PARVOVIRUS B19 INDUCED MYOCARDITIS, SIMULATING ACUTE MYOCARDIAL INFARCTION

Myocarditis is an inflammation of the myocardium associated with mechanical or electrical dysfunctions that usually lead to inappropriate ventricular dilatation or hypertrophy. A number of inciting factors are known to cause myocarditis- genetic defects, viruses, bacteria, parasites, granulomatous inflammations, collagen vascular disorders, chemotherapeutic agents- to name a few. Among the viruses, Adenovirus, Coxsackie virus, Human Herpes virus six and Parvovirus B19 are the encountered pathogens. We hereby present a case of a 14 years old boy who presented with typical cardiac chest pain associated with electrocardiographic changes of ST segment elevation MI in theinferior leads. Cardiac biomarkers were elevated, adding to the diagnostic confusion of MI. On subjecting the patient to a coronary angiography, his arteries were found to be patent, directing us towards the diagnosis of myocarditis. After getting a cardiac MRI and serum tests, the diagnosis of fulminant myocarditis induced by Parvovirus B19 was made. Fortunately, the patient survived on inotropes and other supportive therapy which helped him overcome the cardiac failure.

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Parvovirus B19 myocarditis in children: an observational study

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-308080 ◽

2015 ◽

Vol 101 (2) ◽

pp. 177-180 ◽

Cited By ~ 16

Author(s):

Trisha V Vigneswaran ◽

Julianne R Brown ◽

Judith Breuer ◽

Michael Burch

Keyword(s):

Parvovirus B19 ◽

Complete Recovery ◽

Fulminant Myocarditis ◽

Circulatory Support ◽

Free Survival ◽

St Segment Elevation ◽

Viral Genomes ◽

St Segment ◽

Fractional Shortening ◽

New Onset

BackgroundThe advent of PCR testing for the presence of viral genomes has led to the identification of parvovirus B19 (PVB19) as a causative agent of myocarditis.MethodsThe clinical presentation, course and outcome of children with PVB19 myocarditis was ascertained through a retrospective review. The PVB19 viral genome was detected by PCR from whole blood or endomyocardial biopsy specimens in patients presenting with new onset heart failure.ResultsSeventeen patients presented at a median age of 1.3 years (range: 0.4–15.4 years) in cardiac failure with a mean fractional shortening of 15±3%. Eleven patients required mechanical ventilation and intravenous inotropes and seven required extra-corporeal mechanical oxygenation. Four of the five deaths occurred in patients who had a short prodromal illness of less than 48 hours. All patients with ST segment elevation died (n=4). All non-fulminant cases survived. Event-free survival occurred in 11/17 (65%) patients. Five (29%) patients died and one patient underwent heart transplantation. Complete recovery of cardiac function occurred within a median of 12 months (range: 1–48) in five patients. There was incomplete recovery in five patients and one patient had persistent dilated cardiomyopathy.ConclusionsPVB19 can cause a devastating myocarditis in children. Children with fulminant myocarditis, ST segment changes or a short prodrome have the worst outcome. Transplantation may be considered, but is rarely required in the acute period if mechanical circulatory support is utilised. If the initial presentation is survived, recovery of the myocardium can occur even in those who had fulminant myocarditis.

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Correlation between Thrombolysis in Myocardial Infarction (TIMI) Risk Scores and Electrocardiographic Changes, but Not Biochemical Markers, in Non-ST Segment Elevation Myocardial Infarction and other Acute Coronary Syndromes

Clinical Science ◽

10.1042/cs106003pb ◽

2004 ◽

Vol 106 (s50) ◽

pp. 3P-4P

Author(s):

Alice V Joy ◽

Michael W Millar-Craig

Keyword(s):

Myocardial Infarction ◽

Biochemical Markers ◽

Acute Coronary Syndromes ◽

Risk Scores ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Coronary Syndromes ◽

Electrocardiographic Changes

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Unstable Angina and Other Acute Coronary Syndromes

10.2310/7900.1060 ◽

2013 ◽

Author(s):

