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Current Problems in Cardiology Sep 2022Coronavirus Disease 2019 (COVID-19) has been a significant cause of global mortality and morbidity since it was first reported in December 2019 in Wuhan, China. COVID19... (Review)
Review
Coronavirus Disease 2019 (COVID-19) has been a significant cause of global mortality and morbidity since it was first reported in December 2019 in Wuhan, China. COVID19 like previous coronaviruses primarily affects the lungs causing pneumonia, interstitial pneumonitis, and severe acute respiratory distress syndrome (ARDS). However, there is increasing evidence linking COVID-19 to cardiovascular complications such as arrhythmias, heart failure, cardiogenic shock, fulminant myocarditis, and cardiac death. Given the novelty of this virus, there is paucity of data on some cardiovascular complications of COVID-19, specifically myocarditis. Myocarditis is an inflammatory disease of the heart muscle with a heterogenous clinical presentation and progression. It is mostly caused by viral infections and is the result of interaction of the virus and the host's immune system. There have been several case reports linking COVID-19 with myocarditis, however the true mechanism of cardiac injury remains under investigation. In this paper we review the clinical presentation, proposed pathophysiology, differential diagnoses and management of myocarditis in COVID-19 patients.
Topics: Arrhythmias, Cardiac; COVID-19; Humans; Myocarditis; SARS-CoV-2; Shock, Cardiogenic
PubMed: 35644500
DOI: 10.1016/j.cpcardiol.2022.101268 -
Acta Myologica : Myopathies and... Dec 2020Giant cell myositis (GCMm) and giant cell myocarditis (GCMc) are two rare autoimmune conditions. Among these, GCMc is a life-threatening disease with a 1-year mortality... (Review)
Review
Giant cell myositis (GCMm) and giant cell myocarditis (GCMc) are two rare autoimmune conditions. Among these, GCMc is a life-threatening disease with a 1-year mortality rate of 70%. Lethal ventricular arrhythmias, rapid evolution to heart failure and sudden death risk makes GCMc an emergency condition. It is thought to be mediated by T-cells and characterized by the presence of myofiber necrosis and giant cells in biopsies. Most commonly co-manifesting conditions with GCMm and/or GCMc are thymoma, myasthenia gravis and orbital myositis, all of which are treatable. As suspicion is the key approach in diagnosis, the physician following patients with thymoma with or without myasthenia gravis and with orbital myositis should always be alert. The fatal nature of GCMc associated with these relatively benign diseases deserves a special emergency attention with prompt institution of combined immunosuppressive treatment and very early inclusion of heart failure teams.
Topics: Giant Cells; Humans; Myocarditis; Myositis
PubMed: 33458585
DOI: 10.36185/2532-1900-033 -
Archives of Cardiovascular Diseases Oct 2019Myocarditis encompasses a wide range of myocardial inflammatory diseases, including acute myocarditis, chronic myocarditis and inflammatory cardiomyopathies, and... (Review)
Review
Myocarditis encompasses a wide range of myocardial inflammatory diseases, including acute myocarditis, chronic myocarditis and inflammatory cardiomyopathies, and myocardial inflammation associated with other cardiomyopathies. Because of this heterogeneity in clinical presentation, and the infrequent use of endomyocardial biopsy, cardiac imaging has gradually acquired a key role in the non-invasive detection of myocardial inflammation, the assessment of aetiology and the management of specific therapies. This article summarizes the issue of myocarditis and myocardial inflammation in clinical practice, and reviews the role of different non-invasive imaging techniques in the exploration of myocardial inflammation.
