Myocarditis: somethings old and something new

Razzano, Dana; Fallon, John T.

doi:10.1016/j.carpath.2019.107155

Cited by 26 publications

(16 citation statements)

References 101 publications

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“…Direct viral toxicity on cardiomyocytes has occurred in the setting of other viral infections such as coxsackievirus-induced myocarditis. In this case, the entry of the coxsackievirus is through the coxsackievirus and adenovirus receptor (CAR) and through release of protease 2A coded by coxsackievirus particles, disrupting the dystrophin cytoskeleton complex [53][54][55]. In the case of coronavirus, as mentioned above, the spike (S) protein of coronaviruses facilitates viral entry into target cells.…”

Section: Viral Toxicity and Myocardial Injury In Covid-2mentioning

confidence: 99%

Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response

et al. 2020

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Purpose of Review Coronavirus disease of 2019 (COVID-19) is a cause of significant morbidity and mortality worldwide. While cardiac injury has been demonstrated in critically ill COVID-19 patients, the mechanism of injury remains unclear. Here, we review our current knowledge of the biology of SARS-CoV-2 and the potential mechanisms of myocardial injury due to viral toxicities and host immune responses. Recent Findings A number of studies have reported an epidemiological association between history of cardiac disease and worsened outcome during COVID infection. Development of new onset myocardial injury during COVID-19 also increases mortality. While limited data exist, potential mechanisms of cardiac injury include direct viral entry through the angiotensinconverting enzyme 2 (ACE2) receptor and toxicity in host cells, hypoxia-related myocyte injury, and immune-mediated cytokine release syndrome. Potential treatments for reducing viral infection and excessive immune responses are also discussed. Summary COVID patients with cardiac disease history or acquire new cardiac injury are at an increased risk for in-hospital morbidity and mortality. More studies are needed to address the mechanism of cardiotoxicity and the treatments that can minimize permanent damage to the cardiovascular system.

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Section: Viral Toxicity and Myocardial Injury In Covid-2mentioning

confidence: 99%

Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response

et al. 2020

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“…Clinical presentations of acute myocarditis (AM) vary through a wide range of manifestations [1,2], affecting either children [3] or adults [4]. The infarct-like onset, the most common clinical pattern [5] which seems to be mostly correlated to Parvovirus B19 infection [6], is characterized by flu-like symptoms followed by chest pain, typical electrocardiogram (ECG) features, myocardial necrosis biomarkers release (in particular T-troponin) and normal coronary angiogram [7].…”

Section: Introductionmentioning

confidence: 99%

Use of the new Lake Louise Criteria improves CMR detection of atypical forms of acute myocarditis

Cundari

Galea

Rubeis

et al. 2020

Int J Cardiovasc Imaging

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The purpose of our study was to compare diagnostic performance of old and new Lake Louise Criteria (oLLC and nLLC) among different clinical presentations: infarct-like (IL), cardiomyopathic (CM) and arrhythmic (AR). 102 patients with clinical suspicion of acute myocarditis underwent cardiac magnetic resonance (CMR) on a 1.5 T scanner. Protocol included cine-SSFP, T2-weighted STIR, T2 mapping, early and late gadolinium enhancement and T1 mapping acquired before and after gadolinium administration. The degree of agreement has been calculated with Cohen’s K test. 42 patients also underwent endomyocardial biopsy (EMB). IL onset was present in 54/102 patients, CM in 28/102 and AR in 20/102. nLLC were positive in 58.3% of the patients, while oLLC in 37.9%, k = 0.57 (IC: 0.428–0.713). The degree of agreement between nLLC and oLLC was 0.49 (IC: 0.111–0.876) for AR onset (nLLC positive in 35% vs oLLC in 15%), 0.25 (IC: 0.035–0.459) for CM pattern (nLLC positive in 60.7% vs oLLC 17.9%) and 0.73 (IC: 0.543–0.912) for IL presentation (nLLC positive in 66.7% vs oLLC in 57.4%). Diagnostic accuracy was 75% for both nLLC and oLLC among IL onset, and 41.6% for oLLC vs 66.7% for nLLC, as regards CM clinical presentation. nLLC have improved diagnostic performance of CMR for the diagnosis of acute myocarditis, in particular for atypical clinical presentation.

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“…Causes of myocarditis include viruses such as human herpes virus 6 and parvovirus B19, bacteria, parasites and fungi, drugs and allergies, autoimmune-associated, and specific entities such as giant cell myocarditis and amyloid-associated myocarditis. 2 The gold standard in diagnosis is endomyocardial biopsy with immunohistochemistry staining. 2 Acute myocarditis may resolve spontaneously, be treated successfully or evolve into a dilated cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

“… 2 The gold standard in diagnosis is endomyocardial biopsy with immunohistochemistry staining. 2 Acute myocarditis may resolve spontaneously, be treated successfully or evolve into a dilated cardiomyopathy. 2 …”

Section: Introductionmentioning

confidence: 99%

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Myocarditis in Crohn’s disease: a case report

McGrath-Cadell

Bart

Lin

et al. 2020

European Heart Journal - Case Reports

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Abstract Background Mobile valvular masses are often considered pathognomonic for infective endocarditis. We present a case of a young patient with mobile valvular masses in the context of myocarditis likely secondary to active ileal Crohn’s disease. Cardiac magnetic resonance (CMR) imaging was crucial in diagnosing and monitoring our patient. Case summary A 27-year-old woman presented with pleuritic chest pain, dyspnoea, and a 3-day history of fevers. She also reported a 2-month history of intermittent visual loss in her right eye. She had a history of histologically proven ileal Crohn’s disease, diagnosed 5 months prior. She was haemodynamically unstable on presentation. Abnormalities on a transthoracic echocardiogram necessitated a transoesophageal echocardiogram. After blood cultures were sent, the patient was commenced on empirical treatment for infective endocarditis with gentamicin and flucloxacillin. Eight days after her initial presentation, all blood cultures remained negative and she was changed to empirical treatment for culture negative endocarditis with ceftriaxone and vancomycin, according to local protocol. Despite 8 days of treatment for infective endocarditis she remained febrile. A CMR was organized on Day 9 and this showed myocarditis, which changed the treatment paradigm. She responded swiftly to steroids and anti-coagulation. Discussion In this case, echo-dense valvular lesions are not pathognomonic for infective endocarditis and a careful diagnostic process involving multi-modality imaging, including CMR, occurred to arrive at a diagnosis of myocarditis likely secondary to Crohn’s disease.

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Myocarditis: somethings old and something new

Cited by 26 publications

References 101 publications

Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response

Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response

Use of the new Lake Louise Criteria improves CMR detection of atypical forms of acute myocarditis

Myocarditis in Crohn’s disease: a case report

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