International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Covid 19 and the cardiovascular system implications for risk assessment dia...Ramachandra Barik
The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and
mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial
pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the
cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is
increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer.
The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular
fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant
myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically,
SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane
angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages,
perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis.
Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm
[interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and
continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization
may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures
Cardiovascular Disease Associated with SARS-CoV-2 and HIV InfectionsInsideScientific
Dr. Xuebin Qin discusses the development and characterization of new models of SARS-CoV-2 and HIV, and how his lab uses these models to study cardiovascular injury associated with infection.
Despite ongoing research around the world to better understand the pathogenesis of SARS-CoV-2, the ways in which it exacerbates cardiovascular disease (CVD) are not fully understood. While it is well accepted that SARS-CoV-2 infects lung epithelial cells, whether it can also infect endothelial cells is less clear.
In this webinar, Dr. Xuebin Qin discusses his lab’s development and characterization of new rodent models of COVID-19, and how they use these models to study endothelial dysfunction and injury resulting from immune activation. Dr. Qin also discusses why HIV infection is associated with increased risk of CVD. He provides an overview of the cellular and molecular mechanisms underlying HIV-1-associated CVD, and the mouse and NHP models he has worked with to elucidate them.
Key Topics Include:
- Cellular mechanisms by which SARS-CoV-2 and HIV contribute to cardiovascular disease
- Development, characterization and analysis of Mouse and NHP models for the study of COVID-19- or HIV-associated CVD
- Potential targets for therapeutic vaccine testing and pathogenesis studies
all details explain about corona virus
corona virus slide
covid19 pandemic
epidemiology
pathogenesis
oral pathology
medicine
history
introduction
outbreak
prevent
drugs
test
steps taken by govt
Covid 19 and the cardiovascular system implications for risk assessment dia...Ramachandra Barik
The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and
mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial
pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the
cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is
increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer.
The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular
fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant
myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically,
SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane
angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages,
perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis.
Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm
[interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and
continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization
may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures
Cardiovascular Disease Associated with SARS-CoV-2 and HIV InfectionsInsideScientific
Dr. Xuebin Qin discusses the development and characterization of new models of SARS-CoV-2 and HIV, and how his lab uses these models to study cardiovascular injury associated with infection.
Despite ongoing research around the world to better understand the pathogenesis of SARS-CoV-2, the ways in which it exacerbates cardiovascular disease (CVD) are not fully understood. While it is well accepted that SARS-CoV-2 infects lung epithelial cells, whether it can also infect endothelial cells is less clear.
In this webinar, Dr. Xuebin Qin discusses his lab’s development and characterization of new rodent models of COVID-19, and how they use these models to study endothelial dysfunction and injury resulting from immune activation. Dr. Qin also discusses why HIV infection is associated with increased risk of CVD. He provides an overview of the cellular and molecular mechanisms underlying HIV-1-associated CVD, and the mouse and NHP models he has worked with to elucidate them.
Key Topics Include:
- Cellular mechanisms by which SARS-CoV-2 and HIV contribute to cardiovascular disease
- Development, characterization and analysis of Mouse and NHP models for the study of COVID-19- or HIV-associated CVD
- Potential targets for therapeutic vaccine testing and pathogenesis studies
all details explain about corona virus
corona virus slide
covid19 pandemic
epidemiology
pathogenesis
oral pathology
medicine
history
introduction
outbreak
prevent
drugs
test
steps taken by govt
Certification and classification (coding) of Covid-19 as cause of death based ICF Education
International guidelines for certification and classification (coding) of Covid-19 as cause of death based on ICD international statistical classification of diseases (16 April 2020)
Neurological Manifestations of COVID-19 InfectionSudhir Kumar
COVID-19 primarily affects respiratory system, however, it can affect other systems too, including nervous system. This presentation offers details about neurological symptoms and disorders seen in patients with COVID-19.
this presentation covers the detailed information about the non-infectious meningitis and its pathology, epidemiology, causes, mechanism and its clear pathophysiology. have a glance to know more about it . thank you...
