Expression and Significance of Circulating microRNA-29b in Adult Fulminant Myocarditis / 中国医学科学院学报

Objective To explore the expression profiles of circulating microRNA(miRNA)and potential markers for the diagnosis of adult fulminant myocarditis(FM). Methods The expression profiles of circulating miRNA were determined by microarray analysis and verified by real-time quantitative PCR.The key role of circulating miRNA in FM was determined via KEGG pathway enrichment.The correlations between miRNA and cardiac function parameters in patients with FM were analyzed.The receiver operating characteristic(ROC)curve was established to evaluate the sensitivity and specificity of circulating miRNA in the diagnosis of FM. Results Compared with healthy controls,the FM patients had up-regulated expression levels of miR-29b(t=18.925,P<0.001)and miR-125b(t=5.981,P=0.029)in the plasma.After treatment,the expression levels of miR-29b(t=12.943,P<0.001)and miR-125b(t=14.016,P<0.001)were significantly down-regulated.KEGG pathway enrichment showed that the targets of miR-29b were involved in inflammatory response and apoptosis pathways.The results of cell proliferation and apoptosis assay demonstrated the transfection of miR-29b mimic had a more significant inducing effect on cardiomyocyte apoptosis than that of miR-125b mimic(χ 2=6.168,P=0.047),whereas there was no significant difference in the inhibition of cell proliferation between the two groups(χ2=1.452,P=0.417).The expression levels of miR-29b and miR-125b were negatively correlated with left ventricular ejection fraction(r=-0.67,P=0.071;r=-0.49,P=0.003).They were positively correlated with cardiac troponin I level(r=0.61,P=0.019;r=0.52,P=0.016),interferon β level(r=0.42,P=0.014;r=0.36,P=0.021),and myocardial edema area(r=0.86,P=0.005;r=0.73,P=0.013).The ROC curve analysis demonstrated that miR-29b had higher sensitivity for the diagnosis of FM(93.6% vs.89.2%;t=0.896,P=0.795)and specificity(72.4% vs.59.6%;t=9.478,P=0.002)than miR-125b. Conclusion The circulating miR-29b may be a potential biomarker for the diagnosis of FM.

COVID-19 and acute myocarditis: current literature review and diagnostic challenges

SUMMARY INTRODUCTION In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature. METHODS We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane. RESULTS 16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy. CONCLUSION Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.

RESUMO INTRODUÇÃO Na literatura atual, houve um aumento dos casos apresentados com doença coronavírus de 2019 (COVID-19) induzida por miocardite aguda. Nesta revisão baseada em casos, buscamos descrever as características clínicas, achados de imagem e curso hospitalar de miocardite aguda. Além disso, as limitações em relação ao diagnóstico de miocardite foram discutidas, uma vez que apenas casos de miocardite fulminante foram mencionados na literatura atual. MÉTODOS Fizemos uma revisão da literatura de todos os pacientes diagnosticados com miocardite aguda induzida por COVID-19 com a utilização das bases de dados PubMed, Embase e Cochrane. RESULTADO Dezesseis casos relatados estão relacionados com a miocardite aguda induzida pela COVID-19. Observamos que os achados de ECG na maioria dos pacientes com COVID-19 não eram específicos, incluindo elevação difusa do segmento ST, atraso não específico da condução intraventricular, taquicardia sinusal e ondas T invertidas em pistas anteriores. Os resultados ecocardiográficos de doentes com miocardite aguda COVID-19 variaram entre a fração de ejeção ventricular esquerda preservada (LVEF) sem anomalias segmentais e a LVEF reduzida com hipocinésia global. Curiosamente, alguns pacientes com COVID-19 induzidos à miocardite aguda fulminante eram sensíveis aos esteroides e tinham uma melhoria com glucocorticoides e terapia com imunoglobulina. CONCLUSÃO Apesar da pandemia de COVID-19 em todo o mundo, um número limitado de casos tem sido compartilhado na literatura atual. Há muitas dificuldades para o diagnóstico diferencial de miocardite aguda no contexto da COVID-19.

