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Pericardium
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Recently, checkpoint inhibitors, such as ipilimumab and nivolumab, have emerged as an increasingly recognized cause of cardiac toxicity, including myocarditis and pericarditis. The two most prominent classes are monoclonal antibodies to cytotoxic-T-lymphocyte-associated antigen 4 (CTLA-4), and programmed cell death 1 (PD-1) and its ligand PD-L1, which have had numerous progressive applications in the field of oncology, and are expected to be implicated in more cases as their clinical use increases. Myopericarditis is a condition where there is inflammation involving both the pericardium and the myocardium. Myopericarditis can occur acutely after anthracycline administration. High-dose cyclophosphamide can cause acute cardiotoxicity manifesting as haemorrhagic myopericarditis. Death has also been reported in this context associated with pericardial effusions and tamponade. Pre-existing cardiac dysfunction, older age, use of other chemotherapeutic agents and type of cancer (e.g. lymphoma) are all risk factors. Renal impairment can increase the risk of cyclophosphamide-related acute myopericarditis. Acute myopericarditis has also been reported in the setting of ATRA (all trans retinoic acid) use for the treatment of acute promyelocytic leukaemia.
Other viral infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The typical presenting symptoms of maternal enteroviral infection are those of an upper respiratory tract infection such as fever of a few days of duration with or without rash. The patient may have abdominal pain of such intensity that it may be mistaken for abruptio placentae or chorioamnionitis in the pregnant patient. Rarely, the patient presents with aseptic meningitis or myopericarditis. A presumptive diagnosis can be made by demonstrating virus-specific IgM antibodies or by documenting rising IgG titers in maternal serum. Definitive diagnosis requires culturing of the virus from either respiratory secretions or stool.
Acute coronary syndrome with haemodynamic instability
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Davinder Singh Chadha, Keshavamurthy Ganapathy Bhat
Cardiovascular diseases in which the primary problem is not acute MI are: Stress-induced cardiomyopathy (Takotsubo cardiomyopathy) with characteristic finding of apical ballooning as seen on left ventriculography accompanied with ST-elevation on ECG and may present with CS in 20% patients [23].Hypertrophic cardiomyopathy or acute myopericarditis. These may present with any combination of chest pain, ST or T wave changes on ECG and hypotension.Pulmonary embolism.Acute MI due to ascending aortic dissection. Shock in this setting can result from the infarction caused by occlusion of one or more coronary arteries, acute aortic insufficiency and/or cardiac tamponade.
Stemi mimicking post COVID: a case of focal myopericarditis post COVID infection
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Muhammad Atif Masood Noori, Abanoub Rushdy, Hardik Fichadiya, Sherif Roman, Islam Younes, Peter D. Lenchur, Peter M. Lenchur, Fayaz Shamoon
Given cardiac catheterization showed no significant coronary artery disease, the patient was admitted with a presumed diagnosis of myopericarditis. He was started on aspirin (81 mg once daily), Clopidogrel (75 mg once daily) and colchicine (0.6 mg twice daily). The next day, his troponins started trending down, but ST-elevation persisted in inferior and lateral leads. A transthoracic echocardiogram (TTE) demonstrated left ventricular ejection fraction (LVEF) of 40–45%, mildly decreased globular left ventricular systolic function and moderate to severe hypokinesis involving inferior, inferoposterior wall without thinning of myocardium (Video 1 & 2). Enalapril (2.5 mg once daily) and carvedilol (3.125 mg twice daily) were added to the treatment regimen.
Cardiac magnetic resonance imaging findings in COVID-19 vaccine-related myocarditis
Published in Infectious Diseases, 2023
Rujittika Mungmunpuntipantip, Wiwanitkit Viroj
We would like to share ideas on the publication “Admission and follow-up cardiac magnetic resonance imaging findings in BNT162b2 Vaccine-Related myocarditis in adolescents [1]. The goals of Özen et al. were to describe the myocardial damage brought on by BNT162b2 immunisation, to increase awareness of vaccine-related side effects, and to identify the patterns and extent of cardiac magnetic resonance imaging (MRI) findings [1]. Nine patients with vaccine-associated myopericarditis were tracked by Özen et al. [1]. To establish the clinical significance of persistent cardiac MRI anomalies, Özen et al. came to the conclusion that bigger multicenter investigations and more extensive follow-up evaluation are required [1].
Admission and follow-up cardiac magnetic resonance imaging findings in BNT162b2 Vaccine-Related myocarditis in adolescents
Published in Infectious Diseases, 2023
Seval Özen, Ayşe Esin Kibar Gül, Belgin Gülhan, Nilgün Işıksalan Özbülbül, Saliha Kanık Yüksek, Harun Terin, Özlem Mustafaoğlu, Pınar Bayraktar, İbrahim Ece, İbrahim İlker Çetin, Fatih Üçkardeş, Gülsüm İclal Bayhan, Aslınur Özkaya Parlakay
Developing and administering vaccines is highly important for a solution to the COVID-19 pandemic and a return to the normal. Although the safety of vaccines in general have been proven, comprehensive research on potential adverse effects is going on. In this study, we report 9 myopericarditis cases developing in adolescent male patients after different doses of the BNT162b2 vaccine. Myocarditis has various causes, including infectious and autoimmune aetiologies. The most prevalent causes of viral myocarditis in children are enterovirus, adenovirus, Parvovirus B19, EBV, CMV and HHV-6 infections [16]. Most myocarditis cases are idiopathic, and despite substantial research, an exact cause cannot be typically identified [17]. As an adverse effect, myopericarditis has been researched for years as it is included in several case reports in both adults and children following the administration of various vaccines. Albeit rarely, previously developed vaccines have also been associated with myocarditis. In history, it was reported that smallpox vaccines were associated with a significant number of myopericarditis cases both the first dose and repeated doses [18]. Following the administration of mRNA COVID-19 vaccines, patients usually present typically with chest pain, palpitations and high troponin levels within the first week after their second dose. They are mostly hemodynamically stable, and their symptoms and cardiac biomarkers return to normal in a few days [19]. All our patients had chest pain. The elevations in their CRP and cardiac biomarker values were typical. Their median time of presenting to the hospital was 3 days. They were discharged after being monitored for a median time of 7 days without requiring intensive care.