Viral myocarditis masquerading acute coronary syndrome (ACS)--MRI to the rescue.
TL;DR: A young man with a strong family history of myocardial infarction with sudden death presented with chest pain and was found to have positive cardiac biomarkers and echocardiographic evidence of inferolateral wall hypokinesia, most consistent with acute viral myocarditis.
About: This article is published in International Journal of Cardiology.The article was published on 2007-07-31. It has received 8 citations till now. The article focuses on the topics: Viral Myocarditis & Chest pain.
Citations
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TL;DR: Analysis of endomyocardial biopsies of patients with latent and reactivated B19V infection found 29 differentially regulated miRNAs and, in order to test whether predicted genes are differentially expressed, selected mRNAs were tested by TaqMan-QPCR.
Abstract: Parvovirus B19 is a frequent virus detected in endomyocardial biopsies of patients with clinically suspected myocarditis or dilated cardiomyopathy (DCM). Viruses often cause a more symptomatic disease with increased tissue injury if they become reactivated. A disease-specific differential expression of microRNAs (miRNAs) has been described in the regulation of replicating viruses. Analyzing patients with latent and reactivated B19V infection, we found 29 differentially regulated miRNAs and, in order to test whether predicted genes are differentially expressed, selected mRNAs were tested by TaqMan-QPCR.
37 citations
TL;DR: If the underlying infectious or immune-mediated causes of the disease are carefully defined by clinical and biopsy-based tools, specific immunosuppressive and antiviral treatment options may improve the prognosis of patients with acute and chronic disease.
Abstract: Myocarditis is an inflammatory disease of the cardiac muscle caused by myocardial infiltration of immunocompetent cells following any kind of cardiac injury. Classic myocarditis mainly occurs as a result of the host's immune response against organisms that cause common infectious illnesses, as a manifestation of hypersensitivity or as a toxic reaction to drug therapy. Chronic inflammatory events may survive successful clearance of initial cardiotoxic agents, be triggered or amplified by autoimmunological processes, or develop in the context of systemic diseases. If the underlying infectious or immune-mediated causes of the disease are carefully defined by clinical and biopsy-based tools, specific immunosuppressive and antiviral treatment options may improve the prognosis of patients with acute and chronic disease.
30 citations
Cites background from "Viral myocarditis masquerading acut..."
...These patients present with acute ischaemia-like angina, variable ST and T wave changes by ECG, arrhythmias, elevated cardiac enzymes, and regional or global wall motion abnormalities but without coronary disease by catheterization.([14,69]) The clinical symptoms may recede more or less completely within a few hours, days or weeks, without persisting heart failure....
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TL;DR: A 34-year-old woman of Afro Caribbean origin presented to the HIV clinic with a few days’ history of chest pain, chills, and malaise, preceded by an episode of collapse after palpitations a week earlier.
Abstract: A 34-year-old woman of Afro Caribbean origin presented to the HIV clinic with a few days’ history of chest pain, chills, and malaise. The chest pain was intermittent, severe, central, radiating to the left arm, worse on lying down, and better on sitting forward. This was preceded by an episode of collapse after palpitations a week earlier. On examination, she had a regular pulse of 84 bpm, blood pressure of 131/71 mm Hg, respiratory rate of 20, temperature of 38°C, and oxygen saturation of 99% on air. Cardiovascular, respiratory, abdominal, and neurological examinations were normal. ECG demonstrated anterolateral ischemic changes (Figure 1). Chest radiograph was normal.
Figure 1. ECG showing anterolateral ischemic changes.
Biochemical profile was as follows: C-reactive protein, 296 mg/dL; troponin, 3.8 ng/mL; CD4 count, 459; viral load, <50; and hemoglobin, 9.1 g/dL. Her antistreptolysin O titer was 1 in 40, and no antistreptolysin antibodies were detected. Viral titers were negative for cytomegalovirus, adenovirus, Coxiella burnetii , chlamydia (group) and Mycoplasma pneumoniae , enterovirus (including echoviruses, coxsackie …
13 citations
TL;DR: This case demonstrates the importance of CMRI in patients suffering from apparently idiopathic VT originating in the left ventricle, and identifies a unique ventricular microaneurysm in a patient free of coronary disease.
1 citations
TL;DR: This case illustrates the utility of cardiac magnetic resonance for diagnosis of infarction-like myocarditis when the angiogram is normal and shows that myocardial thickness was significantly thinner than before, and fibrosis was less than before.
Abstract: Myocarditis presenting as typical acute myocardial infarction: A case report and review of the literature
1 citations
References
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TL;DR: Contrast enhancement is a frequent finding in the clinical setting of suspected myocarditis and is associated with active inflammation defined by histopathology and is a valuable tool for the evaluation and monitoring of inflammatory heart disease.