Human pulmonary dirofilariasis with secondary myocarditis

Abstract Dirofilariasis is a little-known zoonosis, with dogs and cats as definitive hosts. It is caused by nematodes and transmitted by mosquito bites. We report the case of a 67-year-old man with a consumptive syndrome with two subpleural pulmonary opacities. A transthoracic lung biopsy revealed a Dirofilaria worm. Myocardial nuclear magnetic resonance (NMR) demonstrated dilated cardiomyopathy after myocarditis related to dirofilariasis. Human infection is rare and occurs accidentally. The most common radiological alteration is a mainly subpleural coin lesion. Dirofilariasis is a neglected emergent disease and knowledge about it is important for differential diagnoses from neoplastic pulmonary nodules.

Left atrial giant cell myocarditis presenting as a tumor: first-in-man case report

Abstract Giant cell myocarditis is a rare and highly lethal disorder with resultant cardiac insufficiency. It necessitates aggressive immune suppression therapy, although the results are often fatal. When it affects only the atria, the characteristics of the disease changes completely. In this case report, we present atypical presentation of atrial giant cell myocarditis with mass lesion, which completely resolved after successful surgical resection without immuno suppression therapy.

Quando a ressonância magnética importa para a avaliação das cardiopatias / When Magnetic resonance imaging matters for the evaluation of cardiopathies

A ressonância magnética cardíaca (RMC) é uma modalidade de imagem não invasiva capaz de fornecer informações precisas e, muitas vezes, únicas na investigação de cardiopatias em geral e, em especial, nas cardiomiopatias. A capacidade de caracterizar precisamente o miocárdio do ponto de vista de sua contratilidade e suas características teciduais, diferenciando precisamente o miocárdio normal da fibrose miocárdica e identificando o edema miocárdio nas situações de agressão aguda ou recente do miocárdio, tornam a RMC indispensável hoje em qualquer serviço terciário e avançado de cardiologia do mundo. Neste artigo revisamos as aplicações clássicas e mais recentes da RMC em cardiopatias não isquêmicas, dividindo o uso das técnicas de RMC em dois grandes grupos: investigação da insuficiência cardíaca e das arritmias ventriculares. Dentro destes dois grupos pontuamos as etiologias mais importantes e frequentemente envolvidas. Na síndrome da insuficiência cardíaca destacam-se a cardiomiopatia dilatada com a fibrose mesocárdica linear septal e a miocardite viral com a manifestação de fibrose multifocal e mesoepicárdica. Uma proporção das cardiomiopatias dilatadas pode ter origem em uma miocardite viral prévia. A sarcoidose cardíaca pode apresentar uma variedade de tipos de realce tardio de padrão não isquêmico e isquêmico, e ser associada tanto ao quadro clínico de IC como de arritmia. A presença de sarcoidose pulmonar ou sistêmica pode ou não estar presente. A amiloidose cardíaca é o protótipo da cardiomiopatia restritiva e pode ser identificada pela RMC pelo padrão de realce tardio miocárdico global circunferencial (tipo AL) ou difuso, poupando o ápex do ventrículo esquerdo (tipo transtirretina). Finalmente, uma entidade ainda pouco entendida, a não compactação do ventrículo esquerdo (VE), em geral não apresenta realce tardio, mas tem fenótipo de trabeculação ventricular típico. No grupo das síndromes arrítmicas revisamos várias etiologias frequentemente associadas a esta apresentação clínica. Na hemossiderose cardíaca os valores de T2* abaixo de 20 ms indicam precisamente sobrecarga significativa de ferro miocárdico e associação com disfunção ventricular e arritmia ventricular. Na cardiomiopatia hipertrófica, a hipertrofia assimétrica e a fibrose miocárdica difusa, heterogênea e que acomete focalmente as inserções ventriculares, constituem o padrão clássico. Quantidade de fibrose acima de 15% da massa ventricular esquerda indica risco duas vezes maior de morte súbita. Na cardiomiopatia/displasia arritmogênica do ventrículo direito (VD), os volumes e a função ventricular direita global e segmentar pela RMC são partes fundamentais dos critérios diagnósticos da displasia pelo consenso atual. A cardiomiopatia chagásica tem mostrado intensa fibrose miocárdica desde as fases iniciais, mais intensa em homens que mulheres e frequentemente associada à edema miocárdico, marcador de provável inflamação crônica. A endomiocardiofibrose apresenta imagem patognomônica no realce tardio, o sinal do duplo V, caracterizando a fibrose miocárdica e trombo/calcificação preenchendo o ápex do VE e/ou VD. Nas valvopatias, além da detecção de fibrose miocárdica, que tem valor prognóstico, a RMC é precisa em quantificar as regurgitações, sendo indicada sua realização na insuficiência mitral antes da decisão de procedimento cirúrgico de troca ou correção valvar, eliminado um número significativo de casos em que a insuficiência mitral é superestimada pela ecocardiografia. Com esta revisão, cobrimos uma vasta gama de cardiopatias para as quais as técnicas de RMC realmente importam no diagnóstico e na estratificação prognóstica

