Acute heart failure in meningococcal disease due to myocarditis and sepsis
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A previously healthy 26-year-old male presented to the emergency department with symptoms of sore throat, fever, headache, nausea and malaise for two days. Physical exam revealed stable vital signs but nuchal rigidity. Tests showed elevated white blood cells, creatinine and lactate levels. A CT scan showed diffuse brain edema and spinal fluid analysis indicated meningococcal meningitis. The patient's condition deteriorated with hemodynamic compromise. Ultrasound revealed acute heart failure and myocarditis secondary to meningococcal meningoencephalitis, confirmed by elevated troponin levels. The patient was treated with antibiotics, steroids and supportive care in the ICU. He developed atrial fibrillation and
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2) It most commonly affects children ages 5-15 and is more prevalent in developing countries.
3) The pathogenesis involves an autoimmune response triggered by antibodies produced against the streptococcal infection. This causes inflammatory lesions and damage to tissues.
4) Diagnosis is based on modified Jones criteria which requires evidence of prior streptococcal infection plus either two major clinical manifestations or one major and two minor manifestations. Treatment involves antibiotics to treat the initial infection along with anti-inflammatory drugs
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Infective endocarditis occurs when bacteria or fungi colonize the heart valves. It is classified into four groups depending on the valve affected and cause. The most common predisposing factors are intravenous drug use, prosthetic valves, previous endocarditis and dental procedures. Clinical presentations include fever, heart murmur, petechiae and neurological changes. Diagnosis involves blood cultures, echocardiography and application of the Duke Criteria. Treatment involves antibiotics for 2-6 weeks depending on the causative organism and affected valve.
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This document summarizes a review article on Staphylococcal Toxic Shock Syndrome (TSS). TSS is a rare but serious complication of Staphylococcus aureus infection where bacterial toxins act as superantigens, activating large numbers of T cells and causing a cytokine storm and multiple organ failure. The document discusses the pathophysiology, epidemiology, clinical presentation and management of TSS. It emphasizes that all clinicians should be aware of TSS given its varied presentations and increasing rates of gram-positive infections including MRSA. Early diagnosis and treatment are important as TSS can rapidly progress to septic shock.
Toxic Shock Syndrome
This document provides information about adverse events following immunization (AEFI), specifically addressing toxic shock syndrome (TSS) and anaphylaxis. It discusses program errors as a common cause of AEFI and outlines proper vaccine handling, storage, and administration to minimize errors. The document also describes signs and symptoms of TSS and anaphylaxis, as well as their treatment, including use of epinephrine, IV fluids, antibiotics, and management of affected organ systems. It emphasizes the importance of rapid transport and treatment of serious AEFI cases.
Meningococcal disease
1) Meningococcal disease is caused by the bacteria Neisseria meningitidis and can cause meningitis or sepsis. It is spread through respiratory and throat secretions.
2) Symptoms include headache, fever, neck stiffness, and rash. Complications can include blood infections, skin necrosis, hearing loss, and limb amputations. Early treatment with antibiotics is important.
3) There are two vaccines that protect against some common strains of N. meningitidis. The CDC recommends routine vaccination of adolescents and those at increased risk. Preventive measures include vaccination and good hygiene.
4 Meningococcal Meningitis
1. The document describes a case of meningococcal meningitis in a 14-year-old male student who presented with high fever, headache, nausea, vomiting, stiff neck and confusion. Examination found a positive Kernig's sign and white blood cell counts were elevated in both blood and cerebrospinal fluid.
2. The document then provides background information on meningococcal meningitis, including that it is caused by Neisseria meningitidis bacteria, signs and symptoms, routes of transmission, risk groups, treatment which includes antibiotics and supportive care, and prevention through vaccination and chemoprophylaxis of close contacts.
3. Differential diagnoses and diagnostic testing are also
Toxic shock syndrome
Toxic shock syndrome is a life-threatening illness caused by toxins from Staphylococcus aureus or Streptococcus pyogenes bacteria. It causes high fever, low blood pressure, rash, and problems affecting multiple organ systems. While often associated with tampon use, it can result from other infections as well. Prompt treatment includes antibiotics, IV fluids, and organ support. Nurses closely monitor patients and management includes infection control, fluid resuscitation, and prevention of recurrence.
