OPTIMIZATION OF ACUTE MYOCARDITIS TREATMENT

Aim. This paper is aimed at investigating the possibility of preventing an adverse outcome of acute viral myocarditis by means of optimal pharmacotherapy without the use of surgical treatment methods.Results. We describe a clinical case of acute viral myocarditis in a 60-year old female patient. According to the conducted echocardioscopy, the dilatation of the heart cavities and the complete insufficiency of the mitral and tricuspid valves were identified. A cumulative effect of the chosen optimal pharmacotherapy, which included an angiotensin converting enzyme inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a loopback diuretic with neurohumoral properties taken in optimal doses, allowed congestion signs to be rapidly eliminated, a reverse remodeling of the heart to be achieved and the heart size to be returned normal values. The double blockade of aldosterone receptors using eplerenone and torasemide prevented both the development of fibrosis in the myocardium and the formation of irreversible dilated cardiomyopathy.Conclusion. The application of antiviral and immunomodulatory therapy, along with the maximum possible doses of drugs used to treat chronic heart failure, allowed the patient’s cardiohemodynamic parameters to be returned to normal values. A timely combination therapy should be used to avoid the formation of dilated cardiomyopathy, thus improving the prognosis of the disease.

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An Echocardiographic Presentation of Severe Dilated Cardiomyopathy Due to Acute Viral Myocarditis From Coxsackie B Enterovirus

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318764116 ◽

2018 ◽

Vol 34 (3) ◽

pp. 230-236

Author(s):

Alison White

Keyword(s):

Dilated Cardiomyopathy ◽

Systolic Function ◽

Acute Myocarditis ◽

Diagnostic Testing ◽

Viral Myocarditis ◽

Infectious Agent ◽

Case Presentation ◽

Testing Method ◽

Function Impairment ◽

Coxsackie B

Dilated cardiomyopathy (DCM) is a disease of the myocardium characterized by changes in cardiac chamber dimension and initial deterioration in systolic function accompanied by eventual diastolic function impairment with possible progression to cardiac failure. Early identification of ventricular dysfunction and etiology is imperative for the subsequent effective treatment of the cardiomyopathy process. One common cause of DCM is an infection from a viral insult that results in inflammation and consequent damage to the myocardium. Viral myocarditis may present as an acute or chronic illness. The clinical presentation of myocarditis demonstrates nonspecific symptomology that is variable between individuals. Accurate diagnosis of viral myocarditis relies upon various diagnostic testing methods to ascertain the origin of the infectious agent and resultant alterations in cardiovascular function. One such diagnostic testing method used in the detection of the presence and severity of DCM associated with viral myocarditis is echocardiography. The following case presentation demonstrates a dilated cardiomyopathy due to an acute myocarditis from Coxsackie B enterovirus evaluated with echocardiography.

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Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1612645p ◽

2016 ◽

Vol 144 (11-12) ◽

pp. 645-649 ◽

Cited By ~ 1

Author(s):

Dragica Pesut ◽

Milan Petrovic ◽

Nada Vasic ◽

Ruza Stevic

Keyword(s):

Pulmonary Tuberculosis ◽

Dilated Cardiomyopathy ◽

Enzyme Inhibitor ◽

Acute Myocarditis ◽

Diagnostic Delay ◽

Bed Rest ◽

Drug Regimen ◽

Wegener Granulomatosis ◽

Direct Microscopy ◽

Wide Range

Introduction. Tuberculosis patients are rarely asymptomatic. Acute virus myocarditis presents with a wide range of symptoms, from mild dyspnea or chest pain to cardiogenic shock and death. Case Outline. A 26-year-old Caucasian man non-smoker presented with one-week history of lower extremities? swelling. The patient?s medical history also revealed a two-day episode of subfebrile temperature with scanty hemoptysis three weeks prior to admission. The episode had not provoked him to seek medical care. Physical examination revealed generalized oedema, and laboratory analysis showed signs of acute renal insufficiency. Enlarged heart and hilar shadows, bilateral massive cavitary pulmonary opacities and pleural effusion were found at chest radiography. Sputum smears were Mycobacteria negative on direct microscopy. Electrocardiogram changes and echocardiography were suggestive of acute myocarditis with dilated cardiomyopathy. IgM titer to adenovirus was positive. Under diuretics, angiotensin-converting-enzyme inhibitor, beta-blocker, antibiotics and bed rest, fast heart compensation and renal function repair were achieved. Radiographic pulmonary changes promptly regressed except for a cavity in the right upper lobe. Bronchial aspirate from the affected lobe was Mycobacteria positive on direct microscopy and culture positive for Mycobacterium tuberculosis. Standard anti-tuberculosis drug regimen led to recovery. Conclusion. In the unusual common existence of two diseases whose presentation initially mimicked Wegener?s granulomatosis, acute dilated cardiomyopathy contributed to pulmonary tuberculosis detection. To prevent diagnostic delay in tuberculosis, further efforts in population education are necessary together with continual medical education.