Cardiovascular magnetic resonance (CMR) imaging is a noninvasive form of imaging capable of providing accurate and often unique information in the investigation of heart disease in general, and especially in cardiomyopathies. The ability to accurately characterize the myocardium in terms of its contractility and tissue characteristics, precisely differentiating normal myocardium from myocardial fibrosis and identifying myocardial edema in situations of acute or recent myocardial injury, has made CMR indispensable in any tertiary and advanced cardiology service around the World. In this paper, we review the classical and more recent applications of CMR in non-ischemic heart diseases, dividing the use of CMR techniques into two main groups: heart failure (HF) and ventricular arrhythmia investigations. Within these two groups, we highlight the most important and frequently involved etiologies. In heart failure syndrome, we focused on dilated cardiomyopathy with septal linear mesocardial fibrosis and viral myocarditis with the manifestation of multifocal and mesoepicardiac fibrosis. A proportion of dilated cardiomyopathies may have originated with an ancient viral myocarditis. Cardiac sarcoidosis may present a variety of late enhancement types of non-ischemic and ischemic patterns, and is associated with clinical signs of both HF and arrhythmia. The presence of pulmonary or systemic sarcoidosis may or may not be present. Cardiac amyloidosis is the prototype of restrictive cardiomyopathy, and can be identified in CMR by the global circumferential subendocardial (AL type) or diffuse myocardial enhancement pattern sparing the left ventricle (LV) apex (transthyretin type). Finally, a poorly understood entity, LV non-compaction generally does not present late enhancement, but has a typical ventricular trabeculation phenotype. In the group of arrhythmic syndromes, we reviewed several etiologies frequently associated with this clinical presentation. In cardiac siderosis, values of T2* below 20 ms accurately indicate a significant overload of myocardial iron and association with ventricular dysfunction and ventricular arrhythmia. In hypertrophic cardiomyopathy, asymmetric hypertrophy and diffuse myocardial fibrosis, which is heterogeneous and focally affects the ventricular insertions, constitute the classic pattern. An amount of fibrosis above 15% of the left ventricular mass indicates a two-fold increased risk of sudden death. In arrhythmogenic right ventricle (RV) cardiomyopathy/dysplasia, global and segmental right ventricular function and volumes by CMR are fundamental parts of the diagnostic criteria of dysplasia, according to current consensus. Chagasic cardiomyopathy has shown intense myocardial fibrosis since the early stages, which is more intense in men than women, and is frequently associated with myocardial edema, a marker of probable chronic inflammation. Endomyocardial fibrosis presents a pathognomonic image in late enhancement, the double V sign, characterizing myocardial fibrosis and thrombus/calcification filling the LV and/or RV apex. In valve diseases, in addition to the detection of myocardial fibrosis that has prognostic value, CMR is precise in quantifying regurgitations, and is indicated in mitral regurgitation prior to the decision for surgical valve replacement/correction, eliminating a significant number of cases in which mitral insufficiency is overestimated by the echocardiogram. This review covers a wide range of cardiopathies in which CMR techniques are extremely important in the diagnosis and prognostic stratification

Valor do Strain Bidimensional no Diagnóstico da Miocardite Aguda: Comparação com a Ressonância Cardíaca / The Value of Two-dimensional Strain in the Diagnosis of Acute Myocarditis: Comparison with Cardiac Magnetic Resonance Imaging