Fever and rash by Dr.Uma
This document discusses diseases that present with fever and rash, focusing on measles, rubella, and hand, foot, and mouth disease. It describes the etiology, symptoms, diagnosis, and treatment of each condition. Measles is caused by a specific RNA virus and presents with a maculopapular rash. Rubella rash appears as pinpoint lesions and is generally milder than measles. Hand, foot, and mouth disease is common in children under 10 and caused by intestinal viruses, presenting with sores in the mouth and a non-itchy rash on the hands and feet.
Dermatology approach
Here are some common causes of mouth ulcers to consider in the differential diagnosis:
- Herpes simplex virus infection
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A thorough history and examination is needed to help determine the underlying cause. Investigations may include
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Bacterial meningitis and meningococcal septicaemia
Bacterial meningitis and meningococcal septicaemia
Similar to Acute heart failure in meningococcal disease due to myocarditis and sepsis
Post cardiac arrest syndrome
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Fibrinolysis in stemi a second thought- tip august 2016
This case report describes a 30-year old male who presented with chest discomfort and progressive breathlessness. An ECG showed ST elevation resembling a STEMI. However, cardiac enzymes were normal and there was incoherence between symptoms and ECG. Cardiac sarcoidosis was considered and confirmed through cardiac MRI, endomyocardial biopsy, and elevated serum ACE level. The patient was started on steroids and anti-arrhythmics, resulting in partial symptom remission. This case highlights that cardiac sarcoidosis can present with ST elevation on ECG and should be considered to avoid unnecessary fibrinolysis when there is discrepancy between presentation and test results.
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Primary CNS Vasculitis - diagnostic and therapeutic challenges
1. This 38-year-old male presented with severe frontal headache, speech difficulties, weakness, and confusion. Imaging showed multiple small white matter lesions that progressed significantly over 4 days.
2. Cerebrospinal fluid analysis showed elevated white blood cells and protein with positive oligoclonal bands. Infectious and autoimmune workups were negative.
3. Brain biopsy showed early acute ischemic changes and a microscopic focus of acute infarction without evidence of vasculitis, inflammation, or other pathologies. This is consistent with a diagnosis of primary central nervous system vasculitis.
A case report of posterior reversible encephalopathy syndrome in a patient di...
Posterior reversible encephalopathy syndrome (PRES), a clinical radiological syndrome, is characterized by the
abrupt development of neurological symptoms such as headaches, convulsions, altered sensorium, and visual
problems. PRES has been linked to a number of risk factors or etiologies, including the use of immunosuppressants
or cytotoxins, hypertensive encephalopathy, eclampsia, preeclampsia, and underlying autoimmune diseases.
A 41-year-old female was admitted with acute necrotizing emphysematous pancreatitis complicated by posterior
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This document discusses a case of dengue fever with myocarditis in an 18-year-old male construction worker presenting with fever, headache, and body aches. Initial tests showed mild left ventricular dysfunction which later improved. Dengue IgM was positive, confirming dengue fever with cardiac involvement. Recent studies show that while cardiac complications of dengue are uncommon, myocarditis is the most documented pathology and can present asymptomatically. Echocardiography is useful for diagnosis where sinus bradycardia is often the only ECG finding.
03. Congenital abnormalities of the cardiovascular system.pptx
The document provides information on common cardiac disorders in neonates. It begins with an overview of normal heart anatomy and physiology. The most common congenital heart defects seen in neonates include ventricular septal defect, atrial septal defect, patent ductus arteriosus, coarctation of the aorta, tetralogy of Fallot, and transposition of the great arteries. Clinical signs, diagnosis, and treatment approaches for each of these conditions are discussed in detail across multiple pages.
kawasaki disease new.pptx
This document summarizes the case of a 7-year-old boy admitted to the hospital for 1 week with Kawasaki disease. He presented with a high fever for 7 days, headache for 7 days, rashes for 4 days, and eye swelling for 4 days. Initial workup showed elevated inflammatory markers and echocardiogram showed enlarged coronary arteries. He was treated with IVIG, steroids, and other supportive care. His symptoms improved and he was discharged on low-dose aspirin with a final diagnosis of Kawasaki disease and multi-organ inflammation that had resolved.
