Miocarditis lúpica: reporte de un caso / Lupus myocarditis: a case report / Miocardite lúpica: relato de um caso

El término miocarditis hace referencia a una inflamación del miocardio, que puede tener diversas causas (infecciones, tóxicos, enfermedades autoinmunes). Su diagnóstico es desafiante debido al gran espectro de presentaciones clínicas que puede adoptar, muchas veces imitando patologías más prevalentes como el infarto agudo de miocardio. La miocarditis asociada a enfermedades autoinmunes es poco frecuente, y la importancia de reconocerla radica en que el diagnóstico e inicio temprano del tratamiento son cruciales para mejorar su pronóstico. Presentamos aquí un caso clínico de una perimiocarditis lúpica.

Myocarditis refers to an inflammation of the myocardium, which can have various causes (infections, toxic substances, autoimmune diseases). Its diagnosis is challenging due to the wide spectrum of clinical presentations, often mimicking more prevalent pathologies such as acute myocardial infarction. Myocarditis associated with autoimmune diseases is rare, and the importance of recognizing is that early diagnosis and initiation of treatment are crucial to improve its prognosis. We present here a clinical case of lupus perimyocarditis.

O termo miocardite refere-se a uma inflamação do miocárdio, que pode ter várias causas (infecções, substâncias tóxicas, doenças autoimunes). Seu diagnóstico é desafiador devido ao amplo espectro de apresentações clínicas que pode ter, muitas vezes mimetizando patologias mais prevalentes como o infarto agudo do miocárdio. A miocardite associada a doenças autoimunes é rara, e a importância de reconhecê-la reside no fato de que o diagnóstico precoce e o início do tratamento são cruciais para melhorar seu prognóstico. Apresentamos aqui um caso clínico de perimiocardite lúpica.

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

INTRODUCTION@#Despite reports suggesting an association between COVID-19 mRNA vaccination and pericarditis and myocarditis, detailed nationwide population-based data are sparsely available. We describe the incidence of pericarditis and myocarditis by age categories and sex after COVID-19 mRNA vaccination from a nationwide mass vaccination programme in Singapore.@*METHODS@#The incidence of adjudicated cases of pericarditis and myocarditis following COVID-19 mRNA vaccination that were reported to the vaccine safety committee between January to July 2021 was compared with the background incidence of myocarditis in Singapore.@*RESULTS@#As of end July 2021, a total of 34 cases were reported (9 pericarditis only, 14 myocarditis only, and 11 concomitant pericarditis and myocarditis) with 7,183,889 doses of COVID-19 mRNA vaccine administered. Of the 9 cases of pericarditis only, all were male except one. The highest incidence of pericarditis was in males aged 12-19 years with an incidence of 1.11 cases per 100,000 doses. Of the 25 cases of myocarditis, 80% (20 cases) were male and the median age was 23 years (range 12-55 years) with 16 cases after the second dose. A higher-than-expected number of cases were seen in males aged 12-19 and 20-29 years, with incidence rates of 3.72 and 0.98 case per 100,000 doses, respectively.@*CONCLUSION@#Data from the national registry in Singapore indicate an increased incidence of pericarditis and myocarditis in younger men after COVID-19 mRNA vaccination.

COVID-19 y afectación cardíaca / Cardiac implications and COVID-19

The coronavirus pandemic has generated a serious global health problem. COVID-19 mainly affects the lung, but it has been seen that myocardial involvement also occurs in some patients, producing myocarditis and arrhythmias.

La pandemia por coronavirus ha generado un grave problema sanitario mundial. El COVID-19 afecta fundamentalmente el pulmón, pero se ha visto que en algunos pacientes también se produce afectación del miocardio produciendo miocarditis y arritmias.

