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Objective:To investigate the predictive value of serum D-dimer combined with myocardial injury markers on admission for early identification of high-risk patients with acute myocarditis.Methods:Patients hospitalized for acute myocarditis in China-Japan Friendship Hospital were retrospectively enrolled from 2010 to 2021. Patients were divided into the high D-dimer level group and low D-dimer level group according to the median value of D-dimer measured by immunoturbidimetry within 24 h of admission. In-hospital adverse events were defined as death, cardiogenic shock, malignant ventricular arrhythmia and new-onset heart failure. Multivariate logistic analysis was used to explore the independent predictors of in-hospital adverse events, and receiver operating characteristic curve was used to evaluate the predictive value.Results:A total of 106 patients were analyzed, including 52 high level D-dimer patients and 54 low level D-dimer patients, with an average age of (36±16) years, and 62.3% were male. Compared with the low D-dimer level group, patients in the high D-dimer level group had lower mean systolic blood pressure [(114±21) mmHg vs. (121±14) mmHg] and diastolic blood pressure [(71±13) mmHg vs. (76±10) mmHg], higher heart rate [(97±26) beats/min vs. (79±15) beats/min], higher C-reactive protein levels [6.82 (1.61, 20.05) mg/dL vs. 1.30 (0.13, 8.93) mg/dL] and creatinine levels [86.95 (67.63, 117.83) μmol/L vs. 68.80 (60.18, 81.93) μmol/L] on admission. The proportion of patients having QRS interval >120 ms on electrocardiogram was higher in high D-dimer level group (25.0% vs. 7.4%). There was no significant difference in patients with positive myocardial injury biomarkers between the two groups. The incidence of in-hospital adverse events was higher in the high D-dimer level group (67.3% vs. 22.2%, P<0.001). Multivariate logistic analysis showed that serum D-dimer levels and elevated myocardial injury markers on admission were independently associated with in-hospital adverse events. The area under the curve (AUC) of elevated serum D-dimer level on admission for predicting in-hospital adverse events was 0.781 (95% CI: 0.690-0.873), the sensitivity was 74.5%, and the specificity was 71.2%. When combined with positive cardiac biomarkers, the AUC was 0.831 (95% CI: 0.752-0.910) with a sensitivity of 80.9% and a specificity of 78.0%. Conclusions:Elevated D-dimer level on admission can predict the risk of in-hospital adverse events in patients with acute myocarditis. The combination of cardiac injury biomarkers can improve the predictive value.
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The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients. In this study, changes in the left ventricular ejection fraction (LVEF) and global and layer-specific myocardial strains over time were monitored. We aimed to determine the echocardiographic patterns of FM and ascertain their significance in FM treatment. Twenty patients who were clinically diagnosed with FM and received mechanical life support were prospectively enrolled. Conventional echocardiographic measurements were obtained, and serial strain echocardiography was performed from admission to hospital discharge until LVEF recovery (> 50%). Global/regional peak systolic longitudinal strains (GLS/RLS) and layer-specific longitudinal strains were quantified, and their changes with time were monitored in 14 FM patients. All patients had severely impaired cardiac function. Steep improvement in LVEF and GLS were observed within 6 days. Layer-specific strain analysis showed that reduction at admission or recovery at discharge in the endocardium and epicardium strains were equal. In conclusion, FM patients who received mechanical circulatory supports exhibited steep improvement in ventricular function within 6 days. The patchy and diffused distribution pattern of reduced RLS and equally and severely impaired strain in the endocardium and epicardium are valuable features in the diagnosis of FM.