Abstract: Background— Myocarditis can occasionally lead to sudden death and may progress to dilated cardiomyopathy in up to 10% of patients. Because the initial onset is difficult to recognize clinically and the diagnostic tools available are unsatisfactory, new strategies to diagnose myocarditis are needed. Methods and Results— Cardiovascular MR imaging (CMR) was performed in 32 patients who were diagnosed with myocarditis by clinical criteria. To determine whether CMR visualizes areas of active myocarditis, endomyocardial biopsy was taken from the region of contrast enhancement and submitted to histopathologic analysis. Follow-up was performed 3 month later. Contrast enhancement was present in 28 patients (88%) and was usually seen with one or several foci in the myocardium. Foci were most frequently located in the lateral free wall. In the 21 patients in whom biopsy was obtained from the region of contrast enhancement, histopathologic analysis revealed active myocarditis in 19 patients (parvovirus B19, n=12; human herpes virus type 6 [HHV 6], n=5). Conversely, in the remaining 11 patients, in whom biopsy could not be taken from the region of contrast enhancement, active myocarditis was found in one case only (HHV6). At follow-up, the area of contrast enhancement decreased from 9±11% to 3±4% of left ventricular mass as the left ventricular ejection fraction improved from 47±19% to 60±10%. Conclusions— Contrast enhancement is a frequent finding in the clinical setting of suspected myocarditis and is associated with active inflammation defined by histopathology. Myocarditis occurs predominantly in the lateral free wall. Contrast CMR is a valuable tool for the evaluation and monitoring of inflammatory heart disease.
1,003 citations
TL;DR: A combined CMR approach using T2-weighted imaging, early and late gadolinium enhancement, provides a high diagnostic accuracy and is a useful tool in the diagnosis and assessment of patients with suspected acute myocarditis.
724 citations
"Viral myocarditis masquerading acut..." refers background or methods or result in this paper
...The overall diagnostic sensitivity and specificity of Contrast enhanced MRI is 86% and 95%, respectively [6,7]....
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...This finding lends further support to the diagnosis of a viral myocarditis [5,6]....
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...Cardiac MRI has recently emerged as a powerful tool that can non-invasively identify myocardial edema and myocyte damage [1–7]....
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TL;DR: In this paper, the authors tested the hypothesis that inflammation is reflected by signal changes in contrastenhanced magnetic resonance imaging (MRI) and assessed 44 consecutive patients with symptoms of acute myocarditis, and 19 patients met the inclusion criteria revealing ECG changes, reduced myocardial function, elevated creatine kinase, positive troponin T, serological evidence for acute viral infection, exclusion of coronary heart disease, and positive antimyosin scintigraphy.
Abstract: Background—The course of tissue changes in acute myocarditis in humans is not well understood. Diagnostic tools currently available are unsatisfactory. We tested the hypothesis that inflammation is reflected by signal changes in contrast-enhanced magnetic resonance imaging (MRI). Methods and Results—We assessed 44 consecutive patients with symptoms of acute myocarditis. Nineteen patients met the inclusion criteria revealing ECG changes, reduced myocardial function, elevated creatine kinase, positive troponin T, serological evidence for acute viral infection, exclusion of coronary heart disease, and positive antimyosin scintigraphy. We studied these patients on days 2, 7, 14, 28, and 84 after the onset of symptoms. We obtained ECG-triggered, T1-weighted images before and after application of 0.1 mmol/kg gadolinium. We measured the global relative signal enhancement of the left ventricular myocardium related to skeletal muscle and compared it with measurements in 18 volunteers. The global relative enhanceme...
536 citations
"Viral myocarditis masquerading acut..." refers background or methods in this paper
...As a result of these limitations, acute myocarditis is usually diagnosed postmortem or after congestive heart failure has occurred [1–4]....
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...Cardiac MRI has recently emerged as a powerful tool that can non-invasively identify myocardial edema and myocyte damage [1–7]....
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...Conversely, MI is associated with early subendocardial perfusion defects and subendocardial or transmural delayed enhancement of a smaller number of segments, all in a vascular distribution – from the epicardium to the endocardium, where they are terminal branches without collateral circulation [2,3]....
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TL;DR: Use of combined early- and late-perfusion MR imaging sequences helps to distinguish AMI from myocarditis.
Abstract: PURPOSE: To prospectively determine whether early first-pass perfusion and delayed-enhancement magnetic resonance (MR) imaging sequences can enable differentiation of acute myocardial infarction (AMI) from myocarditis in patients with acute chest pain. MATERIALS AND METHODS: All examinations were performed according to guidelines of the institutional board on medical ethics and clinical investigation and after informed patient consent was obtained. Fifty-five patients with a clinical presentation suggestive but not typical of AMI were examined. At final diagnosis, 31 patients had AMI and 24 had myocarditis. At-rest MR imaging was performed and included first-pass perfusion and delayed-enhancement sequences. Three independent observers read each image data set separately and then in consensus. The main abnormalities included first-pass perfusion defects and delayed highly enhancing areas. The numbers and distributions of involved segments and the transmural extents and the shapes of the highly enhancing ar...
220 citations
TL;DR: In this paper, the diagnostic performance of MRI for the diagnosis of acute myocarditis, using a comprehensive imaging approach, was explored using a contrast-enhanced T1-weighted subtracted images had 100% sensitivity and specificity for myocardial involvement.
209 citations