1212 diskusi 09 myocarditis wiki 09

8/16/2019 1212 Diskusi 09 Myocarditis Wiki 09

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Myocarditis

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Myocarditis

Classification and external resources

Histopathological image of myocarditis at autopsy in a

patient with acute onset of congestive heart failure

ICD-10 I090, I!"#

ICD-9 $9"%, #%%, #%90

DiseasesDB &'"(

MedlinePlus 000"#9

eMedicine med)"!(9 emerg)$%(

MeSH *009%0!

Myocarditis or inflammatory cardiomyopathy is inflammation of heart muscle+myocardium

http://en.wikipedia.org/wiki/Myocarditis#mw-headhttp://en.wikipedia.org/wiki/Myocarditis#p-searchhttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/ICD-10_Chapter_Ihttp://apps.who.int/classifications/icd10/browse/2010/en#/I09.0http://en.wikipedia.org/wiki/ICD-10_Chapter_Ihttp://en.wikipedia.org/wiki/ICD-10_Chapter_Ihttp://apps.who.int/classifications/icd10/browse/2010/en#/I51.4http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=391.2http://www.icd9data.com/getICD9Code.ashx?icd9=422http://www.icd9data.com/getICD9Code.ashx?icd9=422http://www.icd9data.com/getICD9Code.ashx?icd9=429.0http://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb8716.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000149.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/med/topic1569.htmhttp://www.emedicine.com/emerg/topic326.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?field=uid&term=D009205http://en.wikipedia.org/wiki/Cardiomyopathyhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/File:Viral_myocarditis_(1).JPGhttp://en.wikipedia.org/wiki/Myocarditis#p-searchhttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/ICD-10_Chapter_Ihttp://apps.who.int/classifications/icd10/browse/2010/en#/I09.0http://en.wikipedia.org/wiki/ICD-10_Chapter_Ihttp://apps.who.int/classifications/icd10/browse/2010/en#/I51.4http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=391.2http://www.icd9data.com/getICD9Code.ashx?icd9=422http://www.icd9data.com/getICD9Code.ashx?icd9=429.0http://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb8716.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000149.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/med/topic1569.htmhttp://www.emedicine.com/emerg/topic326.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?field=uid&term=D009205http://en.wikipedia.org/wiki/Cardiomyopathyhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Myocarditis#mw-head


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-yocarditis is most often due to infection .y common viruses, such as parvovirus /"9,less commonly nonviral pathogens such as Borrelia burgdorferi +yme disease orTrypanosoma cruzi , or as a hypersensitivity response to drugs 1"2

3he definition of myocarditis varies, .ut the central feature is an infection of the heart,

with an inflammatory infiltrate, and damage to the heart muscle, without the .lockage ofcoronary arteries that define a heart attack +myocardial infarction or other commonnoninfectious causes1%2 -yocarditis may or may not include death +necrosis of hearttissue It may include dilated cardiomyopathy1"2

Myocarditis is often an autoimmune reaction 4treptococcal - protein andco5sackievirus / have regions +epitopes that are immunologically similar to cardiacmyosin *uring and after the viral infection, the immune system may attack cardiacmyosin1"2

/ecause a definitive diagnosis re6uires a heart .iopsy, which doctors are reluctant to do

.ecause they are invasive, statistics on the incidence of myocarditis vary widely

1"2

3he conse6uences of myocarditis thus also vary widely It can cause a mild diseasewithout any symptoms that resolves itself, or it may cause chest pain, heart failure, orsudden death 7n acute myocardial infarction8like syndrome with normal coronaryarteries has a good prognosis Heart failure, even with dilated left ventricle, may have agood prognosis entricular arrhythmias and high8degree heart .lock have a poorprognosis oss of right ventricular function is a strong predictor of death 1"2

Contents

1 Signs and

symptoms2 Causes2.1 Infections2.2 Toxins2.3 Immunologic2.4 Physicalagents3 Diagnosis4 Treatment !pidemiology" #eferences