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Objective To analyze the risk factors of adverse cardiac events in adults with acute myocarditis during hospitalization and provide reference for clinical diagnosis and treatment.Methods A restrospective study was conducted in 80 patients (54 males and 26 females) with acute myocarditis over 18 years old admitted to our hospital between January 2007 and December 2016.Major adverse cardiac events (MACE) were defined as death,cardiac arrest,cardiogenic shock and ventricular fibrillation.According to whether MACE occurred during hospitalization,patients were divided into two groups:the MACE group and the non-MACE group.The differences between the two groups were compared,and the risk factors were analyzed by logistic regression.Results There were 12 patients in the MACE group and 68 patients in the non-MACE group.The age of patients in the two groups was similar.Compared with the non-MACE group,the proportion of female patient in the MACE group was higher (66.7％ vs 26.5％,P=0.015),and the systolic pressure (mmHg) was lower at admission (89.75±17.63 vs 112.49±16.35,P＜0.01),and the heart rate (beats/min) was faster (106.42±24.39 vs 82.66±20.92,P=0.001);ALT and creatinine levels in the MACE group were higher (P＜0.01),while the levels of TnI,CK-MB,CK and LDH were significantly higher (P＜0.05).The LVEF value of the MACE group was significantly lower at admission (45％ vs 60％,P=0.022),and the proportion of LVEF ＜ 50％ was also higher (58.3％ vs 19.1％,P=0.008) The proportion of prolonged QRS wave (＞120 ms) was significantly higher in the MACE group (75％ vs 17.6％,P＜0.01).In the MACE group,the proportion of diuretics and vasoactive drugs (dopamine,norepinephrine,and adrenaline) was higher (66.7％ vs 25％,91.7％ vs 4.4％,66.7％ vs 0,75％ vs 0％,all P＜0.01);the proportion of glucocorticoids and immunoglobulin was higher (33.3％ vs 8.8％,P=0.038;33.3％ vs 4.4％,P=0.008),and the proportion of ventilator,CRRT,ECMO and IABP were also higher (50％vs 1.5％,33.3％ vs 0,25％ vs 0％,25％ vs 0％,all P＜0.01).Logistic regression analysis showed that the OR value of MACE in female patients during hospitalization was 5.56 (95％CI:1.49-20.71,P=0.011).The OR value of MACE in patients with reduced LVEF at admission was 5.92 (95％CI:1.62-21.67,P=0.007).The OR value of MACE in patients with prolonged QRS wave was 14.00 (95％CI:3.29-59.55,P＜0.01).Conclusions Female patients,LVEF＜50％ at admission,and prolonged QRS wave (QRS＞120 ms) are independent risk factors for MACE in adult patients with acute myocarditis during hospitalization.
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Objective ST segment elevation in adult patients with acute myocarditis is rare in adult.The purpose of this study was to report the outcome of ST segment elevation in adult patients with acute myocarditis in our hospital,in order to provide reference for clinical diagnosis and treatment.Methods A retrospective analysis of Beijing Anzhen Hospital during January 2002 to December 2015 for the diagnosis of acute myocarditis were 105 cases,divided into two groups,one group of ST elevation (ST elevation group) total 57 cases,another group of non ST elevation (non ST elevation group) total 48 cases.The clinical features,laboratory examination,treatment and prognosis were compared between the two groups.The composite primary endpoint of major cardiovascular events (MACE) during hospitalization included:mortality,cardiac shock and ventricular fibrillation.Results The average onset age of patients with ST segment elevation group and non ST segment elevation group were similar [(27.7 ± 10.1) years vs.(28.7 ± 10.0) years,P =0.603].There was a significant difference between the two group in patients of heart rate [(89 ± 22) beats/min vs.(80 ± 23) beats/min,P =0.028],systolic blood pressure on admission [(105 ± 17) mmHg vs.(115 ± 17) mmHg,P =0.003],diastolic blood pressure on admission [(66 ± 11) mmHg vs.(74 ± 11) mmHg,P =0.000],and total number of acute fulminant myocarditis [20 (35.1％) vs.7 (14.6％),P =0.024)].ST segment elevation acute myocarditis patients were significantly more at risk for MACE than non ST segment elevation acute myocarditis patients during hospitalization (P =0.04).Conclusion ST segment elevation acute myocarditis has acute onset and rapid progression.The incidence of MACE during hospitalization was significantly high.Mechanical support can be ve,ry favourable.ST segment elevation acute myocarditis is associated with excellent short-term prognosis.
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Acute fulminant myocarditis can be developed by viral infection, toxic materials, autoimmune disorder to heart and can cause left ventricular dysfunction that predisposes the patients to critical condition. When conventional therapy failed to manage the patients and the failing myocardium to recovery, cardiovascular collapse or even death was followed. Mechanical circulatory support is a useful option for the patient whose condition is resistant to medical therapy. We report a case which successful management of acute fulminant myocarditis patient with percutaneous extracorporeal membrane oxygenation.