Miocarditis fulminante en adultos por el virus de la influenza B: reporte de dos casos y revisión de la literatura / Fulminant myocarditis due to the influenza B virus in adults: Report of two cases and literature review

Resumen La miocarditis es una enfermedad inflamatoria del miocardio. Las infecciones virales son la causa más común, aunque también puede deberse a reacciones de hipersensibilidad y de etiología autoinmunitaria, entre otras. El espectro clínico de la enfermedad es variado y comprende desde un curso asintomático, seguido de dolor torácico, arritmias y falla cardiaca aguda, hasta un cuadro fulminante. El término 'fulminante' se refiere al desarrollo de un shock cardiogénico con necesidad de soporte vasopresor e inotrópico o dispositivos de asistencia circulatoria, ya sea oxigenación por membrana extracorpórea o balón de contrapulsación intraaórtico. Cerca del 10 % de los casos de falla cardiaca por miocarditis corresponde a miocarditis fulminante. La miocarditis por influenza se considera una condición infrecuente; no obstante, su incidencia ha aumentado desde el 2009 a raíz de la pandemia de influenza por el virus AH1N1. Por su parte, la miocarditis por influenza de tipo B sigue siendo una condición infrecuente. Se describen aquí dos casos confirmados de miocarditis fulminante por el virus de la influenza B atendidos en un centro cardiovascular, que requirieron dispositivos de asistencia circulatoria mecánica.

Abstract Myocarditis is an inflammatory disease of the myocardium. Viral infections are the most common cause, although it can also be due to hypersensitivity reactions and autoimmune etiology, among other causes. The clinical spectrum of the disease is varied, from an asymptomatic course, followed by chest pain, arrhythmias, and acute heart failure, to a fulminant episode. The term fulminant refers to the development of cardiogenic shock with a need for vasopressor support and inotropic or assisted circulation devices either extracorporeal membrane oxygenation (ECMO) or intra-aortic counterpulsation balloon. About 10% of cases of heart failure due to myocarditis correspond to fulminant myocarditis. Influenza myocarditis has been considered an infrequent condition. However, its incidence has increased since 2009 as a result of the AH1N1 pandemic; otherwise, myocarditis due to the Influenza type B virus remains an infrequent entity. We describe the experience in a cardiovascular center of two confirmed cases of fulminant myocarditis due to influenza B that required circulatory assistance devices.

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.

Prognóstico da Cardiomiopatia dilatada com insuficiência cardíaca grave de acordo com escalas de classificação funcional na infância / Prognosis of dilated cardiomyopathy with severe heart failure according to functional classification scales in childhood

Fundamento: A insuficiência cardíaca é principal manifestação da cardiomiopatia dilatada na infância, e a avaliação sistematizada dos sinais e sintomas permite acompanhar o resultado do tratamento. Objetivo: Avaliar o uso de três escalas de classificação funcional da insuficiência cardíaca na evolução de crianças e adolescentes com cardiomiopatia dilatada. Métodos: Estudo longitudinal e observacional incluindo pacientes de zero a 18 anos com cardiomiopatia dilatada e insuficiência cardíaca inicial grave. Todos foram acompanhados por meio das escalas New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) e Ross versão 2012. As análises estatísticas foram feitas com uso do Statistical Package for Social Science , versão 14.0, com teste de Mann-Whitney, teste qui quadrado ou de Fisher, aplicação da Curva Característica de Operação, teste de Wilcoxon e coeficiente de Kappa, para comparação das escalas, e curva Kaplan-Meier, para avaliação da sobrevida. O nível de significância adotado foi de 5%. Resultados: Foram incluídos 57 pacientes, com idade de 1 a 200 meses (média de 48,7 ± 55,9) e seguimento de 6 a 209 meses (média de 63,6 ± 48,4). Houve substancial concordância das escalas Ross 2012 e The NYU PHFI com a NYHA (Kappa = 0,71 e 0,82, respectivamente). A análise pareada pelo teste de Wilcoxon, comparando as escalas antes e após o tratamento, foi significativa (p < 0,0001). A sobrevida maior foi encontrada nos pacientes com classes I/II pela NYHA ou pontuação menor que 11 pontos nas outras. Conclusão: O uso das escalas de avaliação funcional da insuficiência cardíaca se mostrou útil no seguimento e na avaliação da resposta terapêutica. Pacientes que permaneceram em classes funcionais III ou IV de NYHA, ou com pontuação igual ou maior que 11 na Ross 2012 ou na The NYU PHFI tiveram pior prognóstico