Topics: Cardiac Imaging Techniques; Cardiomyopathies; Humans; Myocarditis; Predictive Value of Tests; Prognosis; Reproducibility of Results
PubMed: 31494082
DOI: 10.1016/j.acvd.2019.05.007 -
Anales de Pediatria Nov 2022
Topics: Humans; Myocarditis; Coxsackievirus Infections; Antiviral Agents
PubMed: 35995700
DOI: 10.1016/j.anpede.2022.01.006 -
Cardiac Electrophysiology Clinics Mar 2022The clinical manifestations of COVID-19 are widely variable and may involve several districts. Although the clinical course is mostly characterized by respiratory... (Review)
Review
The clinical manifestations of COVID-19 are widely variable and may involve several districts. Although the clinical course is mostly characterized by respiratory involvement, up to 30% of hospitalized patients have evidence of myocardial injury due to acute coronary syndrome, cardiac arrhythmias, myocarditis, and cardiogenic shock. In particular, myocarditis is a well-recognized severe complication of COVID-19 and is associated with fulminant cardiogenic shock and sudden cardiac death. In this article, the authors aim to present a comprehensive review about COVID-19-related myocarditis, including clinical characteristics, diagnostic workup, and management.
Topics: Arrhythmias, Cardiac; COVID-19; Humans; Myocarditis; Prevalence; SARS-CoV-2
PubMed: 35221085
DOI: 10.1016/j.ccep.2021.11.001 -
Heart & Lung : the Journal of Critical... 2020Myocarditis caused by SARS-CoV-2 infection was proposed to account for a proportion of cardiac injury in patients with COVID-19. However, reports of coronavirus-induced... (Review)
Review
BACKGROUND
Myocarditis caused by SARS-CoV-2 infection was proposed to account for a proportion of cardiac injury in patients with COVID-19. However, reports of coronavirus-induced myocarditis were scarce. The aim of this review was to summarise the published cases of myocarditis and describe their presentations, diagnostic processes, clinical characteristics and outcomes.
METHODS
A literature search of MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL and OpenGrey on was performed on 3 June 2020. Studies of myocarditis in patients with COVID-19 were included, and those only reporting cardiac injury or heart failure were excluded. Cases were "confirmed" myocarditis if diagnosed on cardiac magnetic resonance imaging (CMR) or histopathology. Those without were grouped as "possible" myocarditis.
RESULTS
A total of 31 studies on 51 patients were included; 12 cases were confirmed myocarditis while 39 had possible myocarditis. The median age was 55 and 69% were male. The most common presenting symptoms were fever, shortness of breath, cough and chest pain. Electrocardiogram changes included non-specific ST-segment and T-wave changes and ventricular tachycardia. Most patients had elevated cardiac and inflammatory biomarkers. Left ventricular dysfunction and hypokinesis was common. CMR established the diagnosis in 10 patients, with features of cardiac oedema and cardiac injury. Five patients had histopathological examination. Some cases required mechanical ventilation and extracoporeal membrane oxygenation, and 30% of patients recovered but 27% died.
CONCLUSIONS
COVID-19 myocarditis was associated with ECG, cardiac biomarker and echocardiographic changes, and the manifestation could be severe leading to mortality. Endomyocardial biopsy was not available in most cases but CMR was valuable.
Topics: Adolescent; Adult; Aged; Betacoronavirus; COVID-19; Child; Coronavirus Infections; Female; Humans; Male; Middle Aged; Myocarditis; Pandemics; Pneumonia, Viral; SARS-CoV-2; Young Adult
PubMed: 32861884
DOI: 10.1016/j.hrtlng.2020.08.013 -
Advances in Experimental Medicine and... 2017Myocarditis is the inflammation of the muscle tissues of the heart (myocardium). After a pathologic cardiac-specific inflammatory process, it may progress to chronic... (Review)
Review
Myocarditis is the inflammation of the muscle tissues of the heart (myocardium). After a pathologic cardiac-specific inflammatory process, it may progress to chronic damage and dilated cardiomyopathy. The latter is characterized by systolic dysfunction, whose clinical correlate is heart failure. Nevertheless, other acute complications may arise as consequence of tissue damage and electrophysiologic disturbances. Different etiologies are involved in triggering myocarditis. In some cases, such as giant cell myocarditis or eosinophilic necrotizing myocarditis, it is an autoimmune process. Several factors predispose the development of autoimmune myocarditis such as systemic/local primary autoimmunity, viral infection, HLA and gender bias, exposure of cryptic antigens, mimicry, and deficient thymic training/Treg induction. Once the anti-myocardium autoimmune process is triggered, several components of the immune response orchestrate a sustained attack toward myocardial tissues with particular timing and immunopathogenic features. Innate response mediated by monocytes/macrophages, neutrophils, and eosinophils parallels the adaptive response, playing a final effector role and not only a priming function. Stromal cells like fibroblast are also involved in the process through specific cytokines. Furthermore, adaptive T cell responses have anti-paradigmatic features, as Th17 response is dispensable for acute myocarditis but is the main driver of the process leading to dilated cardiomyopathy. Humoral response, thought to be a bystander, is important in the appearance of late-stage hemodynamic complications. The complexity of that process, as well as the unspecific and variable clinical presentation, had generated difficulties for diagnosis and treatment, which remain suboptimal. In this chapter, we will discuss the most relevant immunopathogenic findings from a basic science and clinical perspective.