Subject(s)
Humans , Extracorporeal Membrane Oxygenation , Heart , Myocarditis , Myocardium , Ventricular Dysfunction, LeftABSTRACT
Death due to poisonous scorpion (Buthidae family) stings is a common event in the developing countries. Scorpion envenoming syndrome results in autonomic storm, release of catecholamines, angiotensin II, glucagon, glucocorticoids, either suppressed insulin secretion or hyperinsulinemia; hyperglycemia, lipolysis – sudden increase in free fatty acids (FFA), acute myocarditis, disseminated intravascular coagulation, cardiovascular disturbances, pulmonary oedema, acute pancreatitis, and many clinical manifestations. Under these altered hormonal mileu, insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming in the experimental animals and in scorpion sting victims. Insulin has a primary metabolic role in preventing, counter-acting and reversing the metabolic, cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming and reversing all the deleterious effects of FFA by inhibiting the catecholamine induced lipolysis, and increase intra-cellular K+, facilitating glucose transport to the myocardium and glucose metabolism through different pathways. Profuse sweating, excessive salivation and abdominal pain are the triad of symptoms of ominous significance in scorpion sting victims with acute pancreatitis. Laryngeal spasm and respiratory failure are more common with acute pancreatitis. Continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48–72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance.
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Objective To explore the clinical effect of restructuring human brain natriuretic peptide in treatment of heart failure associated with severe acute myocarditis.Methods Fifty cases of heart failure associated with severe acute myocarditis were divided into experimental group and control group according random number table method,each group 25 cases.The patients in control group were given conventional treatment,and the patients in experimental group were given restructuring human brain natriuretic peptide on the basis of conventional treatment.The clinical effects of two groups were observed.Results The level of N terminal brain natriuretic peptide,left ventricular ejection fraction,urine volume,creatinine in two groups had no significant difference before treatment (P ＞ 0.05).After treatment,these index in experimental group were better than those in control group [(7 785 ± 432) ng/L vs.(10 022 ± 447) ng/L,(45.28 ± 2.67)％ vs.(41.34 ±3.11)％,(1 833 ±49) ml/24 h vs.(1 456 ±47) ml/24 h,(109.34 ± 10.77) μmol/L vs.(125.44 ± 11.00) μ mol/L] (P ＜ 0.05).The rate of clinical symptoms improving in experimental group was significantly higher than that in control group [71.4％ (55/77) vs.26.0％ (20/77)] (P ＜0.01).Conclusion Restructuring human brain natriuretic peptide with conventional treatment can effectively improve heart failure associated with severe clinical symptoms of acute myocarditis,improve the clinical therapeutic effect.
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A 41-year-old man was referred to our hospital suffering from pyrexia. Echocardiogram showed diffuse severe hypokinesis of the left ventricle. The patient was treated medically under a diagnosis of acute myocarditis and anticoagulation therapy had been started. However a large mobile thrombus and multiple small thrombi were detected in the left ventricle 2 days after admission. Because of the deterioration of his left ventricular function (LVEF 14%), he was treated medically with careful monitoring of the thrombi by echocardiogram. His left ventricular function started to improve 3 days after admission (LVEF 27%), and then surgical removal of the thrombi was performed through left ventriculotomy. His postoperative course was uneventful. LVEF was improved to 60% at discharge. He is doing well without any signs of embolic event at 2 years postoperatively. Left ventriculotomy is one of the useful methods for removal of left ventricular thrombus associated with acute myocarditis, if the procedure is performed during the recovery phase.
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No abstract available.
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Adult , Humans , Male , Acute Disease , Echocardiography, Doppler, Color , Myocardial Contraction , Myocarditis/drug therapy , Predictive Value of Tests , Stroke Volume , Ventricular Function, LeftABSTRACT
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi that is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus can have fatal complications, such as acute respiratory distress syndrome, septic shock, and acute kidney injury. However, there are few reports of fatal myocarditis caused by scrub typhus. We present a case of acute fatal myocarditis combined with acute kidney injury complicating scrub typhus.
