Myocarditis with Biventricular Dysfunction Caused by Parvovirus B19 – A case report

2021 ◽  
Author(s):  
Lisa Ferraza ◽  
Pedro Carvalhoa ◽  
Diana Carvalhoa ◽  
Ana Faustinoa ◽  
Ana Faustinoa ◽  
...  
Keyword(s):  
Endomyocardial Biopsy ◽  
Systolic Function ◽  
Parvovirus B19 ◽  
Severe Depression ◽  
Left Ventricular ◽  
Diagnostic Challenge ◽  
Important Diagnostic Tool ◽  
Parvovirus B19 Infection ◽  
Global Systolic Function ◽  
Biventricular Systolic Function

ABSTRACT Introduction: Myocarditis is often a diagnostic challenge given the heterogeneity of the clinical presentation. Cardiac magnetic resonance imaging is an important diagnostic tool required for the diagnosis as well as detecting the prognosis of the patient. Although rarely used, an endomyocardial biopsy is the gold standard diagnostic method. Clinical case: We present the case of a 29-year old man diagnosed with myocarditis who later developed severe depression of biventricular systolic function. An endomyocardial biopsy was performed, which revealed a parvovirus B19 infection. After treatment of the left ventricular dysfunction, the global systolic function was recovered.

Abstract 17062: Reversible Golimumab Induced Cardiomyopathy - First Reported Case Report

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mian Tanveer Ud Din ◽  
Michael Nestasie ◽  
John Balacko ◽  
Craig Alpert
Keyword(s):  
Lower Extremity ◽  
Troponin T ◽  
Inflammatory Diseases ◽  
Systolic Function ◽  
Left Ventricular ◽  
Tnf Alpha ◽  
Lower Extremity Edema ◽  
Ventricular Systolic Function ◽  
Immune Mediated ◽  
Biventricular Systolic Function

Case Presentation: An 80 year old female with medical history of hypertension, diabetes mellitus, chronic atrial fibrillation presented with four weeks of lower extremity edema and dyspnea. Notably, she had also been taking Golimumab for 6 months for Rheumatoid Arthritis (RA). Vital signs on presentations were: Temp:99 F, HR: 140bpm, BP: 105/64, oxygen saturation of 88% on room air. Physical exam revealed crackles at the mid lower lung fields bilaterally and 2+ lower extremity edema. EKG showed new ST inversions in lead 1, avF and V2. Troponin T was elevated to 0.11 ng/ml and proBNP was 21,246 pg/ml. Chest X Ray showed cardiomegaly with diffuse alveolar opacities. Transthoracic echocardiogram (TTE) revealed severely reduced left ventricular systolic function with LVEF of 25-29%, left ventricular regional wall hypokinesis and mildly reduced right ventricular systolic function. All findings were new compared to her last TTE 3 months prior, which showed preserved biventricular systolic function. Coronary angiography revealed no coronary artery disease. The patient was started on intravenous furosemide, and her home beta blocker and ARB were resumed. The patient’s Golimumab was discontinued given prior reports of TNF alpha inhibitor induced cardiomyopathy. Over the ensuing days, she was aggressively diuresed with improvement in oxygenation and ultimately discharged home. Three months after discontinuation of Golimumab, repeat TTE showed normalization of biventricular systolic function. Discussion: TNF alpha inhibitors have revolutionized the treatment of chronic immune mediated inflammatory diseases. Several TNF alpha inhibitors have been associated with cardiomyopathy, however there remains a paucity of evidence regarding cardiotoxicity with Golimumab. We now present, to our knowledge, the first reported case of reversible heart failure due to Golimumab in an 80 year old woman with RA. Golimumab, like other TNF alpha inhibitors, represents a historic advancement in the treatment of immune mediated inflammatory diseases. However, our case implicates this innovative drug in cardiotoxicity similar to other TNF alpha inhibitors. Further prospective studies are needed to establish a stronger correlation between Golimumab and cardiotoxicity.

Determinants of Discrepancy in the Left Ventricular Systolic Function Evaluation Between Preoperative and Intraoperative Evaluations

2020 ◽  
Vol 24 (4) ◽  
pp. 321-327
Author(s):  
Chad Spencer ◽  
Nasir Khatri ◽  
Alan M. Smeltz
Keyword(s):  
Cardiac Surgery ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Function Evaluation ◽  
Ventricular Systolic Function ◽  
Elective Cardiac Surgery ◽  
Global Systolic Function

Unexpectedly decreased left ventricular global systolic function can be difficult to manage, even for patients undergoing elective cardiac surgery, and should prompt a multidisciplinary discussion. Therefore, in this review, we discuss the evidence describing key perioperative variables expected to influence left ventricular systolic function to facilitate this discussion.

scholarly journals 447 Pathology of conduction tissue in cardiac amyloid: correlation with arrhythmic manifestations

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N114-N115
Author(s):  
Maria Alfarano ◽  
Cristina Chimenti ◽  
Romina Verardo ◽  
Nicola Galea ◽  
Marco Francone ◽  
...  
Keyword(s):  
Endomyocardial Biopsy ◽  
Systolic Function ◽  
Fibrous Tissue ◽  
Pacemaker Implantation ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Amyloid Protein ◽  
Icd Implantation ◽  
Cardiac Amyloid ◽  
Maximal Wall Thickness

Abstract Aims Pathology of conduction tissue (CT) and relative arrhythmic manifestations in living subjects with cardiac amyloid (CA) have never been reported. Methods and results In 17 out of 45 consecutive patients with CA, a left ventricular (LV) endomyocardial biopsy included CT sections. Extensive clinical examination, non-invasive (resting ECG, Holter monitoring, echocardiography), and invasive cardiac studies (selective coronary angiography, LV angiography, and LV endomyocardial biopsy) were performed in all patients. Cardiac magnetic resonance (CMR) was performed in 12 of the 17 patients (70%). CT was identified by Aschoff-Monckeberg histologic criteria associated to positive immunostaining for HCN4. Degree of CT infiltration was defined as mild when ≤ 30% of CT area was replaced by fibrous tissue and Congo red+ material, moderate in 30–70% CT area involvement and severe in > 70% CT cell area replacement. CT infiltration was correlated with ventricular arrhythmias, echocardiographic LV maximal wall thickness (MWT) and type of amyloid protein identified by myocardial immunohistochemistry. CMR confirmed the presence of cardiac hypertrophy with preserved systolic function in all but one patient. LGE was present in all patients, predominantly with diffuse (5/11) or subendocardial (4/11) pattern compared to focal (2/11). In 7/11 patients T1 mapping sequences have been acquired; nT1 and ECV were increase in all patients (nT1: 1171 ± 61 ms; ECV: 59.9 ± 7.5%). Mild CT involvement was observed in 5 cases; moderate in 3; severe compromise in 9. CT involvement was associated with a parallel infiltration of CT artery. CT infiltration correlated with severity of arrhythmias (Spearman rho = 0.8, P < 0.001) but not with age, MWT or type of amyloid protein. In particular, major ventricular tachyarrhythmias requiring pharmacologic treatment or ICD implantation occurred in 7 patients with severe, 1 patient with moderate and none with mild CT infiltration. Pacemaker implantation was required in 3 patients with complete CT area replacement. Conclusion CA associated arrhythmias correlate with severity of CT infiltration. CT involvement is independent from type and severity of CA suggesting a variable affinity of amyloid protein to CT.

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