151
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Kato S, Morimoto SI, Hiramitsu S, Uemura A, Ohtsuki M, Kato Y, Miyagishima K, Yoshida Y, Hashimoto S, Hishida H. Risk factors for patients developing a fulminant course with acute myocarditis. Circ J 2005; 68:734-9. [PMID: 15277731 DOI: 10.1253/circj.68.734] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A fulminant course can be difficult to predict at the onset of acute myocarditis, so the aim of the present study was to identify the predictive clinical symptoms/signs or laboratory findings. METHODS AND RESULTS Thirty-nine patients with acute lymphocytic myocarditis, excluding 8 who manifested shock at admission, were studied. The fulminant group was defined as 12 patients who developed shock after admission, requiring intraaortic balloon pumping or percutaneous cardiopulmonary support, and the non-fulminant group comprised the 27 patients without shock. Various parameters at admission were compared between the 2 groups, together with multiple logistic regression analysis, excluding 6 patients with partially missing values. In the fulminant group, C-reactive protein (7.0 +/- 7.0 vs 2.3 +/- 2.2 mg/dl, p<0.01) and creatine kinase (1,147 +/- 876 vs 594 +/- 568 IU/L, p<0.05) concentrations were higher, intraventricular conduction disturbances were more frequent (9/12 vs 7/27 patients, p<0.01) and the left ventricular ejection fraction was lower (40.7 +/- 13.9 vs 50.1 +/- 10.6%, p<0.05) than in the non-fulminant group. In the multiple logistic regression analysis model with the presence/absence of a fulminant course considered as the independent variable, and C-reactive protein, creatine kinase, intraventricular conduction disturbances, and left ventricular ejection fraction as dependent variables, a high-risk group (expected proportion of fulminant course > or = 0.5) and a low-risk group (<0.5) could be differentiated. A fulminant course occurred in 9/13 (69%) patients in the high-risk group, but in only 2/20 (10%) patients in the low risk group (p<0.001). CONCLUSIONS The risk of a fulminant course of acute myocarditis was high in patients with elevated C-reactive protein, and creatine kinase concentrations, decreased left ventricular ejection fraction, and intraventricular conduction disturbances at the time of admission.
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Affiliation(s)
- Shigeru Kato
- Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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152
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Wisten A, Andersson S, Forsberg H, Krantz P, Messner T. Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis. J Intern Med 2004; 255:213-20. [PMID: 14746558 DOI: 10.1046/j.1365-2796.2003.01277.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992-99. DESIGN A register study of a national database of forensic medicine in Sweden, selecting all cases of SCD 15-35 years of age. In this group, 12-lead ECGs and clinical data were searched for in military conscription and medical records. The ECGs were re-analysed and classified according to the Minnesota code criteria. SETTING The whole nation of Sweden. SUBJECTS Sudden cardiac death victims (66 individuals), 15-35 years of age, where it was possible to obtain an ECG recording. RESULTS We observed major or minor ECG abnormalities in 82% of the subjects. The most common changes were T wave abnormalities (35%), ST segment changes (32%) and conduction defects (20%). The ECGs were evaluated as pathological in 50% of the cases, more often in arrhythmogenic right ventricular cardiomyopathy (88%) and hypertrophic cardiomyopathy (82%). Cardiac-related symptoms were seen in 76% of the total group and there was a family history of a similar cardiac condition in 18%. CONCLUSIONS Pathological ECGs were common in young SCD victims, in spite of being taken many years before death. An ECG could help identify prospective victims of SCD, and should always be taken in cases with possible cardiac-related symptoms or a family history of SCD. The pathological ECGs were often found in connection with routine screening at military enlistment for men, which raises the question of a routine screening in the young, including women.
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Affiliation(s)
- A Wisten
- Department of Internal Medicine, Sunderby Hospital, Luleå, Sweden.
