CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Cardiomyopathy, or heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body. The disease can also cause abnormal heart rhythms.
Cor pulmonale is alteration in the structure and function of the right ventricle (RV) of the heart. The overall five-year survival rate for cor pulmonale complicating COPD is approximately 50%.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Cardiomyopathy, or heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body. The disease can also cause abnormal heart rhythms.
Cor pulmonale is alteration in the structure and function of the right ventricle (RV) of the heart. The overall five-year survival rate for cor pulmonale complicating COPD is approximately 50%.
Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
4. WHO DEFINITION
An inflammatory myocardial disease diagnosed by a combination
of histologic, immunologic, and immunohistochemical criteria
Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of
Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93(5):841–842
4
5. CLINICAL PRESENTATION+ PHYSICAL
EXAMINATION
HF symptoms of short duration—> Days to weeks
H/o recent viral prodrome with fever: RTI/ GIT
RTI: 80%
Vitals: Tachycardia/ Tachypnea/ Hypotention/ Hypoperfusion
Lethargy/ Hepatomegaly/ Pallor/ Orthopnea
Kids: Non specific symptoms+ variable presentation
1. Freedman SB, Haladyn JK, Floh A, Kirsh JA, Taylor G, Thull-Freedman J. Pediatric myocarditis: emergency department clinical
findings and diagnostic evaluation. Pediatrics. 2007;120(6):1278–1285
2. Kim HJ, Yoo GH, Kil HR. Clinical outcome of acute myocarditis in children according to treatment modalities. Korean J Pediatr.
2010;53(7):745–752
3. English RF, Janosky JE, Ettedgui JA, Webber SA. Outcomes for children with acute myocarditis. Cardiol Young. 2004;14(5):488–493
5
6. LAB EVALUATION
Non specific:
Raised WBCs/ Inflammatory markers/ Liver enzymes
Trop T+I:
Elevated as a marker of cardiac damage
Absence of increased value: Doesn’t rule out
Used as a differentiating tool b/w cardiac + non cardiac
causes of paediatric chest pain
6
8. NATRIURETIC PEPTIDES
High BNP: Helps in differentiation b/w HF + pul disease in kids
with RD
NT- Pro BNP:
Increased in both myocarditis+ idiopathic DCM
Levels higher in myocarditis at presentation, trends down
over time compared to DCM
Adults: Higher levels predictive of cardiac death/ transplant
Antibodies to cardiac proteins (myocin+ beta adr receptors):
Increased in adults
Kids: Unkown/ Experimental
8
9. OTHER LAB INVESTIGATIONS…
EMB tissue: Gold standard
Cell culture/ PCR: Serum/ respi aspirate/ urine/ stool
Peripheral viral PCR: Co-relation with causative agents from
EMB—> Not established—> Evaluation complicated by
relatively high prevalence of commonly associated viruses in
general population
Mahfoud F, Gartner B, Kindermann M, et al. Virus serology in patients with suspected myocarditis: utility or futility? Eur Heart J.
2011;32(7):897–903
9
10. ECG
Abnormal in majority—> So—> DO IT ALWAYS
Sinus tachycardia/ A+V Tachyarrhythmias
Low voltage complexes
Non- specific ST segment+ T wave abnormalities
Conduction delays/ Blocks (1/2/3rd D HB)—> May require
pacemakers in refractory cases
Mimics ACS: Adolescents+ young adults
10
13. ECHO
Ventricular function+ dilatation—> Prognostic value
PE/ Intracavitary thrombi
Wall thickness/ wall motion abnormalities
Distinction of fulminant/acute (non fulminant myocarditis)/ DCM:
Acute myocarditis: Normal wall thickness, May have LV
dilatation
FM: Markedly dec systolic function, Ventricular
dysfunction: Global/ regional, normal chamber size, may
have inc IVS thickness due to myocardial edema
DCM: Markedly abnormal ventricular dilatation+
dysfunction
13
14. ECHO CONT…
Severity of ventricular dysfunction—> Increased mortality+ requirement
of heart transplantation
Korean review:
72%: Dec EF
64%: Segmental wall abnormality
EF< 15%—> More persistent severe cardiac failure
RV dysfunction: Independent predictor of adverse outcome
Diastolic dysfunction even in presence of normal systolic function
Kim HJ, Yoo GH, Kil HR. Clinical outcome of acute myocarditis in children according to treatment modalities. Korean J Pediatr. 2010;53(7):745–
752
Mendes LA, Dec GW, Picard MH, Palacios IF, Newell J, Davidoff R. Right ventricular dysfunction: an independent predictor of adverse outcome in
patients with myocarditis. Am Heart J. 1994;128(2):301–307
Khoo NS, Smallhorn JF, Atallah J, Kaneko S, Mackie AS, Paterson I. Altered left ventricular tissue velocities, deformation and twist in children and
young adults with acute myocarditis and normal ejection fraction. J Am Soc Echocardiog. 2012;25(3):294–303.
