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PRESENTED BY
R.PRIYA
INTRODUCTION
Myocarditis is the third most common cause of death among young adults with a
cumulative incidence rate globally of 1.5 cases per 100,000 persons
annually. Myocarditis accounts for approximately 20% of sudden cardiac death in
a variety of populations. Populations that experience this increased mortality rate
include: adults under 40, young athletes, U.S. Air Force recruits, and elite
Swedish orienteers. The prevalence rate of myocarditis is about 22 cases per
100,000 persons annually. With individuals who develop myocarditis, the first
year is difficult as a collection of cases have shown there is a 20% mortality rate.
DEFINITION
Myocarditis is inflammation of the heart muscle (myocardium)
TYPES
There are many different types of myocarditis and a wide range of possible
agents that can trigger the disease. Examples include:
•Viral: Coxsackie B virus, enterovirus, adenovirus, inflenza, and many others
•Bacterial: Streptococci, meningococci, clostridia, Corynebacterium,
mycobacteria, and many others
•Fungal and parasites: Candida, aspergillosis cryptococcus, schistosomes,
filaria, malaria, toxoplasma, and many others
•Lymphocytic: Heart muscle infiltrated with lymphocytes
•Eosinophilic: Heart muscle infiltrated with eosinophils
•Autoimmune: Caused by autoimmune diseases, such as lupus
•Fulminant: Inflammatory process in the heart muscle that leads to acute severe
heart failure
•Idiopathic: Inflammatory process in the heart muscle with no known cause
•Acute: Symptoms appear rapidly and usually decrease after a week or two
•Chronic: Slow appearance of symptoms that last greater than two weeks
CAUSES
•Cytotoxic effects of infecting agents like virusesCytomegalovirus, Epstein-Barr virus , Herpes,
HIV
• bacteria sstreptococcal (strep) bacteria Staphylococcal (staph) bacteria
•fungi,Treponema, Borrelia, and/or parasites
•Immune response triggered by infecting agents and cytokines produced in the
myocardium in response to infection or inflammation
•Chemicals released during myocardial cell death
•Autoimmune responses can also trigger myocardial inflammation
•Some medications and/or toxins such as clozapine, radiation therapy, arsenic, carbon
monoxide, and many others
•Certain diseases like lupus, Wegener's granulomatosis, and others
About half of the time, the triggering agent for myocardial inflammation is not known
(idiopathic). This is especially true in pediatric population where the majority of patients are
diagnosed with idiopathic myocarditis.
•AlcoholSnakebites
•Chemotherapy and radiation therapy
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
•Shortness of breath
•Abnormal heartbeat, which causes fainting in rare cases
•Light-headedness
•A sharp or stabbing chest pain or pressure, which may spread to neck and shoulders
•Fatigue
•Signs of infection, such as
• Fever
• Muscle aches
• Sore throat
• Headache
• Diarrhea
•Painful joints
•Swollen joints, legs, or neck veins
•Small amounts of urine
If have symptoms like these, doctor will check for an abnormal or rapid heartbeat, fluid in lungs, or leg swelling.
DIAGNOSTIC EVALUATION
History collection
Physical examination
Lab investigation
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.
DIAGNOSTIC EVALUATION
•Electrocardiogram (ECG). This noninvasive test s how heart's electrical patterns and can
detect abnormal rhythms. myocarditis are diffuse T wave inversions; saddle-shaped ST-
segment elevations may be present (these are also seen in pericarditis).
•Chest X-ray. An X-ray image shows the size and shape of heart, as well as whether have fluid
in or around the heart that might indicate heart failure.
•MRI. Cardiac MRI will show heart's size, shape and structure. This test can show signs of
inflammation of the heart muscle.
•Echocardiogram. Sound waves create moving images of the beating heart. An echocardiogram
might detect enlargement of heart, poor pumping function, valve problems, a clot within the heart
or fluid around heart.
•Blood tests. These measure white and red blood cell counts, as well as levels of certain
enzymes that indicate damage to heart muscle. Blood tests can also detect antibodies against
viruses and other organisms that might indicate a myocarditis-related infection.
•Cardiac catheterization and endomyocardial biopsy. A small tube (catheter) is inserted into a
vein in r leg or neck and threaded into heart. In some cases, doctors use a special instrument to
remove a tiny sample of heart muscle tissue (biopsy) for analysis in the lab to check for
inflammation or infection.