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153
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Lumio JT, Groundstroem KWE, Melnick OB, Huhtala H, Rakhmanova AG. Electrocardiographic abnormalities in patients with diphtheria: a prospective study. Am J Med 2004; 116:78-83. [PMID: 14715320 DOI: 10.1016/j.amjmed.2003.08.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the incidence of and risk factors for electrocardiographic (ECG) abnormalities in adults with diphtheria. METHODS A prospective study was conducted involving 122 adult patients with respiratory tract diphtheria. Diphtheria was confirmed by isolation of a toxin-producing strain of Corynebacterium diphtheriae. Patients had serial clinical evaluations and ECGs for a minimum of 21 days. RESULTS Cardiac involvement was detected in 25 (28%) of 88 evaluable patients, with a median time from symptom onset to an abnormal ECG of 9 days (range, 4 to 24 days). In a logistic regression analysis, age (odds ratio [OR] = 4.1; 95% confidence interval [CI]: 1.6 to 11.0), shared accommodation (OR = 2.9; 95% CI: 1.0 to 8.6), fever (OR = 4.2; 95% CI: 1.1 to 16.6), and extensive respiratory tract infection with subcutaneous edema (OR = 7.0; 95% CI: 1.2 to 42.2) were independent risk factors for cardiac involvement. CONCLUSION Cardiac involvement is a common complication of respiratory tract infection with C. diphtheriae, and occurs more often among older patients, those with lower socioeconomic status, and those with severe respiratory tract involvement.
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Affiliation(s)
- Jukka T Lumio
- Department of Medicine, Tampere University Hospital, Tampere, Finland.
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154
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Chen CJ, Chen MC, Yip HK, Chang HW, Cheng CI, Chen YH, Chai HT, Pan HF, Hsieh CC, Shih SC. Seasonal distribution of pacemaker implantation for symptomatic bradycardia. JAPANESE HEART JOURNAL 2003; 44:379-84. [PMID: 12825805 DOI: 10.1536/jhj.44.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Permanent cardiac-pacemaker therapy is widely recognized as beneficial in the treatment of various types of symptomatic bradycardia. However, the seasonal distribution of pacemaker implantation has never been discussed. The purpose of this study was to investigate the seasonal distribution of pacemaker implantation in a large population of patients with symptomatic bradycardia. The study population consisted of 904 patients who underwent implantation of a new permanent pacemaker between January 1999 and December 2001 and were registered in the database of CPI Company in Taiwan. The number of pacemaker implantations in each month was analyzed to investigate the seasonal distribution of pacemaker implantations in a year. The number of patients who underwent pacemaker implantation between October and December was significantly higher than that of other seasons (P < 0.007). The results indicate that there is a tendency for bradyarrhythmic patients to have symptoms between October and December.
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Affiliation(s)
- Chien-Jen Chen
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
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155
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Hajjar RJ, Kradin RL. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-2002. A 55-year-old man with second-degree atrioventricular block and chest pain. N Engl J Med 2002; 346:1732-8. [PMID: 12037154 DOI: 10.1056/nejmcpc020017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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156
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D'Ambrosio A, Patti G, Manzoli A, Sinagra G, Di Lenarda A, Silvestri F, Di Sciascio G. The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. Heart 2001; 85:499-504. [PMID: 11302994 PMCID: PMC1729727 DOI: 10.1136/heart.85.5.499] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- A D'Ambrosio
- Department of Cardiovascular Sciences, Campus Bio-Medico University, Via E Longoni n 83, 00155 Rome, Italy
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157
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D'Ambrosio A, Patti G, Manzoli A, Sinagra G, Di Lenarda A, Silvestri F, Di Sciascio G. The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. BRITISH HEART JOURNAL 2001. [DOI: 10.1136/hrt.85.5.499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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158
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Pentz WH. Advanced heart block as a manifestation of a paraneoplastic syndrome from malignant thymoma. Chest 1999; 116:1135-6. [PMID: 10531189 DOI: 10.1378/chest.116.4.1135] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Malignant thymoma is a rare tumor that is associated with paraneoplastic syndrome. Myocarditis as a paraneoplastic syndrome has been rarely described. Reported herein is a young male patient with malignant thymoma and myocarditis as part of a paraneoplastic syndrome. This resulted in high-degree heart block and an asystolic cardiac arrest despite placement of a permanent pacemaker.