COVID 19 and The Heart - Lessons Learnt from this Pandemicahvc0858
COVID 19 and The Heart - Lessons Learnt from this Pandemic
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Certification and classification (coding) of Covid-19 as cause of death based ICF Education
International guidelines for certification and classification (coding) of Covid-19 as cause of death based on ICD international statistical classification of diseases (16 April 2020)
Neurological Manifestations of COVID-19 InfectionSudhir Kumar
COVID-19 primarily affects respiratory system, however, it can affect other systems too, including nervous system. This presentation offers details about neurological symptoms and disorders seen in patients with COVID-19.
this presentation covers the detailed information about the non-infectious meningitis and its pathology, epidemiology, causes, mechanism and its clear pathophysiology. have a glance to know more about it . thank you...
COVID 19 and The Heart - Lessons Learnt from this Pandemicahvc0858
COVID 19 and The Heart - Lessons Learnt from this Pandemic
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
A powerpoint presentation about infective Endocarditis, with the most recent updates from the most reliable sources. I highlighted an introduction, pathology, approach to disease & different management plans in this presentation. 2018. Please don't forget to give me credit to my work.
Diagnostic Approaches to Chronic Fungal and Tuberculous Meningitisinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
During my 1st &2nd year of residency period , i used to teach Anatomy and Orthopaedics for foreign undergraduate medical students. At last year i taught Neurology for one batch. so i posted some of my collections for competely educational purpose coz i believe in knowledge ...inseted of deleting these ppts , they may me useful for others so i shared it ....
Meningitis is always cerebrospinal infection. Meningitis is a rare infection that affects the delicate membranes -- called meninges -- that cover the brain and spinal cord.There are several types of this disease, including bacterial, viral, and fungal.
Chronic Pneumonia: Update on Clinical Manifestations, Diagnosis and Therapyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Similar to International Journal of Pharmaceutical Science Invention (IJPSI) (20)
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
International Journal of Pharmaceutical Science Invention (IJPSI)
1. International Journal of Pharmaceutical Science Invention
ISSN (Online): 2319 – 6718, ISSN (Print): 2319 – 670X
www.ijpsi.org Volume 3 Issue 1 ‖ January 2014 ‖ PP.01-04
Myocarditis Pathology
P.S.Subiksha
ABSTRACT: Myocarditis or inflammatory cardiomyopathy is inflammation of heart muscle (myocardium)
diagnosed on endomyocardial biopsy (EMB) established by histological, immunological and immune his to
chemical criteria. Myocarditis is most often due to infection by common viruses.
KEY WORDS: Myocarditis, myocardial infarction, inflammation.
I.
INTRODUCTION
Myocarditis or inflammatory cardiomyopathy is inflammation of heart muscle [1] (myocardium)
diagnosed on endomyocardial biopsy (EMB) established by histological, immunological and
immunohistochemical criteria [2].Myocarditis is most often due to infection by common viruses, such as
parvovirus B19, less commonly nonviral pathogens such as Borrelia burgdorferi (Lyme disease) or
Trypanosoma cruzi, [4, 5] or as a hypersensitivity response to drugs. [3]
II.
ETIOLOGY
Although the etiology of myocarditis often remains undetermined, a large variety of infectious agents,
systemic diseases, drugs, and toxins can cause the disease.[6,7]Some causes of myocarditis are now largely
historical or occur in very specific scenarios such as sepsis or in immunocompromised patients. Molecular
techniques, mainly (reverse transcriptase)(RT)-PCR amplification,[4,8,9]suggest that viral infections are the
most important cause of myocarditis in North America and Europe with genomes of enterovirus, adenovirus,
influenza viruses, human herpes virus-6 (HHV-6), Epstein-Barr-virus, cytomegalovirus, hepatitis C virus, and
parvovirus B19 reported in the myocardium of patients with myocarditis and DCM. Lymphocytic and giant cell
myocarditis are presumed idiopathic or autoimmune if no viruses are identified in EMB and other known causes
are excluded .[6]Similarly, the diagnosis of idiopathic granulomatous myocarditis (cardiac sarcoidosis) requires
negative stains for microorganisms.[8,9]Autoimmune myocarditis may occur with exclusive cardiac
involvement or in the context of autoimmune disorders with extra-cardiac manifestations, most frequently in
sarcoidosis, hypereosinophilic syndrome, scleroderma, and systemic lupus erythematosus.
III.
