Miokarditis

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Miokarditis

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Miokarditis

  1. 1. REFERAT MIOKARDITIS Ferdy Ferdian, dr Erwinanto, dr., SpJP.
  2. 2. Definisi • Myocarditis is defined as inflammation of the heart muscle. • Inflammation of the heart muscle as a result of exposure to either discrete external antigens (such as viruses, bacteria, parasites, toxins, or drugs) or internal triggers, such as autoimmune activation against self antigens Liu P., et al. 2012
  3. 3. Etiologi Schultheiss HP., et al. 2011. The management of myocarditis
  4. 4. Patofisiologi Liu P., et al. 2012
  5. 5. Patofisiologi
  6. 6. Gejala klinis Pemeriksaan fisik Asimptomatik Nyeri dada Palpitasi Cepat lelah Sesak napas Ortopneu Bengkak tungkai Syok Sudden death • • • • • • • • • Tanpa kelainan Unstable hemodinamik Aritmia (Extrabeat, AF) JVP meningkat Kardiomegali S3 / S4 Murmur Rhonki basah halus Edema tungkai Cooper LT, et al. 2013
  7. 7. Penunjang… Endomyocardial biopsy Elektrokardiogram Gold standart Normal, abnormal, nonspesifik Enzim jantung Skintigrafi Peningkatan enzim jantung dapat ditemukan Antimiosin skintigrafi Rontgen dada MRI Normal, Kardiomegali, Edema paru Efusi pleura MRI dengan gandolinium Echocardiografi Disfungsi ventrikel dll Cooper LT, et al. 2013
  8. 8. Diagnosis.. • Dallas criteria – myocarditis active require the presence of inflammatory cells simultaneous with evidence of myocyte necrosis on the same microscopic section on examination of a myocardial biopsy – Borderline myocarditis is characterized by inflammatory cell infiltrate without myocardial necrosis Liu P., et al. 2012
  9. 9. Diagnosis.. Category I: Clinical Symptoms • Clinical heart failure – – – – – – – Fever Viral prodrome Fatigue Dyspnea on exertion Chest pain Palpitations Presyncope or syncope Liu P., et al. 2012
  10. 10. Diagnosis.. Category II Evidence of Cardiac Structural or Functional Perturbation in the absence of Regional Coronary Ischemia • Echocardiography – Regional wall motion abnormalities – Cardiac dilation – Regional cardiac hypertrophy • Troponine – High sensitivity (>0.1 ng/mL) • Positive indium In 111 antimyosin scintigraphy and Normal coronary angiography or Absence of reversible ischemia by coronary distribution on perfusion scan Liu P., et al. 2012
  11. 11. Diagnosis.. Category III: Cardiac Magnetic Resonance Imaging – Increased myocardial T2 signal on inversion recovery sequence – Delayed contrast enhancement after gadolinium-DTPA infusion Liu P., et al. 2012
  12. 12. Diagnosis.. Category IV: Myocardial biopsy (Pathologic or Molecular Analysis) – Pathology findings compatible with Dallas criteria – Presence of viral genome by polymerase chain reaction or in situ hybridization Liu P., et al. 2012
  13. 13. Diagnosis.. • Any matching feature in category = positive for category • Suggestive of myocarditis – 2 positive categories • Compatible with myocarditis – 3 positive categories • High probability of being myocarditis – all 4 categories positive Liu P., et al. 2012
  14. 14. Tatalaksana Liu P., et al. 2012
  15. 15. Sekian

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