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Myocarditis

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  • 1. MYOCARDITIS By Dr.Zulfiqar Butt
  • 2. DEFINITION: Myocarditis is defined as: Acute or chronic inflammation of the myocardium. characterized by: 1. Inflammatory cells infiltrates in myocardium. 2. Myocyte degeneration or necrosis.
  • 3. Etiology
  • 4. Pathogenesis Characterized by: Myocardial inflammation,necrosis and fibrosis. Cardiomegaly and diminished systolic function occur due to myocardial damage. Typical signs of CHF occur which may progress to shock,arrythmias and sudden death.
  • 5. Continue: Virus act on myocardium in three phases. 1) Virus Replication Or Acute Phase 2) Autoimmune Injury Phase 3) Dilated Cardiomyopathy Phase Or Chronic Phase
  • 6. Sign And Symptoms Manifestations of myocarditis range from asymptomatic or nonspecific generalized illness to acute cardiogenic shock and sudden death. Infants and young children more often have a fulminant presentation with:  Fever.  Respiratory distress.  Tachycardia, hypotension, gallop rhythm, and cardiac murmur.  Associated findings may include a rash or evidence of end organ involvement such as hepatitis or aseptic meningitis.
  • 7. Continue: Patients with acute or chronic myocarditis may also present with :  Palpitations, easy fatigability, or syncope.  Chest discomfort.  Cardiac findings include, gallop rhythm, and an apical systolic murmur of mitral insufficiency.  In patients with associated pericardial disease, a rub may be noted.  Hepatic enlargement, peripheral edema, and pulmonary findings such as wheezes or rales may be present in patients with decompensated congestive heart failure
  • 8. Diagnosis 1)-ELECTROCARDIOGRAPHIC CHANGES. Nonspecific and may include sinus tachycardia, atrial or ventricular arrhythmias, heart block. 2)-CHEST X.RAY: Reveal cardiomegaly, pulmonary vascular prominence, pulmonary edema, or pleural effusions. 3)-ECHOCARDIOGRAPHY: Often shows diminished ventricular systolic function, cardiac chamber enlargement, mitral insufficiency, and occasionally, evidence of pericardial effusion.
  • 9. Continue: 4)-Endomyocardial biopsy: May be useful in identifying inflammatory cell infiltrates or myocyte damage. 5)-OTHER SUPPORTIVE BUT NONSPECIFIC TESTS INCLUDE:  Wbc’s often elevated. ESR increased. Troponins elevated in 1/3rd cases. CK-MB may be elevated. AST may be elevated.
  • 10. Treatment • Primary therapy for acute myocarditis is supportive • Management is done according to clinical signs and symptoms. Conventional heart failure therapy is currently the only accepted therapy for myocarditis including: 1. ACE inhibitors. 2. Angiotensin receptor blocking agents. 3. Diuretics. 4. β-blockers. 5. In patients manifesting with significant atrial or ventricular arrhythmias, specific antiarrhythmic agents (for example, amiodarone) should be given.
  • 11. ROLE OF IMMUNOMODULATION THERAPY. Immunomodulation of patients with myocarditis is controversial. Intravenous immune globulin may have a role in the treatment of acute or fulminant myocarditis. Corticosteroids have been reported to improve cardiac function, but the data are not convincing in children. Relapse has been noted in patients receiving immunosuppression. There are no studies to recommend specific antiviral therapies for myocarditis.
  • 12. Prognosis The prognosis of symptomatic myocarditis:  in newborns is poor and 75% mortality has been reported.  The prognosis is better for children and adolescents.  Recovery of ventricular function has been reported in 10-50% of patients.
  • 13. THANK YOU