1/55. Bedside transseptal balloon dilation atrial septostomy for decompression of the left heart during extracorporeal membrane oxygenation.A 10-year-old male presented with severe heart failure secondary to myocarditis. Venoarterial extracorporeal membrane oxygenation was instituted. He developed severe left heart distention with acute pulmonary hemorrhage. Balloon dilation of the atrial septum to decompress the left atrium was performed at the bedside with transesophageal echocardiographic guidance.- - - - - - - - - - ranking = 1keywords = carditis, myocarditis (Clic here for more details about this article) |
2/55. The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients.This report describes the evaluation of 1,278 patients referred to The Johns Hopkins Hospital with dilated cardiomyopathy. After a careful history and physical examination, selected laboratory tests, and endomyocardial biopsy, a specific diagnosis was made in 49% of cases. In 16% of cases the biopsy demonstrated a specific histologic diagnosis. myocarditis and coronary artery disease were the most frequent specific diagnoses; 51% of patients were classified as idiopathic. Thus a rigorous and systematic search can demonstrate an underlying cause for approximately one-half of patients with unexplained cardiomyopathy. Endomyocardial biopsy plays a crucial role in this evaluation. Six cases are presented which demonstrate the utility of endomyocardial biopsy in specific clinical situations. In addition to its routine use in monitoring rejection in heart transplant recipients, endomyocardial biopsy is indicated in the evaluation of possible infiltrative cardiomyopathy, in differentiating restrictive cardiomyopathy from constrictive pericarditis, and in diagnosing and monitoring doxorubicin cardiotoxicity. The importance of diagnosing myocarditis remains controversial, and disagreement persists about the utility of immunosuppressive therapy in these patients. A combination of clinical and histologic features can divide patients with myocarditis into 4 subgroups--acute, fulminant, chronic active, and chronic persistent. This classification provides prognostic information and may identify those patients who may respond to immunosuppression, as well as those likely to have adverse outcomes from such treatment. The continued development of novel molecular techniques may allow endomyocardial biopsy to provide greater prognostic and therapeutic information in the future.- - - - - - - - - - ranking = 3.0202922531854keywords = carditis, myocarditis (Clic here for more details about this article) |
3/55. Heart transplant for dilated cardiomyopathy associated with polymyositis.Cardiac involvement is one of the most significant factors in the poor clinical outcome of polymyositis. The case of a 39 year old African American woman with polymyositis, cardiomyopathy, and severe heart failure who had orthotopic heart transplantation is described. review of the literature reveals that cardiac manifestations of polymyositis are frequent and include conduction system abnormalities, myocarditis, cardiomyopathy, coronary artery atherosclerosis, valvar disease, and pericardial abnormalities.- - - - - - - - - - ranking = 1keywords = carditis, myocarditis (Clic here for more details about this article) |
4/55. A probable primary hiv infection associated with acute non-specific myocarditis causing severe dilated cardiomyopathy.A patient with a probable primary hiv infection and a biopsy proven non-specific myocarditis is reported. The patient developed a severe dilated cardiomyopathy and initially presented with global heartfailure and fever. The left ventricular function partially recovered. One week after discharge the patient was readmitted in a septic shock and died. Current hypotheses concerning the etiology of left ventricular dysfunction in hiv infection are discussed.- - - - - - - - - - ranking = 5keywords = carditis, myocarditis (Clic here for more details about this article) |
5/55. myocarditis and cardiomyopathy associated with clozapine.BACKGROUND: clozapine is effective for resistant schizophrenia. After two sudden deaths in physically well young men soon after starting clozapine, we investigated the cardiovascular complications for this drug. methods: From January, 1993, to March, 1999, 8000 patients started clozapine treatment in australia, and were registered with a mandatory monitoring service. We identified cases of myocarditis and cardiomyopathy from voluntary reports to the Australian Adverse Drug Reaction Committee and sought details of the relevant diagnostic studies, necropsies that had been done in suspicious cases, or both. FINDINGS: 23 cases (20 men, three women, mean age 36 years [SD 9]) were identified: 15 of myocarditis and eight of cardiomyopathy associated with clozapine treatment. Six patients died. All cases of myocarditis (five deaths) occurred within 3 weeks of starting clozapine. Cardiomyopathy (one death) was diagnosed up to 36 months after clozapine was started. Necropsy results showed mainly eosinophilic infiltrates with myocytolysis, consistent with an acute drug reaction. INTERPRETATION: clozapine therapy may be associated with potentially fatal myocarditis and cardiomyopathy in physically healthy young adults with schizophrenia.- - - - - - - - - - ranking = 6.0405845063707keywords = carditis, myocarditis (Clic here for more details about this article) |
6/55. The enigma of recent onset dilated cardiomyopathy: what cause, what consequence, what control?Acute onset dilated cardiomyopathy is a very common presentation encountered by cardiologists in clinical practice, but little is known about the etiology, pathophysiology, definitive diagnosis and management of this syndrome. The vast majority of cases are considered as idiopathic cardiomyopathy, or primary or secondary myocarditis, although rarely definitive diagnoses are obtained after extensive diagnostic procedures. Two scenarios are presented as a basis for a discussion of this challenging syndrome.- - - - - - - - - - ranking = 1keywords = carditis, myocarditis (Clic here for more details about this article) |