Topics: Animals; Autoimmune Diseases; Autoimmunity; Disease Models, Animal; Humans; Immunosuppressive Agents; Myocarditis; Myocardium; Prognosis; Risk Factors; Signal Transduction
PubMed: 28667560
DOI: 10.1007/978-3-319-57613-8_10 -
Mayo Clinic Proceedings Sep 2016Myocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular... (Review)
Review
Myocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular dysfunction and life-threatening arrhythmias represent a demanding challenge for the clinician. Modern techniques of cardiovascular imaging and the exhaustive molecular evaluation of the myocardium with endomyocardial biopsy have provided valuable insight into the pathophysiology of this disease, and several clinical registries have unraveled the disease's long-term evolution and prognosis. However, uncertainties persist in crucial practical issues in the management of patients. This article critically reviews current information for evidence-based management, offering a rational and practical approach to patients with myocarditis. For this review, we searched the PubMed and MEDLINE databases for articles published from January 1, 1980, through December 31, 2015, using the following terms: myocarditis, inflammatory cardiomyopathy, and endomyocardial biopsy. Articles were selected for inclusion if they represented primary data or were review articles published in high-impact journals. In particular, a risk-oriented approach is proposed. The different patterns of presentation of myocarditis are classified as low-, intermediate-, and high-risk syndromes according to the most recent evidence on prognosis, clinical findings, and both invasive and noninvasive testing, and appropriate management strategies are proposed for each risk class.
Topics: Biopsy; Evidence-Based Medicine; Humans; Myocarditis
PubMed: 27489051
DOI: 10.1016/j.mayocp.2016.05.013 -
Annales de Cardiologie Et D'angeiologie Dec 2020Over the past ten years, cardiac MRI has become an indispensable tool for acute myocarditis diagnosis. Under appropriate conditions, cardiac MRI may allow postponement... (Review)
Review
Over the past ten years, cardiac MRI has become an indispensable tool for acute myocarditis diagnosis. Under appropriate conditions, cardiac MRI may allow postponement of initial coronary angiography in many instances. The 2020 ESC guidelines give a class I recommendation to its use in the setting of MINOCA for differential diagnosis between acute myocardial infarction, myocarditis, Tako-Tsubo and other cardiac pathologies, in order to improve therapeutic management and follow-up. This article describes the technical characteristics of MRI in myocarditis (Lake Louise diagnostic criteria and criteria based on myocardial tissue mapping), the main differential diagnoses, the prognostic value and addresses the issue of myocarditis in the setting of COVID-19.
Topics: Acute Disease; COVID-19; Cardiac Imaging Techniques; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Myocarditis
PubMed: 33069385
DOI: 10.1016/j.ancard.2020.09.043 -
Clinical Cardiology Jul 2023
Topics: Humans; Antipyretics; Myocarditis
PubMed: 37249254
DOI: 10.1002/clc.24026