Fundamento: A miocardite aguda é uma das principais causas de morte súbita em pacientes jovens. A ressonância magnética cardíaca (RMC) é um método sensível e não invasivo para detecção de miocardite, mas de alto custo e indisponível na maioria dos centros médicos. O strain bidimensional representa uma nova técnica ecocardiográfica que possibilita a avaliação da deformação miocárdica permitindo a análise da função miocárdica global e regional. Objetivo: Avaliar o valor do strain bidimensional em pacientes com diagnóstico de miocardite. Materiais e métodos: Foram estudados prospectivamente pacientes com quadro de miocardite aguda e contratilidade cardíaca normal pela RMC e submetidos à ecocardiografia convencional e strain bidimensional. O miocárdio ventricular foi dividido em 16 segmentos e esses segmentos divididos em dois grupos. Grupo 0: segmento miocárdico normal pela RMC. Grupo 1: segmento miocárdico compatível com miocardite pela RMC. Resultados: Foram avaliados 28 pacientes sendo 82,1% do sexo masculino, com idade de 35,6 ± 8,9 anos. Dos 448 segmentos miocárdicos avaliados, 316 segmentos foram normais (grupo 0) e 132 segmentos (grupo 1) apresentaram diagnóstico de miocardite pela técnica de realce tardio à RMC. A análise do strain bidimensional mostrou diferença significativa entre os grupos (19,6 ± 2,9 versus 15,4 ± 2,8 p = 0,001), com sensibilidade 75% e especificidade 79% e AUC de 0,86 (IC 95% 0,82 a 0,89). Conclusão: O strain bidimensional pode ser útil na avaliação propedêutica de pacientes com miocardite e contratilidade normal pela RMC e ecocardiografia convencional

Background: Acute myocarditis is one of the most important causes of sudden death in young people. Cardiac magnetic resonance (CMR) is a sensitive and non-invasive method in myocarditis diagnosis, but it is expensive and unavailable in most medical centers. Speckle tracking strain echocardiography is a new echocardiographic technique that enables the evaluation of myocardial deformation allowing analysis of global and regional myocardial function. Objective: To evaluate the value of speckle tracking strain echocardiography in patients with acute myocarditis and normal wall motion contraction. Materials and Methods: We prospectively studied patients with acute myocarditis and normal cardiac contractility by CMR and underwent conventional echocardiography and speckle tracking strain echocardiography. The ventricular myocardium was divided into 16 segments by CMR and echocardiography and separated into two groups: Normal myocardial segment (group 1) myocardial segment compatible with myocarditis (group 1). Results: We evaluated 28 patients (82.1% male), aged 35.6 ± 8.9 years. Of the 448 myocardial segments evaluated, 316 segments were normal (group 0) and 132 segments (group 1) were diagnosed with myocarditis by RMC. Speckle tracking strain echocardiography showed a significant difference between groups (-19.6 ± 2.9 versus -15.4 ± 2.8 p = 0.001), with sensitivity of 75% and specificity of 79% with AUC of 0.86 (95% CI 0.82 to 0.89). Conclusion: Speckle tracking strain echocardiography can be useful in the diagnosis evaluation of patients with myocarditis and normal contractility by CMR and conventional echocardiography

Miocardite aguda sob a forma de síndrome coronariana aguda após infecção do trato urinário / Acute myocarditis presenting as acute coronary syndrome following urinary tract infection

A miocardite é cada vez mais diagnosticada, principalmente pela maior disponibilidade de métodos como a ressonância magnética cardíaca. A apresentação clínica é variável, geralmente posterior a uma infecção respiratória ou gastrointestinal, manifestando-se como síndrome coronariana aguda (SCA), insuficiência cardíaca aguda ou crônica, arritmias cardíacas ou mesmo choque cardiogênico inexplicável. Relatos de casos de miocardite após infecção do trato urinário (ITU) são escassos. Neste relato, descrevemos o caso de um paciente masculino de 24 anos com miocardite após ITU que se apresentou sob a forma de SCA(AU)

The diagnosis of myocarditis has increased mainly due to greater availability of methods such as cardiac magnetic resonance (CMR). Its clinical presentation varies, usually following respiratory or gastrointestinal tract infection, in patients presenting with acute coronary syndrome (ACS), acute or chronic heart failure, cardiac arrhythmias, or even unexplained cardiogenic shock. Case reports of patients with myocarditis following urinary tract infection (UTI) are scarce. This is a case report of a 24-year-old male patient with myocarditis with symptoms of ACS following UTI(AU)