Dressler’s Syndrome Case Report
Dresslers syndrome should be considered in the differential diagnosis of chest pain, especially in patients at late stages of the progression of the ischemic process. Myocardial rupture is a rare event often associated with sudden death after myocardial infarction. This case report describes the 56 years age old man who present in persistent chest pain with radiating in shoulder and breathlessness with high grade fever. He had previously myocardial infraction in one month back and treated with reperfusion therapy and also history of hypertension and type 2 diabetes mellitus under medications. He finally diagnosed in evidence of ECG and CT findings. K Karpagam | Deepan M "Dressler’s Syndrome: Case Report" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd53868.pdf Paper URL: https://www.ijtsrd.com/medicine/other/53868/dressler’s-syndrome-case-report/k-karpagam
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Rheumatic hear disease is a life thretening condition which results damage to heart valves caused by inflammatory reaction of streptococcal bacterias
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This document presents a case study of a 44-year-old man diagnosed with spontaneous intracranial hypotension (SIH) secondary to cerebrospinal fluid leaks at C1-C3 and T6-T10. He presented with progressive headache, nausea, vomiting, and intermittent double vision. Imaging showed bilateral subdural hematomas and evidence of subarachnoid hemorrhage. He deteriorated with additional cranial nerve palsies until epidural blood patches were placed, which provided immediate relief and full recovery. SIH is often misdiagnosed but can be identified through characteristic symptoms, lumbar puncture findings and imaging evidence of CSF hypovolemia.
MANAGEMENT OF MYOCARDITIS
This document summarizes the management of myocarditis. It discusses the diagnosis of myocarditis through lab evaluation including troponins, natriuretic peptides and endomyocardial biopsy. It outlines the treatment of myocarditis including activity restrictions, medical management with immunosuppressors, antivirals and mechanical circulatory supports. It also discusses survival and the potential need for heart transplantation in severe cases.
Pathology of Meningitis & CNS infections.
Pathology of Meningitis, CNS infections, increased cerebral pressure, brain herniations etc. for pre clinical medical students.
9 x miocarditis fulminante covid
This document describes a case of fulminant myocarditis likely caused by COVID-19 infection in a 59-year-old woman. Key points:
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- Echocardiograms showed myocardial thickening, edema, and dysfunction. She deteriorated into cardiogenic shock requiring interventions.
- Treatment for suspected acute myocarditis included immunoglobulins, steroids, and antivirals. Cardiac function improved but she required ongoing ECMO support for respiratory issues.
- This case suggests that in rare cases, COVID-19 can cause severe myocarditis
CNS vasculitis
This clinical discussion presents the case of an 11-year-old girl admitted with complaints of generalized tonic-clonic seizures, fever, headache, and joint pain. Examination found signs of meningeal irritation. Tests showed elevated inflammatory markers and a positive anti-dsDNA antibody. The differential diagnoses included tubercular meningitis and SLE with neurological manifestation. Given the positive anti-dsDNA, the diagnosis was determined to be SLE with CNS vasculitis. The document then provides an overview of childhood CNS vasculitis, its classification, characteristics, pathophysiology, evaluation, imaging, biopsy, treatment, and differential diagnoses.
A Case of Cortical Venous Thrombosis
A 38-year-old man presented with seizures and was diagnosed with cortical venous thrombosis. He had multiple risk factors including diabetes, hyperhomocysteinemia, and dyslipidemia. He was treated with anticoagulation but continued having seizures. Imaging later revealed a venous infarct. His symptoms gradually improved with treatment but he was discharged with some residual neurological deficits. Cortical venous thrombosis can be challenging to diagnose but outcomes have improved with prompt diagnosis and treatment. Hyperhomocysteinemia is an increasingly recognized risk factor.
WJC-6-514.pdf
Acute myocardial infarction should be diagnosed as early as possible for the appropriate management to salvage ischemic myocardium. Accurate diagnosis is typically based on the typical symptoms of angina. Headache is an unusual symptom in patients with acute myocardial infraction. We report a patient with ST-segment elevation acute myocardial infarction who presented to the emergency department complaining of severe occipital headache without chest discomfort.
Infective endocarditis
This document discusses myocarditis, including its definition, etiology, clinical features, diagnosis, treatment, prognosis, and complications. Myocarditis is defined as inflammation of the heart muscle, which can be caused by various viral and bacterial infections. Clinical features include fever, chest pain, and heart failure symptoms. Diagnosis involves electrocardiograms, cardiac imaging like echocardiograms and MRI, and endomyocardial biopsy. Treatment is supportive with medications, while prognosis depends on the age of onset, with higher mortality in newborns and potential for recovery of heart function in older children and adults.