$ !xternal lin%s

Signs and symptoms

he signs and symptoms associated !ith myocarditis are "aried# and relate either to the actual inflammation of the myocardium# or the !ea$ness of the heartmuscle that is secondary to the inflammation 4igns and symptoms of myocarditisinclude:1$2

http://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Parvovirus_B19http://en.wikipedia.org/wiki/Borrelia_burgdorferihttp://en.wikipedia.org/wiki/Trypanosoma_cruzihttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Baughman-2http://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Dilated_cardiomyopathyhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/M_protein_(Streptococcus)http://en.wikipedia.org/wiki/Coxsackievirushttp://en.wikipedia.org/wiki/Epitopehttp://en.wikipedia.org/wiki/Myosinhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Left_ventriclehttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Myocarditis#Signs_and_symptomshttp://en.wikipedia.org/wiki/Myocarditis#Signs_and_symptomshttp://en.wikipedia.org/wiki/Myocarditis#Causeshttp://en.wikipedia.org/wiki/Myocarditis#Infectionshttp://en.wikipedia.org/wiki/Myocarditis#Toxinshttp://en.wikipedia.org/wiki/Myocarditis#Immunologichttp://en.wikipedia.org/wiki/Myocarditis#Physical_agentshttp://en.wikipedia.org/wiki/Myocarditis#Physical_agentshttp://en.wikipedia.org/wiki/Myocarditis#Diagnosishttp://en.wikipedia.org/wiki/Myocarditis#Treatmenthttp://en.wikipedia.org/wiki/Myocarditis#Epidemiologyhttp://en.wikipedia.org/wiki/Myocarditis#Referenceshttp://en.wikipedia.org/wiki/Myocarditis#External_linkshttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Feldman-3http://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Parvovirus_B19http://en.wikipedia.org/wiki/Borrelia_burgdorferihttp://en.wikipedia.org/wiki/Trypanosoma_cruzihttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Baughman-2http://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Dilated_cardiomyopathyhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/M_protein_(Streptococcus)http://en.wikipedia.org/wiki/Coxsackievirushttp://en.wikipedia.org/wiki/Epitopehttp://en.wikipedia.org/wiki/Myosinhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Left_ventriclehttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Cooper-1http://en.wikipedia.org/wiki/Myocarditis#Signs_and_symptomshttp://en.wikipedia.org/wiki/Myocarditis#Signs_and_symptomshttp://en.wikipedia.org/wiki/Myocarditis#Causeshttp://en.wikipedia.org/wiki/Myocarditis#Infectionshttp://en.wikipedia.org/wiki/Myocarditis#Toxinshttp://en.wikipedia.org/wiki/Myocarditis#Immunologichttp://en.wikipedia.org/wiki/Myocarditis#Physical_agentshttp://en.wikipedia.org/wiki/Myocarditis#Physical_agentshttp://en.wikipedia.org/wiki/Myocarditis#Diagnosishttp://en.wikipedia.org/wiki/Myocarditis#Treatmenthttp://en.wikipedia.org/wiki/Myocarditis#Epidemiologyhttp://en.wikipedia.org/wiki/Myocarditis#Referenceshttp://en.wikipedia.org/wiki/Myocarditis#External_linkshttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Feldman-3


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• hest pain +often descri.ed as ;sta..ing; in character

• ongestive heart failure +leading to edema, .reathlessness and hepatic congestion

• ed

malaise, poor appetite, a.dominal pain, and)or chronic cough ater stages of theillness will present with respiratory symptoms with increased work of .reathing,and is often mistaken for asthma

Since myocarditis is often due to a "iral illness# many patients gi"e a history of

symptoms consistent !ith a recent "iral infection# including fe"er# rash# diarrhea# %oint pains# and easy fatiguea&ility'

-yocarditis is often associated with pericarditis, and many patients present with signsand symptoms that suggest concurrent myocarditis and pericarditis

Causes

7 large num.er of causes of myocarditis have .een identified, .ut often a cause cannot.e found In ?urope and @orth 7merica, viruses are common culprits Worldwide,however, the most common cause is hagasA disease, an illness endemic to entral

and 4outh 7merica that is due to infection .y the proto>oan Trypanosoma cruzi 1$2

Infections

• iral +parvovirus /"9, co5sackie virus, HI, enterovirus, ru.ella virus, polio virus,

cytomegalovirus, human herpesvirus ( and possi.ly hepatitis • oan +Trypanosoma cruzi causing Chagas disease and Toxoplasma gondii

• /acterial +Brucella, Corynebacterium diphtheriae, gonococcus, Haemophilusinfluenzae, Actinomyces, Tropheryma whipplei , Vibrio cholerae, Borreliaburgdorferi , leptospirosis, and Bickettsia