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression / Parâmetros indicativos de persistência de patologia valvular no diagnóstico inicial de cardite reumática aguda: o papel da albumina e da expressão de CD19

Abstract Objective: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). Methods: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. Results: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6 ± 0.48 g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. Conclusion: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Resumo Objetivo: Definir os preditores da cardite crônica em pacientes com cardite reumática aguda (CRA). Métodos: Os pacientes diagnosticados com CRA entre maio de 2010 e maio de 2011 foram incluídos no estudo. Foram feitos os testes de ecocardiografia, eletrocardiograma, uma análise do subgrupo de linfócitos, provas de fase aguda, níveis de albumina plasmática, antiestreptolisina-O (ASO) na manifestação inicial. As avaliações ecocardiográficas foram repetidas no 6º mês de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com a persistência da patologia valvular no 6º mês como Grupo 1 e Grupo 2 e todos os parâmetros clínicos e laboratoriais na internação foram comparados entre dois grupos de comprometimento valvular. Resultados: Durante o período do estudo de um ano, 22 pacientes apresentaram doença valvular; 17 (77,2%) apresentaram regressão da patologia valvular. Houve desaparecimento de regurgitação moderada inicial em oito pacientes (36,3%). Entre sete (31,8%) pacientes com regurgitação moderada inicialmente, a regurgitação desapareceu em três e quatro apresentaram melhoria para regurgitação leve. Dois pacientes com regurgitação grave inicialmente apresentaram melhoria para regurgitação moderada (9,1%). Em cinco (22,8%) pacientes o grau de regurgitação (regurgitação moderada em um [4,6%] e regurgitação grave em quatro [18,2]) continuou inalterado. O nível de albumina foi significativamente menor no diagnóstico no Grupo 2 (2,6 ± 0,48 gr/dL). A análise do subgrupo de linfócitos mostrou uma redução significativa no percentual de CD8 e um aumento significativo no percentual de CD19 no Grupo 2 em comparação com o Grupo 1. Conclusão: O nível de albumina no sangue e o percentual de linfócitos CD8 e CD19 (+) no diagnóstico podem ajudar a prever risco de doença valvular crônica em pacientes com cardite reumática aguda.

Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement / Prevalência de miocardite em casos pediátricos na unidade de terapia intensiva, com envolvimento de outros sistemas

OBJECTIVE: To assess children with myocarditis, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis. METHODS: This was an observational study of 63 patients admitted to PICU with non-cardiac diagnosis. Cardiac enzymes, chest-X ray, echocardiography, and electrocardiogram were performed to diagnose myocarditis among those patients. RESULTS: There were 16 cases of definite myocarditis. The age distribution was non-normal, with median of 5.5 months (3.25-21). Of the 16 patients who were diagnosed with myocarditis, 62.5% were originally diagnosed as having respiratory problems, and there were more females than males. Among the present cases, the accuracy of cardiac enzymes (cardiac troponin T [cTn] and creatine phosphokinase MB [CKMB]) in the diagnosis of myocarditis was only 63.5%, while the accuracy of low fractional shortening and of chest-X ray cardiomegaly was 85.7 and 80.9%; respectively. Cardiac troponin folds 2.02 had positive predictive value of 100%, negative predictive value of 88.7%, specificity of 100%, sensitivity of 62.5%, and accuracy of 90.5%. CONCLUSIONS: Children with myocarditis present with symptoms that can be mistaken for other types of illnesses. When clinical suspicion of myocarditis exists, chest-X ray and echocardiography are sufficient as screening tests. Cardiac troponins confirm the diagnosis in screened cases, with specificity of 100%. .