14
18. CMR CONT…
Use in differentiation b/w myocarditis vs MI due to CAD:
Myocarditis LGE enhancement: Subepicardial/ transmural/
pathcy
MI LGE enhancement: Subendocardial/ transmural/
distribution in coronary perfusion territory
Repeat CMR b/w 1-2 weeks after disease onset: If non
diagnostic CMR changes early ds course, but high clinical
suspicion
Extent of LGE decreases over time—> Scar contraction
18
20. EMB: IS IT REALLY GOLD STANDARD??
Limitations:
Patchy tissue involvement
Preferential LV involvement
Difference in inter observer expert interpretation of
histopath samples
Apparent lack of correlation b/w outcomes/ response to
therapy
Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation. 2006;113(4):593–595
Shanes JG, Ghali J, Billingham ME, et al. Interobserver variability in the pathologic interpretation of endomyocardial
biopsy results. Circulation. 1987;75(2):401–405.
20
21. AHA/ ACC/ESC 2007 GUIDELINES
No recommendation for routine EMB for suspected myocarditis
Specific scenarios in which EMB is indicated—> Suspicion of
GCM:
1. New onset HF< 2 weeks duration+ Normal sized/ dilated
LV+ Heamodynamic compromise
2. New onset HF > 2weeks duration+ Dilated LV+
Ventricular arrhythmias/ HB+ Failure to respond to usual
care in 1-2 wks
Cooper LT, Baughman KL, Feldman AM, et al. The role of endomyocardial biopsy in the management of
cardiovascular disease: a scientific statement from the American Heart Association, the American College of
Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart
Failure Association of the European Society of Cardiology. Eur Heart J. 2007;28(24):3076–3093
21
22. 3 TIER CLASSIFICATION: SAGAR ET AL.
MAYO CLINIC… (LANCET- 2012)
Possible subclinical acute myocarditis:
No symptoms+ Elevated biomarkers/ Abnormal ECG of CV
injury/ Abnormal cardiac function by ECHO or CMR
Probable acute myocarditis:
Symptoms+ Any 1/4 of above
Definitive myocarditis:
Histological/ Immunohistological evidence by EMB
Sagar S, Liu PP, Cooper LT Jr. Myocarditis. Lancet. 2012;379(9817):738–747
22
25. ACTIVITY RESTRICTIONS
2005 Bethesda guidelines: Pt should be restricted from all
competitive sports for 6 months after diagnosis
Athletes to return after normalisation of LV function+ size,
absence of arrhythmias on Holter+ exercise testing,
normalization of biomarkers, normalisation of all but relatively
minor ECG changes
Recommendations based on myocarditis found in athletes with
sudden death
Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and other cardiomyopathies,
mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol. 2005;45(8):1340–1345
Harmon KG, Drezner JA, Maleszewski JJ, et al. Pathogeneses of sudden cardiac death in national collegiate athletic association
athletes. Circ Arrhythm Electrophysiol. 2014;7(2):198–204
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths
in the United States, 1980–2006. Circulation. 2009;119(8):1085–1092.
25
26. MEDICAL MANAGEMENT
Main treatment: Supportive+ symptomatic care
80% pts: Require ICU admission
Diuretics/ ACEI/ ARBs/ B- Blockers
ACEI/ ARBs: Decreased myocardial fibrosis, inflammation,
autoantibody production
Adult study: Lack of B-Blocker therapy—> Greater risk of death/
transplantation
Carvidelol: Anti- inflammatory+ antiviral effects (Murine)
Metoprolol: Less robust response
Kindermann I, Kindermann M, Kandolf R, et al. Predictors of outcome in patients with suspected myocarditis. Circulation.