Similar to Acute heart failure in meningococcal disease due to myocarditis and sepsis (20)
Fibrinolysis in stemi a second thought- tip august 2016
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Severe Hyponatremia, SIADH, and Pericardiac Effusion as Initial Presenting Fe...
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Primary CNS Vasculitis - diagnostic and therapeutic challenges
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A case report of posterior reversible encephalopathy syndrome in a patient di...
03. Congenital abnormalities of the cardiovascular system.pptx
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Traumatic Brain Injuries: Pathophysiology, Treatment and Prevention
Traumatic Brain Injuries: Pathophysiology, Treatment and Prevention
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1) Patients with low ejection fraction (EF < 50%) and severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVI) have similar mortality at 1 year compared to those with higher EF, despite being higher risk.
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When is less more minimally invasive surgery in low ef
The document discusses treatment options for patients with reduced ejection fraction and secondary mitral regurgitation, including the use of minimally invasive mitral valve surgery which can be considered for elderly patients or those with comorbidities. It presents a case study of a 69-year-old male with severe secondary mitral regurgitation who underwent a minimally invasive mitral valve repair which eliminated his mitral regurgitation and improved his symptoms and ejection fraction. Long-term data on isolated mitral valve surgery in patients with reduced ejection fraction shows improvement in mitral regurgitation and functional status with no difference in survival between repair and replacement
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The complex patient vad transplant exchange or hospice
This document discusses the case of a 76-year-old man presenting with heart failure symptoms and recurrent cough syncope. Testing revealed cardiac amyloidosis due to a TTR gene mutation. For patients with TTR amyloidosis, treatment options include organ transplantation, TTR stabilizers in clinical trials, or enrollment in hospice. Given his age and comorbidities, the man's options included a left ventricular assist device, extended criteria transplant, or a clinical trial for TTR amyloidosis treatment. He was ultimately listed and transplanted, and has since recovered well.
The complex patient vad transplant exchange or hospice
This document discusses the case of a 76-year-old man presenting with heart failure symptoms and recurrent cough syncope. Testing revealed cardiac amyloidosis due to a TTR gene mutation. For patients with TTR amyloidosis, treatment options include organ transplantation, TTR stabilizers in clinical trials, or enrollment in hospice. Given his age and comorbidities, the man's options included a left ventricular assist device, extended criteria transplant, or a clinical trial for TTR amyloidosis treatment. He was ultimately listed and transplanted within a month, and has since recovered well.
Surgical director heart transplant and mechanical assist device program
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The complex patient vad ransplant vad exchange or hospice
L.B. is a 62-year-old man with a long history of coronary artery disease and heart failure who has undergone multiple coronary bypass surgeries. He now has an ejection fraction of 25% and intractable ventricular tachycardia despite medical management. Due to the risks of ablation, the team is considering options like hospice care, cardiac transplantation, VAD implantation, or VAD exchange to treat his advanced heart failure. A cardiac catheterization revealed multiple occluded arteries and stenoses. Given his medical history and surgical history, the team must determine the best treatment approach for his condition.
The road ahead.
This document discusses the management of mitral regurgitation (MR) in heart failure patients. It explores the differences between primary and functional (secondary) MR, and notes that correcting primary MR may improve outcomes but the benefits are less clear for functional MR which is primarily a ventricular problem. The document reviews potential management options for MR in heart failure including optimal medical therapy, cardiac resynchronization therapy, surgery, and percutaneous techniques such as the MitraClip system. It presents evidence from studies on the acute effects of CRT and the impact of CRT on functional MR severity. It also discusses guidelines on indications for mitral valve surgery in chronic secondary MR and barriers to surgery.
Whom to refer for mitral valve repair and whom not
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Devices and intervention in heart failure.
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Prevention is the best treatment
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Can we afford heart failure management in the future
Heart failure is a major global health problem, affecting 26 million people worldwide. It accounts for 1-3% of hospital admissions in Europe and North America. Hospitalization is the main driver of the high economic costs of heart failure management, which is estimated to rise significantly in the coming decade. To better manage heart failure costs in the future, new models of coordinated and integrated care will need to be implemented, with a focus on preventing hospitalizations and readmissions through improved education, care transitions, and treatment of comorbidities.