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Cellular and molecular bases for the immunopathology of the myocardial cell damage involved in acute viral myocarditis with special reference to dilated cardiomyopathy

Journal of Molecular and Cellular Cardiology ◽

10.1016/0022-2828(92)90977-8 ◽

1992 ◽

Vol 24 ◽

pp. S48

Author(s):

Y SEKO

Keyword(s):

Dilated Cardiomyopathy ◽

Special Reference ◽

Cell Damage ◽

Viral Myocarditis ◽

Myocardial Cell ◽

Acute Viral Myocarditis ◽

Molecular Bases ◽

Myocardial Cell Damage

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Early Administration of Mineralocorticoid Receptor Antagonist Is Useful for Cardiac Reverse Remodeling in Asymptomatic Patients with Dilated Cardiomyopathy

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2017.08.126 ◽

2017 ◽

Vol 23 (10) ◽

pp. S29

Author(s):

Takahiro Okumura ◽

Tasuku Kuwayama ◽

Tomoaki Haga ◽

Hiroaki Hiraiwa ◽

Toru Kondo ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Receptor Antagonist ◽

Mineralocorticoid Receptor ◽

Reverse Remodeling ◽

Early Administration ◽

Mineralocorticoid Receptor Antagonist ◽

Asymptomatic Patients

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Cellular and Molecular Bases for the Immunopathology of the Myocardial Cell Damage Involved in Acute Viral Myocarditis with Special Reference to Dilated Cardiomyopathy.

Japanese Circulation Journal ◽

10.1253/jcj.56.1062 ◽

1992 ◽

Vol 56 (10) ◽

pp. 1062-1072 ◽

Cited By ~ 13

Author(s):

YOSHINORI SEKO ◽

TSUTOMU YAMAZAKI ◽

YOICHI SHINKAI ◽

HIDEO YAGITA ◽

KO OKUMURA ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Special Reference ◽

Cell Damage ◽

Viral Myocarditis ◽

Myocardial Cell ◽

Acute Viral Myocarditis ◽

Molecular Bases ◽

Myocardial Cell Damage

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Peripheral Blood MicroRNAs as Potential Biomarkers of Myocardial Damage in Acute Viral Myocarditis

Genes ◽

10.3390/genes12030420 ◽

2021 ◽

Vol 12 (3) ◽

pp. 420

Author(s):

Maria Marketou ◽

Joanna Kontaraki ◽

Alexandros Patrianakos ◽

George Kochiadakis ◽

Ioannis Anastasiou ◽

...

Keyword(s):

Peripheral Blood ◽

Mononuclear Cells ◽

Troponin I ◽

Left Ventricular Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Viral Myocarditis ◽

Myocardial Damage ◽

Left Ventricular ◽

Cardiovascular Development ◽

Acute Viral Myocarditis

Background: microRNAs (miRs) have emerged as important modulators of cardiovascular development and disease. Our aim was to determine whether cardiac-related miRs such as miR-21-5p and miR-1-3p were differentially expressed in acute viral myocarditis and whether any of them was related with the extent of myocardial damage and left ventricular dysfunction. Methods: We enrolled 40 patients with acute viral myocarditis. Blood samples were taken on admission and miRs expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Results: miR-21-5p, miR-1-3p were significantly elevated in acute myocarditis. miR-21-5p levels showed a strong correlation with global longitudinal strain (r = 0.71, p < 0.01), while miR-1-3p had significant correlations with troponin I (r = 0.79, p < 0.01). Conclusions: The expression of miR-21-5p and miR-1-3p in peripheral blood is increased in acute viral myocarditis, and this increase is correlated with myocardial damage and indicative of left ventricular systolic dysfunction in these patients.

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