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Myocarditis

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Myocarditis

  1. 1. MYOCARDITIS By Dr.Zulfiqar Butt
  2. 2. DEFINITION: Myocarditis is defined as: Acute or chronic inflammation of the myocardium. characterized by: 1. Inflammatory cells infiltrates in myocardium. 2. Myocyte degeneration or necrosis.
  3. 3. Etiology
  4. 4. Pathogenesis Characterized by: Myocardial inflammation,necrosis and fibrosis. Cardiomegaly and diminished systolic function occur due to myocardial damage. Typical signs of CHF occur which may progress to shock,arrythmias and sudden death.
  5. 5. Continue: Virus act on myocardium in three phases. 1) Virus Replication Or Acute Phase 2) Autoimmune Injury Phase 3) Dilated Cardiomyopathy Phase Or Chronic Phase
  6. 6. Sign And Symptoms Manifestations of myocarditis range from asymptomatic or nonspecific generalized illness to acute cardiogenic shock and sudden death. Infants and young children more often have a fulminant presentation with:  Fever.  Respiratory distress.  Tachycardia, hypotension, gallop rhythm, and cardiac murmur.  Associated findings may include a rash or evidence of end organ involvement such as hepatitis or aseptic meningitis.
  7. 7. Continue: Patients with acute or chronic myocarditis may also present with :  Palpitations, easy fatigability, or syncope.  Chest discomfort.  Cardiac findings include, gallop rhythm, and an apical systolic murmur of mitral insufficiency.  In patients with associated pericardial disease, a rub may be noted.  Hepatic enlargement, peripheral edema, and pulmonary findings such as wheezes or rales may be present in patients with decompensated congestive heart failure
  8. 8. Diagnosis 1)-ELECTROCARDIOGRAPHIC CHANGES. Nonspecific and may include sinus tachycardia, atrial or ventricular arrhythmias, heart block. 2)-CHEST X.RAY: Reveal cardiomegaly, pulmonary vascular prominence, pulmonary edema, or pleural effusions. 3)-ECHOCARDIOGRAPHY: Often shows diminished ventricular systolic function, cardiac chamber enlargement, mitral insufficiency, and occasionally, evidence of pericardial effusion.
  9. 9. Continue: 4)-Endomyocardial biopsy: May be useful in identifying inflammatory cell infiltrates or myocyte damage. 5)-OTHER SUPPORTIVE BUT NONSPECIFIC TESTS INCLUDE:  Wbc’s often elevated. ESR increased. Troponins elevated in 1/3rd cases. CK-MB may be elevated. AST may be elevated.
  10. 10. Treatment • Primary therapy for acute myocarditis is supportive • Management is done according to clinical signs and symptoms. Conventional heart failure therapy is currently the only accepted therapy for myocarditis including: 1. ACE inhibitors. 2. Angiotensin receptor blocking agents. 3. Diuretics. 4. β-blockers. 5. In patients manifesting with significant atrial or ventricular arrhythmias, specific antiarrhythmic agents (for example, amiodarone) should be given.
  11. 11. ROLE OF IMMUNOMODULATION THERAPY. Immunomodulation of patients with myocarditis is controversial. Intravenous immune globulin may have a role in the treatment of acute or fulminant myocarditis. Corticosteroids have been reported to improve cardiac function, but the data are not convincing in children. Relapse has been noted in patients receiving immunosuppression. There are no studies to recommend specific antiviral therapies for myocarditis.
  12. 12. Prognosis The prognosis of symptomatic myocarditis:  in newborns is poor and 75% mortality has been reported.  The prognosis is better for children and adolescents.  Recovery of ventricular function has been reported in 10-50% of patients.
  13. 13. THANK YOU

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