PATHOGENESIS
In human myocarditis, there is evidence for viral and autoimmune mechanisms, acting in individuals
with or without a genetic predisposition (familial or sporadic cases, respectively). [10]Murine studies of viral
myocarditis are based mostly on Coxsackievirus B3-infected animals, which exhibit strain-specific
susceptibility. Enteroviruses that preferentially enter cardiomyocytes via specific receptors cause severe
cytopathic effects due to virus replication in the first 2 weeks post-infection [11]. As a consequence, a humoral
and cellular immune response, mainly consisting of macrophages and CD4+ and CD8+ T- lymphocytes, is
initiated in resistant animals[12,13] (C57BL/6 mice, Sv129 mice) and leads to the elimination of the infectious
agent within 2 weeks following infection.[4,15,16]
IV.
DIAGNOSIS
Myocarditis refers to an underlying process that causes inflammation and injury of the heart. It does
not refer to inflammation of the heart as a consequence of some other insult [14]. Many secondary causes, such
as a myocardial infarction, can lead to inflammation of the myocardium and therefore the diagnosis of
myocarditis cannot be made by evidence of inflammation of the myocardium alone.
Myocardial inflammation can be suspected on the basis of electrocardiographic (ECG) results; elevated
C-reactive protein (CRP) and/or Erythrocyte sedimentation rate (ESR) and increased IgM (serology) against
viruses known to affect the myocardium. Markers of myocardial damage (troponin or creatine kinase cardiac
isoenzymes) are elevated.
-Nuclear Imaging
Data on radionuclide evaluation, including antimyosin antibody imaging, are scarce but suggest that its
sensitivity for detecting myocardial inflammation is variable and its specificity low [17]. Due to their limited
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2. Myocarditis Pathology
availability and risk from radiation exposure, nuclear techniques are not routinely recommended for the
diagnosis of myocarditis, with the possible exception of sarcoidosis. [18, 19, 20].Thallium 201 and technetium
99m scintigraphy have been used to detect cardiac sarcoidosis but lack specificity. Gallium-67 scintigraphy and
more recently positron emission tomography using 18 fluorodeoxyglucose are probably more sensitive and may
be useful in the acute phase of sarcoidosis and to monitor disease progression. The detection of extracardiac
disease can suggest a diagnosis of cardiac
sarcoidosis.
-Cardiovascular Magnetic Resonance (Cmr) Imaging
Cardiovascular magnetic resonance imaging provides non-invasive tissue characterization of the myocardium
and can support the diagnosis of myocarditis. The timing of CMR in suspected myocarditis will depend upon
local availability and expertise, but it is reasonable to first perform CMR in clinically stable patients, prior to
EMB [21, 22]. It should not be performed in life-threatening presentations where EMB is urgently indicated [23,
24]. Cardiovascular magnetic resonance imaging techniques have been evaluated in animal models of
myocarditis as well as in patients
V.
SIGNS AND SYMPTOMS
The signs and symptoms associated with myocarditis are varied, and relate either to the actual
inflammation of the myocardium, or the weakness of the heart muscle that is secondary to the inflammation
[26]. Signs and symptoms of myocarditis include: Chest pain (often described as "stabbing" in character)
Congestive heart failure (leading to edema, breathlessness and hepatic congestion) Palpitations (due to
arrhythmias) Sudden death (in young adults, myocarditis causes up to 20% of all cases of sudden death) Fever
(especially when infectious, e.g. in rheumatic fever) Symptoms in infants and toddlers tend to be more
nonspecific, with generalized malaise, poor appetite, abdominal pain, and/or chronic cough. Later stages of the
illness will present with respiratory symptoms with increased work of breathing, and is often mistaken for
asthma.
Since myocarditis is often due to a viral illness, many patients give a history of symptoms consistent
with a recent viral infection, including fever, rash, diarrhea, joint pains, and easy fatigue ability [27, 15].
Myocarditis is often associated with pericarditis, and many patients present with signs and symptoms that
suggest concurrent myocarditis and pericarditis.
VI.
CAUSES
A large number of causes of myocarditis have been identified, but often a cause cannot be found. In
Europe and North America, viruses are common culprits. Worldwide, however, the most common cause is
Chagas' disease, an illness endemic to Central and South America that is due to infection by the protozoan
Trypanosoma cruzi [22, 28].
VII.