DOI: 10.5935/2359-4802.20170085 12 International Journal of Cardiovascular Sciences. 2018;31(1)12-21 ARTIGO ORIGINAL Correspondência: Fátima Derlene da Rocha Araújo Rua Indiana, 789, Ap 301. CEP: 30460350, Jardim América, Belo Horizonte, MG ­ Brasil. E-mail: fatima.derlene@hotmail.com, cleverpsi@hotmail.com Prognóstico da Cardiomiopatia Dilatada com Insuficiência Cardíaca Grave de Acordo com Escalas de Classificação Funcional na Infância Prognosis of Dilated Cardiomyopathy with Severe Heart Failure according to Functional Classification Scales in Childhood Fátima Derlene da Rocha Araújo, Rose Mary Ferreira Lisboa da Silva, Henrique de Assis Fonseca Tonelli, Adriana Furletti M Guimarães, Sandra Regina Tolentino Castilho, Zilda Maria Alves Meira Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG ­ Brasil Artigo recebido em 14/02/2017; revisado em 17/04/2017; aceito em 05/06/2017 Resumo Fundamento: A insuficiência cardíaca é principal manifestação da cardiomiopatia dilatada na infância, e a avaliação sistematizada dos sinais e sintomas permite acompanhar o resultado do tratamento. Objetivo: Avaliar o uso de três escalas de classificação funcional da insuficiência cardíaca na evolução de crianças e adolescentes com cardiomiopatia dilatada. Métodos: Estudo longitudinal e observacional incluindo pacientes de zero a 18 anos com cardiomiopatia dilatada e insuficiência cardíaca inicial grave. Todos foram acompanhados por meio das escalas New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) e Ross versão 2012. As análises estatísticas foram feitas com uso do Statistical Package for Social Science , versão 14.0, com teste de Mann-Whitney, teste qui quadrado ou de Fisher, aplicação da Curva Característica de Operação, teste de Wilcoxon e coeficiente de Kappa, para comparação das escalas, e curva Kaplan-Meier, para avaliação da sobrevida. O nível de significância adotado foi de 5%. Resultados: Foram incluídos 57 pacientes, com idade de 1 a 200 meses (média de 48,7 ± 55,9) e seguimento de 6 a 209 meses (média de 63,6 ± 48,4). Houve substancial concordância das escalas Ross 2012 e The NYU PHFI com a NYHA (Kappa = 0,71 e 0,82, respectivamente). A análise pareada pelo teste de Wilcoxon, comparando as escalas antes e após o tratamento, foi significativa (p < 0,0001). A sobrevida maior foi encontrada nos pacientes com classes I/II pela NYHA ou pontuação menor que 11 pontos nas outras. Conclusão: O uso das escalas de avaliação funcional da insuficiência cardíaca se mostrou útil no seguimento e na avaliação da resposta terapêutica. Pacientes que permaneceram em classes funcionais III ou IV de NYHA, ou com pontuação igual ou maior que 11 na Ross 2012 ou na The NYU PHFI tiveram pior prognóstico. (Int J Cardiovasc Sci. 2018;31(1)12-21) Palavras-chave: Cardiomiopatia Dilatada, Prognóstico, Insuficiência Cardíaca, Escalas, Criança, Adolescentes. Abstract Background: Heart failure is the main manifestation of dilated cardiomyopathy in childhood, and the systematic evaluation of signs and symptoms allows monitoring the treatment outcome. Objective: To evaluate the use of three functional classification scales of heart failure in children and adolescents with dilated cardiomyopathy. Methods: Longitudinal and observational study including patients from zero to 18 years with dilated cardiomyopathy and severe initial heart failure. All of them were followed up using the New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) and Ross version 2012 scales. Statistical analyzes were done using Statistical Package for Social Science, version 14.0, with Mann-Whitney test, Chi-Square test or Fisher's test, application of the Operating Characteristic Curve, Wilcoxon test and Kappa coefficient for comparison of scales and Kaplan-Meier curve for survival evaluation. The level of significance adopted was 5%. Results: A total of 57 patients, aged from 1 to 200 months (mean of 48.7 ± 55.9) and follow-up of 6 to 209 months (mean of 63.6 ± 48.4) were included. There was substantial agreement between the Ross 2012 scales, The NYU PHFI and NYHA (Kappa = 0.71 and 0.82, respectively). Paired analysis by the Wilcoxon test, comparing the scales before and after treatment, was significant (p < 0.0001). The greatest survival was found in patients with class I/II by NYHA or scores lower than 11 points in the others. Conclusion: The use of functional assessment scales of heart failure proved to be useful in the follow-up and evaluation of the therapeutic response and there was no difference between them. Patients who remained in functional classification III or IV NYHA or scores ≥ 11 in Ross 2012 or The NYU PHFI had worse prognosis