7/55. Reversible hyperthyroidism and cardiomyopathy caused by consumption of iodocasein.We report the case of a 52-year-old woman with recent diagnosis of acute myocarditis and pericarditis, admitted for fever, tachycardia, and dyspnea upon exertion. Hematochemical parameters and instrumental examinations suggested iatrogenic hyperthyroidism and secondary dilated cardiomyopathy. Although gathering information about the medication used at home was initially difficult because of the patient's refusal to cooperate, she ended up by disclosing the regular assumption of an iodocasein drug. A complete and stable regression of the clinical picture was reached by suspending the iodine derivative and using cardiovascular drugs.- - - - - - - - - - ranking = 1.5101461265927keywords = carditis, myocarditis (Clic here for more details about this article) |
8/55. diagnosis and management of left ventricular assist device valve-endocarditis: LVAD valve replacement.A 57-year-old man who has been wearing a Novacor N100 left ventricular assist device (LVAD) for more than 3 years suffered from LVAD endocarditis. Only by immunoscintigraphic methods was it possible to localize the septic focus. After successful exchange of in- and outflow tract valves, the infection was eradicated. Microscopic investigation confirmed the scintigraphic findings: gram-positive bacteria were found. The valves showed no gross degenerative lesions after more than 1,100 days of implantation. The patient is now doing well.- - - - - - - - - - ranking = 2.5507306329634keywords = carditis (Clic here for more details about this article) |
9/55. Diffuse and severe left ventricular dysfunction induced by epicardial coronary artery spasm.Endothelial dysfunction and effectiveness of treatment of calcium antagonists are suggestive of coronary artery spasm as an underlying disorder in dilated cardiomyopathy (DCM). The aim of this study is to determine whether or not the epicardial coronary artery spasm can induce severe cardiac dysfunction like DCM. Thirty-four consecutive patients with angiographically normal coronary arteries and diffuse left ventricular hypokinesis whose causes had been unknown underwent acetylcholine provocation test and left ventricular biopsy. Eight patients were excluded according to the clinical and laboratory data and biopsy findings suggesting myocarditis or other systemic diseases. According to the results of the acetylcholine provocation test, 17 patients were finally diagnosed as having DCM, and nine patients (35% of the study patients), who had acetylcholine-induced diffuse and multivessel coronary spasm, were diagnosed as having DCM-like vasospastic angina pectoris (VSA). Clinical and cardiac catheterization data including hemodynamics and biopsy findings were similar between the two groups except that left ventricular end-systolic volume was significantly greater in DCM than in DCM-like VSA. After the acetylcholine provocation test, DCM patients received both a beta blocker and an angiotensin-converting enzyme inhibitor, and DCM-like VSA patients received antianginal drugs. In echocardiographic findings at predischarge and those after 6-month drug treatment, both DCM-lke VSA and DCM showed significant reduction in end-diastolic and end-systolic diameters and significant increase in fractional shortening and ejection fraction, whereas changes in ejection fraction and fractional shortening were significantly greater in DCM-like VSA than those in DCM. Epicardial coronary artery spasm can induce diffuse and severe left ventricular dysfunction like DCM in VSA. Although antianginal drugs markedly improve left ventricular function of these patients, only the acetylcholine provocation test can identify DCM-like VSA.- - - - - - - - - - ranking = 1keywords = carditis, myocarditis (Clic here for more details about this article) |
10/55. Healing of acute myocarditis with left ventricular assist device: morphological recovery and evolution to the aspecific features of dilated cardiomyopathy.Dilated cardiomyopathy may result from an acute myocarditis. Little is reported in vivo documenting the progression from the acute inflammatory disease to the healing phase. We describe the consecutive light and electron microscopy studies performed on five myocardial sample series in a 47-year-old female patient who was referred to our hospital with acute myocarditis. She was sustained with left ventricular assist device (LVAD) for 63 days, and then she died of cerebral hemorrhage. The first three consecutive endomyocardial biopsies (days 2, 4, 36 from onset) documented the acute and early healing phase of the inflammatory disease. In the last two biopsies (days 50 and 64 from onset) active inflammation and myocyte necrosis were absent. The histopathological features were those commonly observed in most patients diagnosed with dilated cardiomyopathy, namely myocyte hypertrophy, nuclear size and shape irregularities, and interstitial fibrosis. overall, the myocyte morphology significantly improved and LVAD support likely contributed to the structural recovery. The major conclusions to be drawn from this case are: 1) the aspecific pathologic findings of dilated cardiomyopathy patients may result from an acute myocardial inflammation; 2) immediate endomyocardial biopsy in patients with clinically diagnosed myocarditis minimizes the risk of missing the diagnosis of inflammatory disease; to this aim a precise definition of "early onset" is especially needed; 3) LVAD support may contribute to the morphological recovery of severely damaged myocytes.- - - - - - - - - - ranking = 7keywords = carditis, myocarditis (Clic here for more details about this article) |
| | Next -> |