2008;118(6):639–648
26
27. MEDICAL MANAGEMENT CONT…
CCBs: Decrease in inflammatory cytokines+ increased survival
(Murine)—> Effects on production of NO
IMAC-2 Trial: Adults/ 373 pts/ 12 centers/ 2014:
> 90% patients received ACEI/ ARBs+ B-Blockers—>
94%: Transplant free survival, 88%: HF hospitalization free
survival on 1 year follow up
Similar data in kids—> Limited
27
28. RHYTHM ISSUES
Digoxin: Not recommended: Evidence of worsening viral
myocarditisibn murine models—> Increased mortality+
cytokines
Matsumori A, Igata H, Ono K, et al. High doses of digitalis increase the myocardial production of proinflammatory cytokines and
worsen myocardial injury in viral myocarditis: a possible mechanism of digitalis toxicity. Jpn Circ J. 1999;63(12):934–940
Amiodarone: Inhibits IL6 production, better survival (Murine)
Ito H, Ono K, Nishio R, Sasayama S, Matsumori A. Amiodarone inhibits interleukin 6 production and attenuates myocardial injury
induced by viral myocarditis in mice. Cytokine. 2002;17(4):197–202
40 kids with CHB:
27%—> PPI for prolonged HB
67%—> Resolution (Av: 3.3 days)
Batra AS, Epstein D, Silka MJ. The clinical course of acquired complete heart block in children with acute myocarditis. Pediatr
Cardiol. 2003;24(5):495–497
28
29. ANTI VIRAL THERAPY
Ribavarin+ IFN- alpha:
Suppresses coxsackie virusin infected cultured human
myocardial cells/ Entero virus: Improvement in function and
viral clearance
IFN- beta:
Entero/ adenovirus—> Elimination of virus+ improvement in
LV systolic function at 6 Mts follow up
Pleconaril:
Prevents binding of coxsackie virus to cell receptor CAR
Ganciclovir+ Cidofovir:
CMV infected—> Reduction in myocarditis
29
30. IMMUNO MODULATORS & SUPPRESSORS
Both inflammatory+ AI mediated cellular damage
IVIG:
Anti inflammatory+ immunomodulatory effects
2g/ kg IV
Significantly improved functions+ dimensions+ survival
Steroids,Usually in combination with cyclosporin/ azathioprine:
Improvement in inflammation on EMB follow up
Some also had recurrence of symptoms after
discontinuation of therapy
30
31. IMMUNOADSORPTION
Antibody production+ antibody mediated cell signaling—>
Participate in myocardial damage
Role of immunoadsorption for antibody removal—> Increased
LV EF+NCI on follow up
IgG3: Role in complement activation—> Reduction
Staudt A, Bohm M, Knebel F, et al. Potential role of autoantibodies belonging to the immunoglobulin G-3 subclass in cardiac
dysfunction among patients with dilated cardiomyopathy. Circulation. 2002;106(19):2448–2453.
31
32. GCM+ EOSINOPHILIC MYOCARDITIS
Use of immunosuppressant therapy well established
EM: Reduced exposure to inciting exposure/ toxin+ steroids
GCM: Steroids+ cyclosporin/ azathioprine—> Av transplant free
survival of 12.3 months compared to only 3 months in untreated
patients
32
33. MECHANICAL CIRCULATORY SUPPORT
For refractory heart failure, bridge to recovery/ heart transplant
ECMO/ VAD
Significant morbidity:
Major bleeding: 42-50%
Infection: 50-63%
Stroke: 29%
Fraser CD Jr, Jaquiss RD, Rosenthal DN, et al. Prospective trial of a pediatric ventricular assist device. N Engl J Med.
2012;367(6):532–541
33
34. SURVIVAL+ HEART TRANSPLANTATION
Overall transplant free survival: 88%
Transplantation: 4.1%-18%
Myocarditis patients have worse post transplant survival
compared to other DCMs—> 2.7 x Increased mortality risk
Cause of death: Rejection
Cause: Persistence of infectious and/ or immune mechanisms
34
35. TAKE HOME MESSAGE
Despite controversies in use of immunosuppression+ anti viral
therapy—> Primary therapy remains supportive care
Long term outcomes in kids still lacking
Late cardiac effects of childhood myocarditis: Still poorly
understood
35