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)

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.

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

Efecto del ejercicio agudo sobre la expresión del receptor tipo Toll-4 y los mecanismos inflamatorios en corazón de rata / Effect of an acute exercise bout on Toll-like receptor 4 and inflammatory mechanisms in rat hear

Background: Toll like receptor 4 (TLR-4) is a protein located in the cell membrane with an important function in the immune response of the organism. Its activation decreases heart contractility and activates nuclear transcription factor kappa B (NF-kB ). This in turn, increases the synthesis of different pro-inflammatory cytokines and the inducible enzyme nitric oxide (iNOS), which plays an important role in the inflammatory processes when nitric oxide production is enhanced. Aim: To determine if, after one session of acute exercise, expression of TLR-4 and iNOS, and activation of NF-kB are induced in rat cardiac tissue. Material and Methods: Exercise and control groups of eight male Wistar rats each, were studied. The exercise group was subjected to an acute exercise bout lasting one hour. After the exercise, the heart was excised to measure the expression of iNOS and TLR-4 genes by quantitative polyme-rase chain reaction, NF-kB activation by electrophoretic mobility shift assay (EMSA) and p50 by Western blot. Results: After exercise, there was an increase in TLR-4 and of iNOS mRNA levels (+46.7 and +74.3% respectively). NF-kB activation and the nuclear expression of its p50 subunit also increased significantly (+240 and +306% respectively). Conclusions: Increased expression of TLR4 following a session of acute exercise may contribute to the activation of the NF-kB signaling route, promoting the synthesis of nitric oxide, which could influence negatively the cardiac response to high intensity physical exercise.

Manifestação rara de edema agudo de pulmão associado à miocardite lúpica aguda / Rare manifestation of acute pulmonary edema associated with acute lupus myocarditis

O lupus eritematoso sistêmico (LES) é a mais comum das doenças auto-imunes sistêmicas, ocorrendo com maior freqüência no sexo feminino, usualmente na faixa etária entre 16 e 55 anos1,2. Embora os rins classicamente sejam os órgãos mais acometidos no LES, o coração e a circulação cardiopulmonar também podem ser afetados de forma significativa3. Nesse contexto, a ocorrência de edema agudo de pulmão associado à miocardite lúpica é rara e de tratamento imunossupressor específico ainda incerto.

Systemic Lupus Erythematosus (SLE) is the most common systemic autoimmune disease, occurring more frequently in women, usually aged between 16 and 55 years1,2. Although classically the kidneys are the organs most affected in SLE, cardiopulmonary circulation and the heart may also be affected significantly3. In this context, the occurrence of acute pulmonary edema associated with lupus myocarditis is rare and specific immunosuppressive therapy remains unclear.