The deadly statistics of heart failure.
This document discusses statistics related to heart failure. It summarizes data on outcomes for hospitalized heart failure patients compared to chronic heart failure patients. Hospitalized patients generally have worse outcomes, with high 1-year mortality rates around 25-27%. Chronic heart failure patients have lower but still significant 1-year mortality rates of around 5-6%. The document also reviews real-world data showing high readmission rates after hospitalization for heart failure. It concludes that while treatments for chronic heart failure with reduced ejection fraction have improved outcomes over decades, more efforts are still needed to improve care and outcomes for hospitalized patients and those with preserved ejection fraction.
The heart failure association global awareness programme.
The Global Heart Failure Awareness Programme aims to make the prevention and management of heart failure a global health priority. It is led by the Heart Failure Association of the European Society of Cardiology and supported by educational grants. The programme's objectives are to build a common global approach to raising awareness of heart failure among targeted audiences and to call for heart failure to be a health priority in every country. It plans to achieve this through developing educational content, building advocacy coalitions, and implementing initiatives at the national and local levels between 2015 and 2017.
Prevention is the best treatment
This document discusses the importance of prevention in treating cardiovascular disease. It outlines stages of heart failure progression from asymptomatic left ventricular dysfunction to refractory heart failure. Clinical trials show benefits of treating hypertension and post-MI left ventricular dysfunction to prevent heart failure. Treatment with ACE inhibitors reduces mortality and morbidity from heart failure. Prevention of risk factors is emphasized as the best strategy to avoid full-blown heart disease.
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FACIAL NERVE
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
Hypotension and role of physiotherapy in it
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Pneumothorax and role of Physiotherapy in it.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Mental Health and Physical Wellbeing.pdf
Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
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Acute heart failure in meningococcal disease due to myocarditis and sepsis
- 2. Acute heart failure in meningococcal disease due to myocarditis and sepsis CASE REPORT: Healthy 26 years-old male comes to the emergency department; History: sore throat, fever, headache, nausea/vomiting and malaise for 2 days; Physical exam: stable vital signs, no respiratory distress, warm, nuchal rigidity, normal pupils and no neurologic deficit. Normal cardiac / pulmonary auscultation. Exams: Labs (high WBC, creatinine, lactate), CXR, Head CT (diffused edema), LP (CSF w/ low glucose, high protein, diplococci gram negative -> Neisseria meningitidis) 2155 L. Celia Petersen, TR. Reichert, CVE. Drebes, JS. Jardim, SVG. Wanderley, M. Crecenzio, M. Wiehe, LC. Bodanese, JCVC. Guaragna, LC. Danzmann Hospital São Lucas / PUC-RS, Cardiology, Porto Alegre-RS, Brazil INTRODUCTION: Acute heart failure -> syndrome with different aetiologies (cardiac vs non-cardiac) -> context of infection: myocarditis vs sepsis.
- 3. => The patient becomes less responsive with hemodynamic compromise, non-responsive to volume infusion. => Intubation - MV, noradrenaline infusion, ceftriaxone, dexametasone. => ECG was done and Cardiology (resident) was called at 2:00am:
- 4. => Point of care (bedside) ultrasound was done:
- 5. Dx: Acute heart failure – Sepsis Myocarditis – meningococcal meningoencephalitis (max. troponin 8.660pg/ml) FOLLOW-UP: ICU -> pupura-fulminans / atrial fibrillation Discharged after 20 days -> sinus rhythm, normal EF, no deficit. DISCUSSION: The use of point of care ultrasound to define shock aetiology; Sepsis induced myocardial dysfunction; Myocarditis = 50% meningoccocal disease; DDx: ACS (hyperdynamic + coagulation) Myocardial dysfunction indicates a higher Incidence of fatal outcome in meningococcal disease… not in this case! REFERENCES: 1- Gore I, Saphir O. Myocarditis; a classification of 1402 cases. Am Heart J 1947; 34: 827. 2- Boucek MM, Boerth RC, Artman M, et al. Myocardial dysfunction in children with acute meningococcemia. J Pediatr 1984; 105:538. 3- Merx MW, Weber C. Sepsis and the heart. Circ 2007; 116: 793-802. 4- Leslie T, Cooper Jr. Myocarditis Review. N Engl J Med 2009;360:1526-38.