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Affiliation(s)
- W H Pentz
- Section of Cardiology, University of Chicago Hospitals, Chicago, IL 60637, USA.
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159
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Mendes LA, Picard MH, Dec GW, Hartz VL, Palacios IF, Davidoff R. Ventricular remodeling in active myocarditis. Myocarditis Treatment Trial. Am Heart J 1999; 138:303-8. [PMID: 10426843 DOI: 10.1016/s0002-8703(99)70116-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Remodeling of the left ventricle with the development of a spherical cavity occurs in dilated cardiomyopathy and is associated with a poor long-term prognosis. The early effects of myocarditis on left ventricular geometry have not been previously described or correlated with clinical outcome. METHODS The baseline echocardiograms of 35 patients with biopsy-confirmed myocarditis were compared with 20 normal controls. Left ventricular end-diastolic volume, long axis length, and mid-cavity diameter were measured. The degree of sphericity was expressed as the ratio of the mid-cavity diameter to the long axis length. Left ventricular ejection fraction was assessed by radionuclide angiography. RESULTS In patients with myocarditis, mean left ventricular volume of 81 +/- 29 mL/m(2) was significantly greater than 50 +/- 8 mL/m(2) in controls (P =.001). Chamber dilatation occurred primarily along the mid-cavity diameter, which measured 5.3 +/- 0.8 cm in patients with myocarditis versus 4.2 +/- 0.4 cm in controls (P =.001). The degree of left ventricular sphericity in patients with myocarditis, 0.64 +/- 0.08, was significantly greater than that of controls, 0.54 +/- 0.04 (P =.001). When patients were stratified according to left ventricular volume, patients with increased left ventricular volume (>75 mL/m(2)) were associated with a more spherical chamber and lower left ventricular ejection fraction than patients with a more normal left ventricular volume (</=75 mL/m(2)). CONCLUSIONS Active myocarditis is associated with early left ventricular remodeling and the development of a spherical chamber. These changes correlate with ventricular dilatation and reduced left ventricular ejection fraction.
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Affiliation(s)
- L A Mendes
- Evans Memorial Department of Clinical Research, Boston Medical Center, Boston, MA, USA
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160
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Pawsat DE, Lee JY. Inflammatory disorders of the heart. Pericarditis, myocarditis, and endocarditis. Emerg Med Clin North Am 1998; 16:665-81, ix. [PMID: 9739781 DOI: 10.1016/s0733-8627(05)70024-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The emergency physician frequently sees patients with cardiac complaints. Too often, ischemic heart disease is overwhelmingly considered to the exclusion of other diagnostic possibilities such as inflammatory cardiac disorders. These disorders can cause considerable discomfort, have long-term implications, or lead to more serious cardiac disorders. Emergency physicians must have a practical understanding of the diagnostic evaluation and therapeutic approach to patients with inflammatory cardiac disorders.
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Affiliation(s)
- D E Pawsat
- Michigan State University Emergency Medicine Residency, Ingham Regional Medical Center, Lansing, USA
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161
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Jeong MH, Ahn YK, Gill GC, Park JH, Cho JG, Park JC, Kang JC. Tsutsugamushi myocarditis with congestive heart failure and persistent atrial standstill. JAPANESE CIRCULATION JOURNAL 1996; 60:382-8. [PMID: 8844306 DOI: 10.1253/jcj.60.382] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Acute infectious myocarditis is primarily by viruses and bacteria, but sometimes by rickettsia. Tsutsugamushi disease is a febrile illness caused by Rickettsia tsutsugamushi, and has been prevalent in Korea since 1985. Characteristics of tsutsugamushi disease are fever, rash and eschar. Tsutsugamushi myocarditis is rare. Cardiac involvement may include ST-T changes, PR prolongation, mild mitral regurgitation, and perivascular inflammation with myocardial necrosis. We describe here a 50-year-old woman who complained of fever, orthopnea and chest pain. Work-up of the patient revealed abdominal scar, positive tsutsugamushi antibody, congestive heart failure with severe mitral and tricuspid regurgitation, persistent atrial standstill on electrophysiologic study, junctional rhythm and ST-T changes mimicking anterior myocardial infarction and myocardial inflammation with perivasculitis on endomyocardial biopsy. The patient's condition improved with doxycycline and inotropics. Persistent atrial standstill during was found at the one-year follow-up.
