninvasive test shows your heart's electrical patterns and can detect abnormal rhythms, as well as a weakened or damaged heart muscle.

Holter monitor
If your doctor can't detect any problems with your heart during an...
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