myocarditis - prof djoko soemantri, md, phd, fiha(1).pdf
Post on 07-Jul-2018
230 Views
Preview:
TRANSCRIPT
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
1/12
DJOKO SOEMANTRI
MYOCARDITIS
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
2/12
MYOCARDITISIS AN UNCOMMON DISEASE OF THE HEART CHARACTERIZED BY INFLAMMATION AND SUBSEQUENT
MYOCARDIAL DESTRUCTION
:
THE AVERAGE AGE OF PATIENTS WITH MYOCARDITIS IS 42, THE MALE TO FEMALE RATIO IS 1.5 : 1
OFTEN
NONSPECIFIC
ACUTE
UNLESS
CHFDEVELOPS
OVERT
I N T R O D U C T I O N
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
3/12
CAUSES OF MYOCARDITIS
VIRUSES ARE THE MOST IMPORTANT INFECTIOUS AGENT1
ENTEROVIRUSES
HIV HAS BEEN SHOWN TO DIRECTLY
ATTACK THE MYOCARDIUM
BACTERIA, CHLAMYDIA, RICKETSSIA, FUNGI AND PROTOZOAN
2
ALONG WITH TOXIN & SYSTEMIC ILLNESS
CHAGAS DISEASE THE MOST COMMON CAUSE OF MYOCARDITIS &
CARDIOMYOPATHY IN CENTRAL AND SOUTH AMERICA
HYPERSENSITIVITY3
PENICILLIN, AMPICILLIN, HCT, METHYLDOPA, SULFONAMIDE
DIRECT CYTOTOXIC EFFECT ON MYOCYTE
4
LITHIUM, DOXORUBICIN, COCAINE, NUMEROUS CATHECOLAMINE & ACETOMINOPHEN
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
4/12
ENVIROMENTAL TOXIN5
SYSTEMIC DISEASE6
LEAD, ARSENIC, CARBONMONOSIDE
SARCOIDOSIS, CONNECTIVE TISSUE DISORDER, SLE, GIANT CELL ARTERITIS
CAUSES OF MYOCARDITIS
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
5/12
P T I E N T P R E S E N T T I O N
OFTEN NON SPECIFIC
ACUTE
CONGESTIVE
HEART FAILURE
DEVELOPS
FULMINANT
FATIGUE AND MILDDYSPNEA
60% OF PATIENTS WITH
ANTECEDENT VIRAL SYNDROME
FEVER, FATIGUE, MYALGIA &
MALAISE
TYPICAL TIME
INTERVAL
BETWEEN VIRAL
ILLNESS & CARDIAC
INVOLVEMENT IS 2
WEEKS
ORTOPNEA,
SHORTNESS OF
BREATH
35 % OF PATIENTS
WITH CHEST PAIN
PALPITATIONS
MAY SIGNAL THE
DEVELOPMENT OF AV
BLOCK OR MALIGNANT
DYSRYTHMIAS
SYNCOPE
SUDDEN CARDIAC DEATH
PEDIATRIC (ESPECIALLY INFANTS) WILL PRESENTS WITH NON-SPECIFIC SYMPTOMPS. NEONATAL MYOCARDITIS SHOULD BE CONSIDERED
IN ANY INFANT WITH VIRAL-LIKE ILLNESS WHO DEVELOPS COMPROMISE OF CARDIAC FUNCTION.