OBJETIVO: Determinar as crianças com miocardite, a frequência de sintomas apresentados e a precisão de investigações no diagnóstico. MÉTODOS: Estudo observacional de 63 pacientes internados na UTIP com diagnóstico de problemas não cardíacos. Os exames de enzimas cardíacas, raios-X do tórax, ecocardiograma e eletrocardiograma (ECG) foram feitos para diagnosticar miocardite entre os pacientes. RESULTADOS: Houve 16 casos de miocardite definida. A distribuição etária não foi normal, com média de 5,5 meses (3,25-21). Dos 16 pacientes, 62,5% foram originalmente diagnosticados com problemas respiratórios e a mulheres estavam em maior número do que os homens. Dentre nossos casos, a precisão das enzimas cardíacas (cTn e CKMB) no diagnóstico da miocardite foi de apenas 63,5%, apesar de a precisão da baixa fração de encurtamento (FS) e dos raios-X de tórax que revelaram cardiomegalia ter sido 85,7% e 80,9%; respectivamente. A troponina cardíaca em 2,02 vezes apresentou valor preditivo positivo = 100%, valor preditivo negativo = 88,7%, especificidade = 100%, sensibilidade = 62,5% e precisão = 90,5%. CONCLUSÕES: As crianças com miocardite apresentam sintomas que podem ser confundidos com outros tipos de doenças. Quando há suspeita clínica de miocardite, raios-X de tórax e ecocardiografia são testes de rastreamento suficientes. As troponinas cardíacas confirmam o diagnóstico em casos examinados, com especificidade de 100%. .

Myocarditis associated with Plasmodium vivax malaria: a case report

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Miocarditis fulminante, simuladora de síndrome coronario agudo / Fulminant myocarditis mimicking acute coronary syndrome

Informamos el caso de un hombre de 48 años, con el antecedente de enfermedad coronaria y enfermedad autoinmune, quien sufrió dolor torácico, con posterior desarrollo de falla cardíaca aguda y colapso hemodinámico. Se presentan su evolución clínica y las ayudas que permitieron llegar al diagnóstico de miocarditis fulminante de etiología lúpica. Se incluye también una revisión de los aspectos más importantes de esta enfermedad.

We report the case of a 48 year-old man with chest pain and history of coronary and autoimmune diseases, who developed acute heart failure and hemodynamic collapse. We present his clinical evolution and the tests that allowed the diagnosis of fulminant myocarditis secondary to systemic lupus erythematosus. A review of the most important aspects of this disease is also included.

Síndrome coronario agudo en Guatemala / Acute coronary syndrome in Guatemala

El término “Síndrome Coronario Agudo” (SCA) implica una constelación de síntomas atribuibles a isquemiaaguda del miocardio. Se incluyen bajo esta denominación los infartos del miocardio con elevación delsegmento ST(IMCEST), los Infartos sin elevación del ST(IMSEST) y la angina inestable. Para conocer elcomportamiento y manejo del SCA en los países emergentes, entre Enero del 2007 y Enero del 2009 serealizó el estudio ACCESS (ACute Coronary Events Strategies Survey) para evaluar los mecanismos deestratificación del riesgo, patrones de práctica clínica, manejo, en un año, entre los pacientes reclutados en Guatemala, el SCA fue confirmado en 289 casos: 37 IMSEST, 188 IMCEST y 64 con angina inestable.

The term "acute coronary syndrome" (ACS) involves a constellation of symptoms attributable to acutemyocardial ischemia. Under this designation are included: myocardial infarction with ST segmentelevation(IMCEST), myocardial infarction without ST segment elevation(IMSEST) and unstable angina. Tounderstand the behavior and management of ACS in emerging countries, between January 2007 and January2009, the ACCESS study (ACute Coronary Events Strategies Survey) was conducted to evaluate themechanisms of risk stratification, clinical practice patterns, management, in one year, in the patients enrolledin Guatemala, the SCA was confirmed in 289 cases: 37 NSTEMI, 188 STEMI and 64 with unstable angina.

Miocarditis por dengue / Dengue fever myocarditis

El dengue es un arbovirus transmitido por el Aedes aegypti, produce los cuadros clínicos de dengue clásico, dengue hemorrágico y síndrome de choque por dengue, aisladamente se reportan casos de miocarditis. Se presentó un paciente con antecedentes de dengue clásico que manifestó dolor precordial asociado a cambios electrocardiográficos y fue ingresado en este hospital por síndrome coronario agudo probable, al cual se le diagnosticó clínicamente miocarditis por dengue

Dengue is an arbovirus transmitted by the Aedes Aegypti mosquito that produces the clinical picture of classical dengue fever, hemorrhagic dengue fever and dengue shock syndrome. In an isolated form, cases of myocarditis are reported. We presented a case about a patient with antecedents of classical dengue fever and chest pain associated to electrocardiograph changes who was admitted to this hospital presenting a probable acute coronary syndrome. Myocarditis following dengue fever was clinically diagnosed