,
MANAGEMENT
•Angiotensin-converting enzyme (ACE) inhibitors. These medications,
such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil)
and ramipril (Altace), relax the blood vessels in heart and help blood flow
more easily.
•Angiotensin II receptor blockers (ARBs). These medications, such as
losartan (Cozaar) and valsartan (Diovan), relax the blood vessels in heart
and help blood flow more easily.
•Beta blockers. Beta blockers, such as metoprolol (Lopressor, Toprol-XL),
bisoprolol and carvedilol (Coreg), work in multiple ways to treat heart
failure and help control arrhythmias.
•Diuretics. These medications, such as furosemide (Lasix), relieve sodium
and fluid retention.
PROCEDURE FOR MYOCARDITIS
•Ventricular assist devices. Ventricular assist devices (VADs) are mechanical
pumps that help pump blood from the lower chambers of heart (the ventricles) to
the rest of body. VADs are used in people who have weakened hearts or heart
failure. This treatment may be used to allow the heart to recover or while waiting for
other treatments, such as a heart transplant.
•Intra-aortic balloon pump. Doctors insert a thin tube (catheter) in a blood vessel
in leg and guide it to heart using X-ray imaging. Doctors place a balloon attached
to the end of the catheter in the main artery leading out to the body from the heart
(aorta). As the balloon inflates and deflates, it helps to increase blood flow and
decrease the workload on the heart.
•Extracorporeal membrane oxygenation (ECMO). With severe heart failure, this
device can provide oxygen to the body. When blood is removed from the body, it
passes through a special membrane in the ECMO machine that removes carbon
dioxide and adds oxygen to the blood. The newly oxygenated blood is then returned
to the body.
BEFORE TRANSPLANTATION TO CHECK THE
DONORS HEART BY THE FOLLOWING
Once decide on a center, 'll need to have an evaluation to see if 're eligible
for a transplant. The evaluation will check to see if :
•Have a heart condition that would benefit from transplantation
•Might benefit from other, less aggressive treatment options
•Are healthy enough to undergo surgery and post-transplant treatments
•Will agree to quit smoking, if smoke
•Are willing and able to follow the medical program outlined by the
transplant team
•Can emotionally handle the wait for a donor heart
•Have a supportive network of family and friends to help during this
stressful time
HEART TRANSPLANTATION PROCEDURE
Heart transplant surgery is an open-heart procedure that takes several hours. If
've had previous heart surgeries, the surgery is more complicated and will take
longer.
'll receive medication that causes to sleep (general anesthetic) before the
procedure. surgeons will connect to a heart-lung bypass machine to keep
oxygen-rich blood flowing throughout body.
surgeon will make an incision in chest. surgeon will separate chest bone and
open rib cage so that he or she can operate on heart.
surgeon then removes the diseased heart and sews the donor heart into place.
He or she then attaches the major blood vessels to the donor heart. The new
heart often starts beating when blood flow is restored. Sometimes an electric
shock is needed to make the donor heart beat properly.
'll be given medication to help with pain control after the surgery. 'll also have a
ventilator to help breathe and tubes in chest to drain fluids from around lungs
and heart. After surgery, 'll also receive fluids and medications through
intravenous (IV) tubes.
AFTER TRANSPLANTATION MEDICATION TO BE TAKEN
need to make several long-term adjustments after have had
heart transplant. These include:
•Taking immunosuppressants. These medications decrease the
activity of immune system to prevent it from attacking donated
heart. 'll take some of these medications for the rest of life.
•Because immunosuppressants render body more vulnerable to
infection, doctor might also prescribe antibacterial, antiviral and
antifungal medications. Some drugs could worsen — or raise risk
of developing — conditions such as high blood pressure, high
cholesterol, cancer or diabetes.
AFTER HEART TRANSPLANTATION DIET AND EXERCISE
Dietitian's recommendations may include:
•Eating plenty of fruits and vegetables each day
•Eating whole-grain breads, cereals and other grains
•Drinking low-fat or fat-free milk or eating other low-fat or fat-free dairy products, to help
maintain enough calcium in body
•Eating lean meats, such as fish or poultry
•Maintaining a low-salt diet
•Avoiding unhealthy fats, such as saturated fats or trans fats
•Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppressant
medications (calcineurin inhibitors)
•Avoiding excessive alcohol
•Staying hydrated by drinking adequate water and other fluids each day
•Following food safety guidelines to reduce the risk of infection
•exercise program may include warm-up exercises such as stretching or slow
walking. treatment team may suggest physical activities such as walking,
bicycling and strength training as part of r exercise program. Specialists in the
treatment team will likely recommend cool down after exercise, perhaps by
walking slowly. Discuss with treatment team what activities may be appropriate
for .