• Fungal + Aspergillus

•


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o(ins

• *rugs +ethanol, anthracyclines and some other forms of chemotherapy, and

antipsychotics, eg clo>apine, also some designer drugs such as mephedrone1!2

Immunologic

• 7llergic +aceta>olamide, amitriptyline

• BeCection after a heart transplant

• 7utoantigens +scleroderma, systemic lupus erythematosis, sarcoidosis, systemic

vasculitis such as hurg84trauss syndrome, and WegenerAs granulomatosis

• 3o5ins +arsenic, to5ic shock syndrome to5in, car.on mono5ide, or snake venom

• Heavy metals +copper or iron

Physical agents

• ?lectric shock, hyperpyre5ia, and radiation

Diagnosis

?ndomyocardial .iopsy specimen with e5tensive eosinophilic infiltrate involving theendocardium and myocardium +hemato5ylin and eosin stain

-yocarditis refers to an underlying process that causes inflammation and inCury of theheart It does not refer to inflammation of the heart as a conse6uence of some otherinsult -any secondary causes, such as a heart attack, can lead to inflammation of themyocardium and therefore the diagnosis of myocarditis cannot .e made .y evidence ofinflammation of the myocardium alone1(2

http://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Ethanolhttp://en.wikipedia.org/wiki/Anthracyclinehttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Antipsychotichttp://en.wikipedia.org/wiki/Clozapinehttp://en.wikipedia.org/wiki/Designer_drughttp://en.wikipedia.org/wiki/Designer_drughttp://en.wikipedia.org/wiki/Mephedronehttp://en.wikipedia.org/wiki/Myocarditis#cite_note-pmid21062771-5http://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Amitriptylinehttp://en.wikipedia.org/wiki/Heart_transplanthttp://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Sclerodermahttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosishttp://en.wikipedia.org/wiki/Sarcoidosishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Churg-Strauss_syndromehttp://en.wikipedia.org/wiki/Churg-Strauss_syndromehttp://en.wikipedia.org/wiki/Wegener's_granulomatosishttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Arsenichttp://en.wikipedia.org/wiki/Toxic_shock_syndrome_toxinhttp://en.wikipedia.org/wiki/Carbon_monoxidehttp://en.wikipedia.org/wiki/Snake_venomhttp://en.wikipedia.org/wiki/Heavy_metalshttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Ironhttp://en.wikipedia.org/wiki/Electric_shockhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Radiationhttp://en.wikipedia.org/wiki/Eosinophil_granulocytehttp://en.wikipedia.org/wiki/Endocardiumhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/H%26E_stainhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Robbins-6http://en.wikipedia.org/wiki/File:Eosinophilic_myocarditis_HE_stain.jpghttp://en.wikipedia.org/wiki/File:Eosinophilic_myocarditis_HE_stain.jpghttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Ethanolhttp://en.wikipedia.org/wiki/Anthracyclinehttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Antipsychotichttp://en.wikipedia.org/wiki/Clozapinehttp://en.wikipedia.org/wiki/Designer_drughttp://en.wikipedia.org/wiki/Mephedronehttp://en.wikipedia.org/wiki/Myocarditis#cite_note-pmid21062771-5http://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Amitriptylinehttp://en.wikipedia.org/wiki/Heart_transplanthttp://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Sclerodermahttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosishttp://en.wikipedia.org/wiki/Sarcoidosishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Churg-Strauss_syndromehttp://en.wikipedia.org/wiki/Wegener's_granulomatosishttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Arsenichttp://en.wikipedia.org/wiki/Toxic_shock_syndrome_toxinhttp://en.wikipedia.org/wiki/Carbon_monoxidehttp://en.wikipedia.org/wiki/Snake_venomhttp://en.wikipedia.org/wiki/Heavy_metalshttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Ironhttp://en.wikipedia.org/wiki/Electric_shockhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Radiationhttp://en.wikipedia.org/wiki/Eosinophil_granulocytehttp://en.wikipedia.org/wiki/Endocardiumhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/H%26E_stainhttp://en.wikipedia.org/wiki/Myocarditis#cite_note-Robbins-6


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-yocardial inflammation can .e suspected on the .asis of electrocardiographic +?Dresults, elevated 8reactive protein +Bymes are elevated1$2

3he ?D findings most commonly seen in myocarditis are diffuse 3 wave inversionsEsaddle8shaped 438segment elevations may .e present +these are also seen inpericarditis 1$2