Subject(s)
Acute Kidney Injury , Myocarditis , Orientia tsutsugamushi , Respiratory Distress Syndrome , Scrub Typhus , Shock, Septic , VasculitisABSTRACT
La transmisión oral de la enfermedad de Chagas habitual en el ciclo selvático es una forma rará en el ser humano. En este último, se debe a la contaminación de las heces con Trypanosoma cruzi (Tcruzi) en los alimentos o a la manipulación infectada de los mismos. Más raramente a la ingesta de carne de reservorios infectados. En esta comunicación, se ponen en el tapete, los trabajos experimentales y naturales del investigador Díaz-Ungría quien demostró el importante papel que juega la mosca doméstica en la contaminación de los alimentos con las heces infectadas de los vectores. Igualmente, se destaca la importancia del perro como reservorio doméstico, todos los cuales podrían ser factores determinantes en la causa de los brotes agudos presentados en los dos últimos años en nuestro país. Se exponen las características de la miocarditis aguda chagásica como la expresión más constante de la forma aguda de la enfermedad por transmisión oral. Se destacan las medidas de prevención efectuadas por las autoridades sanitarias en estas circunstancias
Oral transmission of Chagas disease is common in the forest'cycle and is a rare form in humans. In the human is due to contamination of the stool with T.cruzi in food or infected by their manipulation. More rarely due to reservoirs infected T.cruzi meat intake. In this communication we described the natural and experimental works of the Díaz-Ungría researcher who demonstrated the important role played bi the house fly in the contamination of food with vectors infected faeces. It also highlights the importance of the dog as domestic reservoir, all of which could be determining factors in the cause of acute outbreaks in the past two years in our country. The features of acute Chagasic'myocarditis are exposed as the constant expression of the acute form of the disease by oral transmission. The prevention measures carried out by the health authorities in these circunstances are high lighted
Subject(s)
Humans , Chagas Cardiomyopathy/etiology , Chagas Disease/epidemiology , Chagas Disease/metabolism , Chagas Disease/mortality , Insect Vectors/parasitology , Houseflies/microbiology , Communicable Period , Food Contamination , Morphogenesis/immunology , Trypanosoma cruzi/parasitologyABSTRACT
Objetivo: analisar o quadro clinico-laboratorial de casos de Doença de Chagas aguda autóctone da Amazônia brasileira avaliados sob regime hospitalar, enfatizando a síndrome febril e sinais potenciais de comprometimento cardíaco futuro. Método: estudo transversal de casos de Doença de Chagas aguda, internados no Hospital Universitário João de Barros Barreto, de janeiro de 1990 a outubro de 2003. Resultados: em 20 casos estudados encontramos febre em 95% deles, sendo metade do tipo recorrente, dispnéia (75%), astenia (65%), edema de membros inferiores (65%) e cefaléia (60%). As principais alterações eletrocardiográficas foram: taquicardia sinusal, alterações difusas da repolarização ventricular e complexo QRS de baixa voltagem. Observou-se derrame pericárdico em 35% dos ecocardiogramas realizados. Conclusõe. a elevada freqüência da síndrome febril na doença de Chagas aguda expressa a importância do correto diagnóstico diferencial com as demais endemiasfebris da Amazônia. As alterações eletrocardiográficas e ecocardiográficas encontradas podem sugerir forma clínica de transição para cronicidade, além de indicar gravidade.
Objective: To analyze clinical and laboratorial findings of authoctononus acute Chagas disease from Brazilian Amazon, evaluated under hospital regimen, emphasizing feverish syndrome observations and potential signs of future cardiac commitment. Method: Transversal study of acute Chagas disease in patients from University Hospital João de Barros Barreto, within jan 1990 to at 2003. Results: In a total of 20 studied cases we found predominant symptoms: fever (95%), dyspnea (75%), asthenia (65%), edema of lower members (65%) and headache (60%). Main abnonnalities found in electrocardiograms were: sinusal tachycardia, diffuse ventricular repolarization abnormalities and low voltage of QRS. We demonstrated 35% with pericardial effusion show in echocardiograms. Conclusions: Raised frequency of feverish syndrome in acute Chagas disease shows the importance of the correct distinguishing diagnosis with others febrile endemic diseases occurred in Amazon. The electrocardiographics and echocardiographics abnormalíties found could suggest clínical form of transition for chronicity, besides expressing gravity.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Chagas Cardiomyopathy , Chagas Disease/diagnosis , Cross-Sectional Studies , Acute Disease , FeverABSTRACT
Intravenous immunoglobulin (IVIG) therapy has been introduced to idiopathic dilated cardiomyopathy due to their antiviral and anti-inflammatory effects. But each study reported conflicting result and treatment regimen has not been clearly established. We experienced a case of 28-year-old woman with idiopathic dilated cardiomyopathy with severely depressed cardiac function. Its onset time was obvious within 1 month. Despite of conservative treatment of heart failure, sudden cardiac arrest was developed. We tried IVIG therapy, and her symptoms and cardiac function were improved after IVIG treatment.