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Myocarditis

  • 2. INTRODUCTION Myocarditis is the third most common cause of death among young adults with a cumulative incidence rate globally of 1.5 cases per 100,000 persons annually. Myocarditis accounts for approximately 20% of sudden cardiac death in a variety of populations. Populations that experience this increased mortality rate include: adults under 40, young athletes, U.S. Air Force recruits, and elite Swedish orienteers. The prevalence rate of myocarditis is about 22 cases per 100,000 persons annually. With individuals who develop myocarditis, the first year is difficult as a collection of cases have shown there is a 20% mortality rate.
  • 3. DEFINITION Myocarditis is inflammation of the heart muscle (myocardium)
  • 4. TYPES There are many different types of myocarditis and a wide range of possible agents that can trigger the disease. Examples include: •Viral: Coxsackie B virus, enterovirus, adenovirus, inflenza, and many others •Bacterial: Streptococci, meningococci, clostridia, Corynebacterium, mycobacteria, and many others •Fungal and parasites: Candida, aspergillosis cryptococcus, schistosomes, filaria, malaria, toxoplasma, and many others •Lymphocytic: Heart muscle infiltrated with lymphocytes •Eosinophilic: Heart muscle infiltrated with eosinophils •Autoimmune: Caused by autoimmune diseases, such as lupus •Fulminant: Inflammatory process in the heart muscle that leads to acute severe heart failure •Idiopathic: Inflammatory process in the heart muscle with no known cause •Acute: Symptoms appear rapidly and usually decrease after a week or two •Chronic: Slow appearance of symptoms that last greater than two weeks
  • 5. CAUSES •Cytotoxic effects of infecting agents like virusesCytomegalovirus, Epstein-Barr virus , Herpes, HIV • bacteria sstreptococcal (strep) bacteria Staphylococcal (staph) bacteria •fungi,Treponema, Borrelia, and/or parasites •Immune response triggered by infecting agents and cytokines produced in the myocardium in response to infection or inflammation •Chemicals released during myocardial cell death •Autoimmune responses can also trigger myocardial inflammation •Some medications and/or toxins such as clozapine, radiation therapy, arsenic, carbon monoxide, and many others •Certain diseases like lupus, Wegener's granulomatosis, and others About half of the time, the triggering agent for myocardial inflammation is not known (idiopathic). This is especially true in pediatric population where the majority of patients are diagnosed with idiopathic myocarditis. •AlcoholSnakebites •Chemotherapy and radiation therapy
  • 7. SIGNS AND SYMPTOMS •Shortness of breath •Abnormal heartbeat, which causes fainting in rare cases •Light-headedness •A sharp or stabbing chest pain or pressure, which may spread to neck and shoulders •Fatigue •Signs of infection, such as • Fever • Muscle aches • Sore throat • Headache • Diarrhea •Painful joints •Swollen joints, legs, or neck veins •Small amounts of urine If have symptoms like these, doctor will check for an abnormal or rapid heartbeat, fluid in lungs, or leg swelling.
  • 8. DIAGNOSTIC EVALUATION History collection Physical examination Lab investigation 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.
  • 9. DIAGNOSTIC EVALUATION •Electrocardiogram (ECG). This noninvasive test s how heart's electrical patterns and can detect abnormal rhythms. myocarditis are diffuse T wave inversions; saddle-shaped ST- segment elevations may be present (these are also seen in pericarditis). •Chest X-ray. An X-ray image shows the size and shape of heart, as well as whether have fluid in or around the heart that might indicate heart failure. •MRI. Cardiac MRI will show heart's size, shape and structure. This test can show signs of inflammation of the heart muscle. •Echocardiogram. Sound waves create moving images of the beating heart. An echocardiogram might detect enlargement of heart, poor pumping function, valve problems, a clot within the heart or fluid around heart. •Blood tests. These measure white and red blood cell counts, as well as levels of certain enzymes that indicate damage to heart muscle. Blood tests can also detect antibodies against viruses and other organisms that might indicate a myocarditis-related infection. •Cardiac catheterization and endomyocardial biopsy. A small tube (catheter) is inserted into a vein in r leg or neck and threaded into heart. In some cases, doctors use a special instrument to remove a tiny sample of heart muscle tissue (biopsy) for analysis in the lab to check for inflammation or infection. ,
  • 10. MANAGEMENT •Angiotensin-converting enzyme (ACE) inhibitors. These medications, such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil) and ramipril (Altace), relax the blood vessels in heart and help blood flow more easily. •Angiotensin II receptor blockers (ARBs). These medications, such as losartan (Cozaar) and valsartan (Diovan), relax the blood vessels in heart and help blood flow more easily. •Beta blockers. Beta blockers, such as metoprolol (Lopressor, Toprol-XL), bisoprolol and carvedilol (Coreg), work in multiple ways to treat heart failure and help control arrhythmias. •Diuretics. These medications, such as furosemide (Lasix), relieve sodium and fluid retention.