INFECTIONS
Viral (adenovirus, parvovirus B19, coxsackie virus, HIV, enterovirus, rubella virus, polio virus,
cytomegalovirus, human herpesvirus 6 and possibly hepatitis C)Protozoan (Trypanosoma cruzi causing Chagas
disease and Toxoplasma gondii)
Bacterial (Brucella, Corynebacterium diphtheriae, gonococcus, Haemophilus influenzae, Actinomyces,
Tropheryma whipplei, Vibrio cholerae, Borrelia burgdorferi, leptospirosis, and Rickettsia)
Fungal (Aspergillus)
Parasitic (ascaris, Echinococcus granulosus, Paragonimus westermani, schistosoma, Taenia solium,
Trichinella spiralis, visceral larva migrans, and Wuchereria bancrofti)
Bacterial myocarditis is rare in patients without immunodeficiency.
-Toxins
Drugs (ethanol, anthracyclines and some other forms of chemotherapy, and antipsychotics, e.g.
clozapine, also some designer drugs such as mephedrone) [8]
-Immunologic
Allergic (acetazolamide, amitriptyline ) Rejection after a heart transplant [29].
Autoantigens (scleroderma, systemic lupus erythematosis, sarcoidosis, systemic vasculitis such as
Churg-Strauss syndrome, and Wegener's granulomatosis)
Toxins (arsenic, toxic shock syndrome toxin, carbon monoxide, or snake venom)
Heavy metals (copper or iron)
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3. Myocarditis Pathology
-Physical Agents
Electric shock, hyperpyrexia, and radiation
VIII.
TREATMENT
The core principle in treatment of myocarditis are optimal care of arrhythmia and of heart failure, and
where supported by evidence, and etiology targeted therapy. As most viral infections cannot be treated with
directed therapy, symptomatic treatment is the only form of therapy for those forms of myocarditis. In the acute
phase, supportive therapy, including bed rest, is indicated [23, 30]. For symptomatic patients, digoxin and
diuretics provide clinical improvement. For patients with moderate to severe dysfunction, cardiac function can
be supported by use of inotropes such as Milrinone in the acute phase, followed by oral therapy with ACE
inhibitors (Captopril, Lisinopril) when tolerated. People who do not respond to conventional therapy are
candidates for bridge therapy with left ventricular assist devices. Heart transplantation is reserved for patients
who fail to improve with conventional therapy.
In several small case series and randomized control trials, systemic corticosteroids have shown to have
beneficial effects in patients with proven myocarditis.However, data on the usefulness of corticosteroids should
be interpreted with caution, since 58% of adults recover spontaneously, while most studies on children and
infants lack control groups.
IX.
NATURAL HISTORY
The natural history of myocarditis in community based populations is not known with any accuracy
because there is no widely available noninvasive diagnostic test to confirm the diagnosis. However,
seroepidemiologic studies suggest that the majority of cases of Coxsackie B virus infection are subclinical and
have a benign course [31].In hospital or clinic based referral populations, the natural history of myocarditis
varies with the underlying cause and the presenting symptoms . In the majority of patients who develop
inflammation as evidenced by electrocardiographic (ECG) changes, the inflammatory process is apparently selflimited without short-term, overt sequelae. More severe ECG changes such as bundle branch block, high degree
AV block, and Q waves are associated with worse long term clinical outcomes. A minority of initially
asymptomatic patients, however, develop HF, serious arrhythmias, disturbances of conduction, or even
circulatory collapse [32]. Rarely, postviral myocarditis may be fatal due to myocardial failure or sudden,
unexpected death.
In contrast, most patients with symptomatic post-viral or lymphocytic myocarditis present with HF and
dilated cardiomyopathy (DCM). However, subtle signs and symptoms of cardiac involvement may be
overshadowed by systemic manifestations of the viral infection. As an example, in the US Myocarditis
Treatment Trial, 89 percent of subjects reported a syndrome consistent with a viral prodrome [33]. Although
only a small fraction of patients with lymphocytic myocarditis present with ventricular arrhythmias, the
percentage of patients with idiopathic ventricular tachycardia [34] who have myocarditis may be as high as 33
percent. Myocarditis may also cause some cases of atrial fibrillation[35]
X.
CONCLUSION
The diagnosis of myocarditis arises from the integration of clinical information,
immunohistochemical analysis, laboratory data and imaging findings
Today, CMR is the main technique for identifying tissue damage secondary to myocarditis, and
concomitantly may allow the exclusion of myocardial damage secondary to MI.
Further studies are needed in order to correlate the histological and imaging information with the
various treatment options.
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