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Adult , Female , Humans , Cardiomyopathy, Dilated , Death, Sudden, Cardiac , Heart Failure , Immunoglobulins , Immunoglobulins, IntravenousABSTRACT
PURPOSE: We made investigation into the etiology, clinical manifestations, laboratory findings, treatments, outcomes, prognosis and prognostic factors of acute myocarditis in children. METHODS: We have reviewed the medical records of the patients who were admitted to the Chonbuk National University Hospital for recent 10 years. Patients were divided in two groups with base on the outcomes. One is recovery group and the other is mortality group. And we analyzed the clinical findings and compared between two groups. RESULTS: Ten of 27 patients were expired with fulminant myocarditis or complication of acute myocarditis. Seventeen patients were recovered. Left ventricular fractional shortening on the echocardiogram was a valuable prognostic factor. Seventeen patients were treated with IVIG. Seven patients were evaluated the viral etiology. Coxsackie B5, coxsackie B3, coxsackie A10 and adenovirus were detected. CONCLUSION: Left ventricular fractional shortening was a valuable prognostic factor. It is necessary to research antegrade multicenter study about acute myocarditis.
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Child , Humans , Adenoviridae , Immunoglobulins, Intravenous , Medical Records , Mortality , Myocarditis , PrognosisABSTRACT
Myocarditis is defined as the myocardial inflammation caused by various infectious agents (such as virus, rickettsia , bacteria, protozoa, fungus and parasites). The clinical manifestations of myocarditis ranges from the asymptomatic state due to focal inflammation to fulminant fatal congestive heart failure secondary to diffuse myocardial involvement. Clinically, in some cases, it may simulate an acute myocardial infarction. We experienced a case of acute fulminant myocarditis that presented as acute myocardial infarction initially, and then progressed into and recovered from congestive heart failure and multiorgan failure.
Subject(s)
Asymptomatic Diseases , Bacteria , Estrogens, Conjugated (USP) , Fungi , Heart Failure , Inflammation , Myocardial Infarction , Myocarditis , RickettsiaABSTRACT
Neonatal lupus is a model of passively acquired autoimmunity in which immune abnormalities in the mother lead to production of antibodies that cross the placenta and injure the developing fetus. The serologic markers for the diagnosis of neonatal lupus are auto-antibodies specific to SS-A/Ro and/or SS-B/La. More than 95% of affected infants are anti-SS-A/Ro positive. We experienced a neonatal lupus with acute myocarditis at 2 months of age. The baby was born in gestational age of 36 weeks with a birth weight of 2,350gm by Caesarean section. At birth, chest X-ray showed mild cardiomegaly, but electrocardiography and echocardiography were normal. Laboratory findings for LDH, CPK and CK-MB were increased above the normal range. At 2 months of age, controlled echocardiography showed dilated left ventricle(LV) dimension with decreased fractional shortening and ejection fraction. However, this infant did not show clinical symptoms of congestive heart failure. We followed up on this patient without giving any medical treatment. At 1 year of age, controlled echocardiography showed increased thickness of the posterior wall of LV, but the fractional shortening and ejection fraction returned to normal range.
Subject(s)
Female , Humans , Infant , Pregnancy , Antibodies , Autoimmunity , Birth Weight , Cardiomegaly , Cesarean Section , Diagnosis , Echocardiography , Electrocardiography , Fetus , Gestational Age , Heart Failure , Mothers , Myocarditis , Parturition , Placenta , Reference Values , ThoraxABSTRACT
Estudar aspectos etiopatológicos e de evoluçäo em portadores de miocardite. Dentre 44 crianças com miocardite aguda estudadas clínica e virologicamente, foram selecionados 16 casos positivos para Coxasackie B. O protocolo clínico incluiu dosagens enzímicas, radiografia de tórax, eletro e ecocardiograma. A investigaçäo virológica para Coxsacke B1, B3, B4, B5 e B6 se baseou em cultura, teste de neutralizaçäo e pesquisa de IgM por imunofluorescência indireta. Obtivemos vírus B4 em 9 (57%), B5 em 4 (25%), B1 em 2 (12%) e B3 em 1 (6%). Nenhum paciente foi submetido à terapêutica imunossupressora. A evoluçäo de pelo menos 1 ano foi; 7 (43%) permaneceram com miocardiopatia dilatada, 1 (6%) faleceu e 4 (25%) tiveram alta hospitalar, mas näo seguiram o acompanhamento. Uma das pacientes que teve evoluçäo crônica (extra-sístoles ventriculares, BAV do 2§ grau) está agora assintomática. Näo observamos diferença significativa entre os vários tipos de Coxsackie B em relaçäo à evoluçäo clínica