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Myocarditis
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
George Lazaros, Emilia Lazarou, Dimitris Tousoulis
The most common symptoms of acute myocarditis include chest pain and dyspnea of variable intensity.2 Symptoms usually appear within one to four weeks after a respiratory or gastrointestinal tract viral infection.5 Physical examination usually yields non-specific findings and does not offer any specific clues. According to a position statement of the pertinent working group of the European Society of Cardiology (ESC), there are five possible scenarios in patients with biopsy-proven myocarditis (Table 34.2).2
SARS-CoV-2 and COVID-19
Published in Patricia G. Melloy, Viruses and Society, 2023
Cardiovascular complications have been associated with COVID-19. These patients may have a range of symptoms including myocarditis (inflammation of the muscle of the heart), shortness of breath, chest pain, irregular heartbeat, or even a sudden heart attack. It is not known why the cardiovascular system specifically would be affected, but it may be due to viral infection of cardiac cells or a side effect of cytokine storm. Physicians have noted that COVID-19 may make the diagnosis of other disease conditions difficult because it may “mask” these other conditions (Giyanani et al. 2021; Wright 2021).
Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The treatment of myocarditis includes: Bed restTreatment of HF with diuretics and vasodilatorsTreatment of arrhythmias (AF with digoxin, ventricular tachyarrhythmias with amiodarone)Role for beta blockers, ACE inhibitors (all routine in chemotherapy-induced myocarditis)Corticosteroids and other immunosuppressive drugs – not routinely but these are indicated in specific causes: giant cell myocarditis, lymphocytic myocarditis (including secondary to checkpoint inhibitors) and acute cardiac sarcoidosisAciclovir or interferon, which may help if given early in the course of viral myocarditis but not routinely in all patients
Myocarditis and autoimmunity
Published in Expert Review of Cardiovascular Therapy, 2023
Myocarditis, inflammation of the myocardium, may be acute or chronic, and persistent inflammation may progress to cardiomyopathy [1–3]. Myocarditis is often difficult to diagnose clinically because it may present with various signs and symptoms and may mimic other common heart diseases. However, early diagnosis is important since the treatment is different depending on the etiology, and an appropriate therapy can improve clinical course and prevent sequelae to dilated cardiomyopathy. Myocarditis is often caused by viral infections, but it is also associated with systemic autoimmune diseases, bacteria and other microorganisms, and drugs and other substances [1–3]. Persistent inflammation following acute myocarditis may lead to the development of dilated cardiomyopathy or cardiac dysfunction. Cytokines and immune cells that contribute to the innate immunity are involved in the inflammation of the acute stage, and the acquired immunity plays a role in the chronic stage [1–3]. Autoantibodies against various epitopes present on the heart were considered to contribute to the development of the disease [3,4].
A case of myocarditis following ChAdOx1 nCov-19 vaccination
Published in Acta Cardiologica, 2022
Olivier Van Kerkhove, Frank Renders, Mathias Leys
Myocarditis, an inflammatory disease of the myocardium, might lead to reduced cardiac function and in the most severe cases to mortality. Diagnoses of myocarditis are based on histological, immunological and immunohistochemical criteria, as defined by the WHO [1]. Typical causes are bacterial and viral infections, auto-immune diseases and severe toxins. Vaccination against coronavirus disease 2019 (COVID-19) has been suggested as a possible inducer of myocarditis. However, most cases were reported after vaccination with messenger RNA (mRNA) vaccines [2,3]. Myocarditis following viral vector vaccines seems to be a lot less common, and occurred only after administration of the Ad26COVS1 vaccine by Johnson & Johnson® (New Brunswick, NJ) [3,4]. Here, we report the first case of myocarditis following vaccination with ChAdOx1 nCov-19.
Managing Covid-19 in patients with heart failure: current status and future prospects
Published in Expert Review of Cardiovascular Therapy, 2022
Hawani Sasmaya Prameswari, Iwan Cahyo Santosa Putra, Wilson Matthew Raffaello, Michael Nathaniel, Adrian Sebastian Suhendro, Achmad Fitrah Khalid, Raymond Pranata
Multiple foci of inflammation and myocyte injury with predominant lymphocytic cells were found in some patients presenting with deterioration of the heart function [16,20–22]. Direct viral infiltration to the myocardium might be responsible for the cardiac cell damage as virus particles in the cardiomyocyte were detected [22–27]. In a study conducted by Tavazzi et al., low-grade myocardial inflammation and coronavirus particles were found from the endomyocardial biopsy of a COVID-19 patient who was experiencing clinical deterioration leading to cardiogenic shock [20]. However, these findings were not consistently found in the other study [16]. Moreover, several studies had concluded that the viral presence in the myocardium was not associated with inflammatory cell influx [16,21,28]. There has also been a report of myocarditis without proof of direct viral infiltration [29]. These findings may lead to the possibility of pro-inflammatory cytokines involvement which promotes cardiac cell necrosis during systemic inflammation [29–31]. Interestingly, acute myocarditis was found only in sporadic cases, and histologic findings mostly showed low-grade inflammation without specific myocardial changes [32]. Therefore, further studies are needed to determine the true nature of COVID-19 and myocardial damage.