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Affiliation(s)
- M H Jeong
- Department of Internal Medicine, Chonnam University Medical School, Dongku, Kwang Ju, Korea
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162
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Johnsrude CL, Perry JC, Cecchin F, Smith EO, Fraley K, Friedman RA, Towbin JA. Differentiating anomalous left main coronary artery originating from the pulmonary artery in infants from myocarditis and dilated cardiomyopathy by electrocardiogram. Am J Cardiol 1995; 75:71-4. [PMID: 7801869 DOI: 10.1016/s0002-9149(99)80531-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Anomalous left main coronary artery (ALMCA) originating from the pulmonary artery is an important cause of morbidity from heart failure and mortality in infants. Discriminating ALMCA from myocarditis or other forms of dilated cardiomyopathy (DC) in infants is critical for proper early management of this treatable disease. This study was performed to characterize electrocardiographic (ECG) patterns in infants with ALMCA, and to identify features that would allow differentiation of these infants from those with myocarditis/DC. Presenting electrocardiograms from 28 patients with ALMCA < 2 years of age were analyzed for 103 variables, and compared with electrocardiograms from 28 aged-matched infants with myocarditis/DC using the t test, Fisher's exact test, and discriminant analysis using stepwise logistic regression techniques. ECG findings characteristic of infants with ALMCA were confirmed, including deep (> or = 3 mm) and wide (> or = 30 ms) Q waves and a QR pattern in at least 1 of the following leads: I, aVL, V5 to V7. Also, the complete absence of Q waves from leads II, III, and aVF in all infants with ALMCA was noted. These and other ECG patterns were more common in infants with ALMCA than in those with myocarditis/DC (p < 0.05), but were also noted in some patients with myocarditis/DC. Stepwise logistic regression analysis identified 3 ECG variables that best discriminated ALMCA from myocarditis/DC, including Q wave width (w) in lead I, and Q-wave depth (d) and ST-segment amplitude (s) in lead aVL.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C L Johnsrude
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas
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163
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Matsuura H, Palacios IF, Dec GW, Fallon JT, Garan H, Ruskin JN, Yasuda T. Intraventricular conduction abnormalities in patients with clinically suspected myocarditis are associated with myocardial necrosis. Am Heart J 1994; 127:1290-7. [PMID: 8172058 DOI: 10.1016/0002-8703(94)90048-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Twenty-nine patients with suspected myocarditis, either with or without intraventricular conduction abnormalities, were investigated for degree of myocardial necrosis by antimyosin scintigraphy. Among those 29 patients, 16 had intraventricular conduction abnormalities. Antimyosin scans were analyzed for heart/lung ratios and semiquantitative visual uptake scores (0 to 4+ scale). Of the 16 patients with conduction abnormalities, 15 (94%) demonstrated visual antimyosin uptake versus 7 (54%) of 13 cases without conduction abnormalities (p < 0.03). In addition, the heart/lung ratios and uptake scores were significantly higher in the group with conduction abnormalities than in the group without (1.64 +/- 0.31 vs 1.39 +/- 0.20, p < 0.03; and 2.3 +/- 0.7 vs 1.4 +/- 0.7, p < 0.005; respectively). In conclusion, intraventricular conduction abnormalities in patients with suspected myocarditis were more strongly associated with active and more severe myocardial necrosis as judged by antimyosin imaging than patients with normal electrocardiograms.
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Affiliation(s)
- H Matsuura
- Division of Nuclear Medicine, Massachusetts General Hospital 02114
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