R Scott Wright ◽

Joseph G Murphy

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Risk Stratification ◽

Unstable Angina ◽

The United States ◽

Cardiac Biomarkers ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Patients with coronary artery disease (CAD) present clinically when their disease enters an unstable phase known as an acute coronary syndrome (ACS), in which the cap of a previously stable atheromatous coronary plaque ruptures or erodes, which in turn activates a thrombotic cascade that may lead to coronary artery occlusion, myocardial infarction (MI), cardiogenic shock, and patient death. There are nearly 2 million episodes of ACS in the United States annually; it is the most common reason for hospitalization with CAD and is the leading cause of death in the developed world. ACS patients include those with unstable angina (UA), non–ST segment elevation myocardial infarction (non-STEMI), and ST segment elevation myocardial infarction (STEMI) and patients who die suddenly of an arrhythmia precipitated by coronary occlusion. The distinction among various ACS subgroups reflects varying characteristics of clinical presentation (presence or absence of elevated cardiac biomarkers) and the type of electrocardiographic (ECG) changes manifested on the initial ECG at the time of hospitalization. This chapter focuses on UA and non-STEMI. A graph outlines mortality risks faced by patients with varying degrees of renal insufficiency. An algorithm describes the suggested management of patients admitted with UA or non-STEMI. Tables describe the risk stratification of the patient with chest pain, categories of Killip class, examination findings of a patient with high-risk ACS, diagnosis of MI, causes of troponin elevation other than ischemic heart disease, initial risk stratification of ACS patients, and long-term medical therapies and goals in ACS patients. This review contains 2 highly rendered figures, 11 tables, and 76 references.

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Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Case Reports in Cardiology ◽

10.1155/2018/9382904 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Akanksha Agrawal ◽

Nuzhat Sayyida ◽

Jorge Luis Penalver ◽

Mary R. Ziccardi

Keyword(s):

Acute Pancreatitis ◽

Sinus Bradycardia ◽

Fluid Collection ◽

Uncinate Process ◽

Heart Catheterization ◽

St Segment Elevation ◽

Computed Tomographic ◽

St Segment ◽

Electrocardiographic Changes ◽

Artery Disease

Introduction. Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis. Case Report. A 60-year-old man with no past medical history presented to the emergency department (ED) after a syncopal episode. In ED, his vitals were stable. His ECG showed sinus bradycardia at 53 beats per minute, peaked T waves, 1 mm ST-segment elevation in leads II, III, and aVF, and 2 mm ST elevation in V3 as shown in the figures. With the concern for STEMI, he was taken for left heart catheterization (LHC) emergently, showing nonobstructive coronary artery disease (CAD). His laboratory workup was remarkable for lipase of 25,304 IU/l (normal level 8–78 IU/l). His liver function test and triglyceride level were normal. Troponin was <0.01 ng/ml. A computed tomographic exam of the abdomen revealed acute interstitial pancreatitis with a small discrete fluid collection in the uncinate process. He was treated with aggressive intravenous fluid resuscitation and was discharged on day 3. Discussion. Intra-abdominal pathologies like acute pancreatitis can lead to transient ECG changes mimicking STEMI. It is important to use ECG clues, echocardiographic findings, and clinical judgement to avoid cardiac catheterization, contrast exposure, and associated health care costs.

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Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome

Anesthesiology ◽

10.1097/aln.0000000000003030 ◽

2020 ◽

Vol 132 (3) ◽

pp. 440-451 ◽

Cited By ~ 4

Author(s):

Panagiotis Flamée ◽

Varnavas Varnavas ◽

Wendy Dewals ◽

Hugo Carvalho ◽

Wilfried Cools ◽

...

Keyword(s):

Brugada Syndrome ◽

St Segment Elevation ◽

St Depression ◽

St Segment ◽

Qrs Prolongation ◽

Significant Difference ◽

Electrocardiographic Changes ◽

St Elevation ◽

The Right ◽

Double Blinded

Abstract Background Brugada Syndrome is an inherited arrhythmogenic disease, characterized by the typical coved type ST-segment elevation in the right precordial leads from V1 through V3. The BrugadaDrugs.org Advisory Board recommends avoiding administration of propofol in patients with Brugada Syndrome. Since prospective studies are lacking, it was the purpose of this study to assess the electrocardiographic effects of propofol and etomidate on the ST- and QRS-segments. In this trial, it was hypothesized that administration of propofol or etomidate in bolus for induction of anesthesia, in patients with Brugada Syndrome, do not clinically affect the ST- and QRS-segments and do not induce arrhythmias. Methods In this prospective, double-blinded trial, 98 patients with established Brugada syndrome were randomized to receive propofol (2 to 3 mg/kg-1) or etomidate (0.2 to 0.3 mg/kg-1) for induction of anesthesia. The primary endpoints were the changes of the ST- and QRS-segment, and the occurrence of new arrhythmias upon induction of anesthesia. Results The analysis included 80 patients: 43 were administered propofol and 37 etomidate. None of the patients had a ST elevation greater than or equal to 0.2 mV, one in each group had a ST elevation of 0.15 mV. An ST depression up to −0.15mV was observed eleven times with propofol and five with etomidate. A QRS-prolongation of 25% upon induction was seen in one patient with propofol and three with etomidate. This trial failed to establish any evidence to suggest that changes in either group differed, with most percentiles being zero (median [25th, 75th], 0 [0, 0] vs. 0 [0, 0]). Finally, no new arrhythmias occurred perioperatively in both groups. Conclusions In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofol versus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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