11/846. A case of peripartum eosinophilic myocarditis. A 19-year-old postpartum patient with a previous history of asthma and eosinophilic myocarditis is described. Eosinophilic myocarditis is thought to be caused by exacerbation of the idiopathic hypereosinophilic syndrome by pregnancy. The diagnosis was made by a right ventricular endomyocardial biopsy, which showed an eosinophilic infiltrate with a few scattered foci of myonecrosis, but no fibrosis, vasculitis or granulomas. The patient's myocardial function continued to decline over a two-year follow-up period, despite normal levels of eosinophils. She developed echocardiographic evidence of diastolic and systolic dysfunction. ( info) |
12/846. Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP. A case of eosinophilic myocarditis following high serum levels of eosinophil cationic protein (ECP) is described. A 27 year old woman was admitted with new york Heart association (NYHA) class III congestive heart failure. A haematological study showed hypereosinophilia with degranulation and vacuoles; the total eosinophil count was 7980/ml and the ECP serum concentration was noticeably high at 150 ng/ml. Endomyocardial biopsy from the right ventricle showed infiltration of eosinophils and dense deposits of ECP in the endocardium as well as the myocardium. Steroid treatment returned the total eosinophil count and serum ECP to normal, with satisfactory improvement in clinical features. eosinophilia may cause cardiac damage, and this report confirms that eosinophil degranulation is toxic. Thus, serum ECP seems to be a reliable indicator for diagnosis and for determining treatment parameters of eosinophilic myocarditis. ( info) |
13/846. The use of molecular technologies for the detection of enteroviral ribonucleic acid in myocarditis. The introduction of molecular technology to the field of cardiovascular research has revolutionized the diagnosis and determination of the pathogenesis of diseases. This has been the case for viral myocarditis. Although rapid identification and specific treatment for viral disorders such as myocarditis continue to challenge researchers, molecular detection techniques have provided an insight into the role of viral genomes in this disorder. Although in situ hybridization (ISH) continues to be an effective detection method and is utilized in many laboratories, polymerase chain reaction (PCR) techniques are fast becoming the standard for molecular analysis in patients with viral myocarditis. Following a review of viral myocarditis, the roles of ISH and PCR will be discussed. Lastly, clinical relevance and areas of future research will be presented. ( info) |
| A 10-week-old, 31-week gestation preterm boy re-presented with heart failure after an initial episode of neonatal aseptic meningitis with positive CSF enterovirus polymerase chain reaction. Investigation demonstrated global myocardial dysfunction with left ventricle posterolateral myocardial infarction. The boy's heart failure was controlled with medical treatment but his myocardial dysfunction persisted 9 months after presentation. ( info) |
| We describe congestive heart failure caused by autoimmune myocarditis in a patient with primary sjogren's syndrome. Only after corticosteroids were given did the symptoms and laboratory abnormalities disappear. ( info) |
16/846. Children may survive severe myocarditis with prolonged use of biventricular assist devices. The outcome of acute myocarditis with cardiogenic shock is poor. In some children in whom aggressive medical treatment fails, artificial replacement of heart function may offer lifesaving support until the myocardium has recovered. Four previously healthy children (three boys aged 4, 6, and 1 years; one girl aged 5) developed acute myocarditis with ventricular failure and multiorgan dysfunction caused by low cardiac output. Biventricular assist devices (BVAD) were implanted for prolonged support. In three children cardiac function improved and after up to 21 days mechanical support could be withdrawn. They had full recovery of heart function. In the fourth patient there was no myocardial recovery after a period of 20 days. He underwent orthotopic heart transplantation with an uneventful postoperative course. Prolonged circulatory support with BVAD is an effective method for bridging until cardiac recovery or transplantation in children. ( info) |
17/846. Septicaemia and endomyocarditis caused by aerococcus urinae. aerococcus urinae, an uncommon urinary tract pathogen, was recently shown to cause septicaemia and endocarditis in a few patients in denmark and the netherlands. In austria this is the first report of a fatal course of endomyocarditis by aerococcus urinae, associated with multiple septic infarcts. ( info) |
18/846. 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. ( info) |
19/846. Lyme carditis: complete AV dissociation with episodic asystole presenting as syncope in the emergency department. We report a case of Lyme carditis in an otherwise-healthy young male who presented to the Emergency Department (ED) with syncope and a possible seizure. This patient, without documented history of lyme disease, acutely developed third-degree atrioventricular (AV) block with episodic asystole, which required placement of a transvenous pacemaker in the ED and resolved only after the patient had been placed on ceftriaxone. We discuss the significance of Lyme carditis and its increasing prevalence, and review the current literature. We also recommend appropriate screening modalities for patients with known lyme disease, or an atypical profile for cardiac abnormalities. ( info) |
20/846. inflammation of the cardiac conduction system in a case of hyperthyroidism. A 37-year-old female showed signs of hyperthyroidism 2 weeks before death after a partial thyroidectomy was carried out 15 years previously. An examination 3 days before death revealed a normal blood cell count, an increased level of thyroidal hormones, sinus tachycardia and a high blood pressure of 170/90 mm Hg. A hyperthyroidism was diagnosed and therapy with carbimazol (2 x 10 mg) was started but 2 days later fever and chill occurred and before death short phases of unconsciousness and dyspnoea. The autopsy findings showed an interstitial inflammation of the AV-node, the His-bundle and its branches which can correlate with typical ECG changes in hyperthyroidism. ( info) |