3he gold standard is still .iopsy of the myocardium, generally done in the setting ofangiography 7 small tissue sample of the endocardium and myocardium is taken, andinvestigated .y a pathologist .y light microscopy andif necessaryimmunochemistry and special staining methods Histopathological features are myocardial interstitium witha.undant edema and inflammatory infiltrate, rich in lymphocytes and macrophagesFocal destruction of myocytes e5plains the myocardial pump failure 1$2

ardiac magnetic resonance imaging +c-BI or -B has .een shown to .e very usefulin diagnosing myocarditis .y visuali>ing markers for inflammation of the myocardium1'2 Becently, consensus criteria for the diagnosis of myocarditis .y -B have .eenpu.lished 1&2

reatment

7s most viral infections cannot .e treated with directed therapy, symptomatic treatmentis the only form of therapy for those forms of myocarditis192 In the acute phase,supportive therapy, including .ed rest, is indicated For symptomatic patients, digo5in and diuretics provide clinical improvement For patients with moderate to severe

dysfunction, cardiac function can .e supported .y use of inotropes such as -ilrinone inthe acute phase, followed .y oral therapy with 7? inhi.itors +aptopril, isinoprilwhen tolerated


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7mong patients with HI, myocarditis is the most common cardiac pathological findingat autopsy, with a prevalence of !0= or more 1"2

*eferences

" a b c d e f eslie 3 ooper, Jr, +7pril 9, %009 -yocarditis, @ ?ngl J -ed$(0+"!:"!%(8$&

% + enneth /aughman, 4pecial Beport: *iagnosis of -yocarditisE *eath of*allas riteria irculation %00(E""$:!9$8!9! Free full te5t

$ a b c d e f Feldman 7-, -c@amara * [email protected] %000 ;-yocarditis; !" Engl" #"$ed" ,, +"9: "$&&G9& doi:"0"0!()@?J-%000""09$#$"90& i>, LE


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n. A virus without an enclosing envelope, consisting only of a

nucleocapsid.

viral envelope

Sponsored &in%s

Immunogenicity Testing

!piscreen T cell assay technology for

'iologics

(((.antitope.co.u%

scheme of a Cytomegalo)irus

-any viruses +eg influen>a and many animal viruses have "iral en"elopes covering their protein capsids 3he envelopes are typically derived from portions ofthe host cell mem.ranes +phospholipids and proteins, .ut include some viralglycoproteins Functionally, viral envelopes are used to help viruses enter host cellsDlycoproteins on the surface of the envelope serve to identify and .ind to receptorsites on the hostAs mem.rane 3he viral envelope then fuses with the hostAsmem.rane, allowing the capsid and viral genome to enter and infect the host

Lsually, the cell from which the virus itself .uds from goes on to survive, and shedmore viral particles for an e5tended period Interestingly, the lipid .ilayer envelope of these viruses is relatively sensitive to desiccation, heat and detergents, and so these

viruses are easier to sterili>e than non8enveloped viruses 8 in other words theycannot survive outside host environment and must transfer directly from host to host
http://www.answers.com/topic/envelopehttp://www.answers.com/topic/nucleocapsidhttp://www.answers.com/topic/cytomegalovirushttp://www.answers.com/topic/virus-1999-filmhttp://www.answers.com/topic/capsidhttp://www.answers.com/topic/cell-membranehttp://www.answers.com/topic/phospholipidhttp://www.answers.com/topic/glycoproteinhttp://www.answers.com/topic/host-biologyhttp://www.answers.com/topic/receptorhttp://www.answers.com/topic/receptorhttp://www.answers.com/topic/buddinghttp://www.answers.com/topic/lipid-bilayerhttp://www.answers.com/topic/desiccationhttp://www.answers.com/main/Record2?a=NR&url=http%3A%2F%2Fcommons.wikimedia.org%2Fwiki%2FImage%3ACMVschema.svghttp://www.answers.com/main/Record2?a=NR&url=http%3A%2F%2Fcommons.wikimedia.org%2Fwiki%2FImage%3ACMVschema.svghttp://www.answers.com/topic/envelopehttp://www.answers.com/topic/nucleocapsidhttp://www.answers.com/topic/cytomegalovirushttp://www.answers.com/topic/virus-1999-filmhttp://www.answers.com/topic/capsidhttp://www.answers.com/topic/cell-membranehttp://www.answers.com/topic/phospholipidhttp://www.answers.com/topic/glycoproteinhttp://www.answers.com/topic/host-biologyhttp://www.answers.com/topic/receptorhttp://www.answers.com/topic/receptorhttp://www.answers.com/topic/buddinghttp://www.answers.com/topic/lipid-bilayerhttp://www.answers.com/topic/desiccation

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