  • 11. PROCEDURE FOR MYOCARDITIS •Ventricular assist devices. Ventricular assist devices (VADs) are mechanical pumps that help pump blood from the lower chambers of heart (the ventricles) to the rest of body. VADs are used in people who have weakened hearts or heart failure. This treatment may be used to allow the heart to recover or while waiting for other treatments, such as a heart transplant. •Intra-aortic balloon pump. Doctors insert a thin tube (catheter) in a blood vessel in leg and guide it to heart using X-ray imaging. Doctors place a balloon attached to the end of the catheter in the main artery leading out to the body from the heart (aorta). As the balloon inflates and deflates, it helps to increase blood flow and decrease the workload on the heart. •Extracorporeal membrane oxygenation (ECMO). With severe heart failure, this device can provide oxygen to the body. When blood is removed from the body, it passes through a special membrane in the ECMO machine that removes carbon dioxide and adds oxygen to the blood. The newly oxygenated blood is then returned to the body.
  • 12. BEFORE TRANSPLANTATION TO CHECK THE DONORS HEART BY THE FOLLOWING Once decide on a center, 'll need to have an evaluation to see if 're eligible for a transplant. The evaluation will check to see if : •Have a heart condition that would benefit from transplantation •Might benefit from other, less aggressive treatment options •Are healthy enough to undergo surgery and post-transplant treatments •Will agree to quit smoking, if smoke •Are willing and able to follow the medical program outlined by the transplant team •Can emotionally handle the wait for a donor heart •Have a supportive network of family and friends to help during this stressful time
  • 13. HEART TRANSPLANTATION PROCEDURE Heart transplant surgery is an open-heart procedure that takes several hours. If 've had previous heart surgeries, the surgery is more complicated and will take longer. 'll receive medication that causes to sleep (general anesthetic) before the procedure. surgeons will connect to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout body. surgeon will make an incision in chest. surgeon will separate chest bone and open rib cage so that he or she can operate on heart. surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly. 'll be given medication to help with pain control after the surgery. 'll also have a ventilator to help breathe and tubes in chest to drain fluids from around lungs and heart. After surgery, 'll also receive fluids and medications through intravenous (IV) tubes.
  • 14. AFTER TRANSPLANTATION MEDICATION TO BE TAKEN need to make several long-term adjustments after have had heart transplant. These include: •Taking immunosuppressants. These medications decrease the activity of immune system to prevent it from attacking donated heart. 'll take some of these medications for the rest of life. •Because immunosuppressants render body more vulnerable to infection, doctor might also prescribe antibacterial, antiviral and antifungal medications. Some drugs could worsen — or raise risk of developing — conditions such as high blood pressure, high cholesterol, cancer or diabetes.
  • 15. AFTER HEART TRANSPLANTATION DIET AND EXERCISE Dietitian's recommendations may include: •Eating plenty of fruits and vegetables each day •Eating whole-grain breads, cereals and other grains •Drinking low-fat or fat-free milk or eating other low-fat or fat-free dairy products, to help maintain enough calcium in body •Eating lean meats, such as fish or poultry •Maintaining a low-salt diet •Avoiding unhealthy fats, such as saturated fats or trans fats •Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppressant medications (calcineurin inhibitors) •Avoiding excessive alcohol •Staying hydrated by drinking adequate water and other fluids each day •Following food safety guidelines to reduce the risk of infection •exercise program may include warm-up exercises such as stretching or slow walking. treatment team may suggest physical activities such as walking, bicycling and strength training as part of r exercise program. Specialists in the treatment team will likely recommend cool down after exercise, perhaps by walking slowly. Discuss with treatment team what activities may be appropriate for .