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
6/12
P H Y S I C L E X M I N T I O N
MILD CASE NON-TOXIC APPEARANCE & SIMPLY APPEAR TO HAVE VIRAL SYNDROME
SEVERE CASE HYPOTENSION
CARDIOGENIC SHOCK
S3 & GALLOP
MURMUR OF MITRAL &
TRICUSPID
REGURGITATION
FRICTION RUB
PERICARDIAL EFFUSION
TAMPONADE
POOR PROGNOSIS
MAY BE PRESENT DUE TO
VENTRICULAR DILATION
MAY BE PRESENT IF THERE IS AN
ASSOCIATED PERICARDITIS
PE IS COMMON, BUT SIGNS OF
TAMPONADE IS RARE
TACHYPNEA &
TACHYCARDIAOFTEN OUT OF PROPORTION TO FEVER
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
7/12
SLOW ELEVATION & FALL OVER A
PERIOD OF DAYS CONTRAST TO
THE MORE ABRUPT RISE IN AMI
P T I E N T S S E S M E N T
LABORATORY
CARDIAC ENZIM OTHERS
(↑) IN MINORITY
PATIENT ONLY
SPECIFIC IF THEY
ARE
DEMONSTRATE
CHARACTERISTIC
ECG PATTERN
(↑) ESR (ERYTROCYTESEDIMENTATION RATE) 60%
OF CASES
(↑) LEUKOCYTOSIS 25%OF CASES
(↑) CRP
BLOOD CULTURE ASO
MYCOPLASMA CULTURES
HEPATITIS PANELMONOSPOT
CMV SEROLOGY
NOT TYPICALLY HELPFUL IN
SECURING THE DIAGNOSIS INEMERGENCY DEPARTEMENT
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
8/12
P T I E N T S S E S M E N T
CHEST X-RAY (CXR)
OFTEN NORMAL
CARDIAC
SILHOUETTE
CARDIOMEGALY
PLEURAL EFFUSION
ENGORGEDPULMONARY VEINS
INTERSTITIAL
PULMONARY EDEMA
IN YOUNGER PEOPLE
PRESENCE OF
INFILTRAT BILATERAL
LEADS TO
MISDIAGNOSIS
PNEUMONIA
PAC, PVC, SVT, AF, ATRIAL FLUTTER, AV
BLOCK
ELECTROCARDIOGRAM (ECG)
MAY REVEAL A WIDE VARIETY
OF ABNORMALITES
THE MOST COMMON ABNORMALITY IS
SINUS TACHYCARDIA
CARDIAC DYSRHYTHMIAS
SYNCOPE or SUDDEN
CARDIAC DEATH (SCD)
TAVB(TOTAL AV BLOCK)
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
9/12
SIGNIFICANT SAMPLING ERROR
LEADING TO ONLY 30% PATIENT WITH
POSITIVE BIOPSIES IN WHICH DISEASE
SUSPECTED
DIAGNOSTIC PROCEDURE OF CHOICE
P T I E N T S S E S M E N T
ECHOCARDIOGRAM
NUCLEAR MEDICINE
STUDY
ECHOCARDIOGRAM MYOCARDIAL BIOPSY
IMPAIRMENT LV SYSTOLIC &
DIASTOLIC
IMPAIRMENT EF
PERICARDIAL EFFUSION
RARE
LV THROMBUS 15% OF CASES
SENSITIVITY & SPECIFICITY 83%
NEGATIVE PREDICTIVE VALUE OF 95 %
ENDOMYOCARDIAL BIOPSY
ACTIVE MYOCARDITIS
INFLAMMATORY INFILTRATE OF
THE MYOCARDIUM WITH
NECROSIS & DEGENERATION
OF ADJACENT MYOCYTES NOT
TYPICAL OF ISCHEMIA
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
10/12
P T I E N T M N G E M E N T
MILD
MILD SYMPTOMS & NO SIGNS
OF CARDIAC FAILURE & NO
DYSSRHYTMIASMAY BE TREATED OUTPATIENTS
SEVERE
LV DYSFUNCTION
LUNG EDEMA
LOW SODIUM DIET
DIGOXIN
VASODILATOR
ACE ICLASS OF DRUGS HAS BEEN SHOWN TO
BENEFICIAL IN THE TREATMENT OF AGENTS
DIURETIC
+
IN GENERAL, SYMPATHOMIMETIC & BETA BLOCKER DRUGS SHOULD BE AVOIDED
IABP
ANTICOAGULATION
LIFE SAVING
REDUCE THE RISK OF
THROMBOEMBOLIZATI
ON IN PATIENTS WITH
DILATED VENTRICLES
RESTRICT ACTIVITY++
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
11/12
FOR SEVERE HF, SYNCOPE, HEART BLOCK & OTHER DYSRHYTHMIAS
GLUCOCORTICOID, OTHER
IMMUNOSUPPRESIVE DRUGS & NSAID
P T I E N T M N G E M E N T
IMMUNOSUPPRESIVE
THERAPY
LITTLE USE IN THE EMERGENCY
DEPARTEMENT
POTENTIAL TO WORSEN THE ACUTE PHASE
OF VIRAL MYOCARDITIS
ANTIVIRAL THERAPY
PLECONARILBOARD SPECTRUM
ANTIVIRAL DRUGHAS BEEN SHOWN PROMISING RESULT
AGAINTS ENTEROVIRUSES
ADMISSION BED RESTVIRAL MYOCARDITIS IS TYPICALLY A MILD
DISEASE & RESPON WELL TO BED REST
ICCU
-
8/18/2019 Myocarditis - Prof Djoko Soemantri, MD, PhD, FIHA(1).pdf
12/12
top related