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Lankapothu PBR, Dasi SC, Bhaskaran S, Bathena AK. Evaluating the Effectiveness of the Salzburg Myocarditis Score in Differentiating Acute Coronary Syndrome and Myocarditis Among Adults Presenting With Acute Chest Pain: An Observational Study. Cureus 2024; 16:e68460. [PMID: 39360084 PMCID: PMC11446261 DOI: 10.7759/cureus.68460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Acute chest pain is a common and challenging clinical presentation, necessitating rapid and accurate differentiation between potentially life-threatening etiologies like acute coronary syndrome (ACS) and acute myocarditis. The Salzburg Myocarditis Score (SMS), designed to aid in the early detection of myocarditis, offers a structured approach to this diagnostic challenge. However, the lack of a reliable clinical score for differentiating between these two conditions has been highlighted in recent literature, particularly in the context of limitations in using troponin levels alone for myocarditis diagnosis. OBJECTIVE This study aimed to assess the diagnostic accuracy of the SMS for differentiating ACS and myocarditis in adult patients presenting with acute chest pain at Saveetha Medical College, Chennai, India. METHODS A retrospective observational cohort study was conducted involving 100 consecutive patients presenting with acute chest pain. The SMS was calculated for each patient, and the final diagnoses of ACS or myocarditis were confirmed through comprehensive cardiac imaging (echocardiography or cardiac MRI) and additional biomarker analysis, following recommendations from established guidelines. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and a chi-square test were employed for statistical analysis. RESULTS Among the 100 patients, 60 were diagnosed with ACS, and one was diagnosed with myocarditis. The SMS demonstrated high sensitivity (84.09%) and specificity (88.76%) for ACS, aligning with previous research findings. However, for myocarditis, the sensitivity was notably lower (25.81%), while specificity remained high (95.12%), consistent with concerns raised about the limitations of the score in identifying myocarditis. The PPV and NPV for ACS were 60% and 100%, respectively, while for myocarditis, the PPV and NPV were 2.5% and 100%, respectively. A chi-square test revealed a significant association between SMS predictions and the final diagnosis (p<0.001). CONCLUSION The SMS is a valuable tool for identifying ACS in patients with acute chest pain. However, due to its low sensitivity for myocarditis, additional diagnostic tests, such as cardiac MRI, are crucial when myocarditis is suspected, despite a low SMS.
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Affiliation(s)
- Prem Balaji Reddy Lankapothu
- General Medicine, Saveetha Medical College and Hospitals, Saveetha Institute Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sharath Chandra Dasi
- General Medicine, Saveetha Medical College and Hospitals, Saveetha Institute Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Shrinidhi Bhaskaran
- General Medicine, Saveetha Medical College and Hospitals, Saveetha Institute Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Arun Kumar Bathena
- General Medicine, Saveetha Medical College and Hospitals, Saveetha Institute Medical and Technical Sciences, Saveetha University, Chennai, IND
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2
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Van Ochten N, deQuillfeldt NP, Edward JA, Meyer M, Bollinger D, Le P, Frasca K, Garcia Rivera MV, Moudgal AN, Rogers K. Challenging chest pain: salmonella myopericarditis. BMJ Case Rep 2024; 17:e260573. [PMID: 39181573 DOI: 10.1136/bcr-2024-260573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Salmonella infections have been associated with cardiovascular complications, including myocarditis and myopericarditis. This presentation of Salmonella myopericarditis highlights key clinical features to aid in diagnosis and the importance of prompt treatment with antibiotics, colchicine and non-steroidal anti-inflammatory drugs (NSAIDs).
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Affiliation(s)
- Natalie Van Ochten
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Natalie P deQuillfeldt
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Justin A Edward
- Department of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marita Meyer
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel Bollinger
- University of Colorado Medical School, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Preston Le
- University of Colorado Medical School, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine Frasca
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mirian V Garcia Rivera
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anita N Moudgal
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kevin Rogers
- Department of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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3
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Domínguez F, Uribarri A, Larrañaga-Moreira JM, Ruiz-Guerrero L, Pastor-Pueyo P, Gayán-Ordás J, Fernández-González B, Esteban-Fernández A, Barreiro M, López-Fernández S, Gutiérrez-Larraya Aguado F, Pascual-Figal D. Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:667-679. [PMID: 38763214 DOI: 10.1016/j.rec.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 05/21/2024]
Abstract
Myocarditis is defined as myocardial inflammation and its etiology is highly diverse, including infectious agents, drugs, and autoimmune diseases. The clinical presentation also varies widely, extending beyond the classic clinical picture of acute chest pain, and includes cases of cardiomyopathy of unknown cause whose etiology may be inflammatory. Because certain patients may benefit from targeted treatments, the search for the etiology should begin when myocarditis is first suspected. There remain several areas of uncertainty in the diagnosis and treatment of this disease. Consequently, this consensus document aims to provide clear recommendations for its diagnosis and treatment. Hence, a diagnostic algorithm is proposed, specifying when non-invasive diagnosis with cardiac MR is appropriate vs a noninvasive approach with endomyocardial biopsy. In addition, more novel aspects are discussed, such as when to suspect an underlying genetic etiology. The recommendations cover the management of myocarditis and inflammatory cardiomyopathy, both for general complications and specific clinical entities.
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Affiliation(s)
- Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Luis Ruiz-Guerrero
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Pablo Pastor-Pueyo
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Jara Gayán-Ordás
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | | | - Manuel Barreiro
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | | | - Domingo Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, El Palmar, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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4
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Huang JH, Ju KS, Liao TW, Lin YK, Yeh JS, Chen YJ. Adverse Cardiovascular Effects of COVID-19 Vaccination: A Systematic Review. Cardiol Rev 2024; 32:314-319. [PMID: 38848534 DOI: 10.1097/crd.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Several vaccines against coronavirus disease 2019 (COVID-19)-caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-have been developed since the COVID-19 pandemic began. Of these, 7 have been approved in the World Health Organization's Emergency Use Listing. However, these vaccines have been reported to have rare or serious adverse cardiovascular effects. This review presents updated information on the adverse cardiovascular effects of the approved COVID-19 vaccines-including inactivated vaccines, protein subunit vaccines, virus-like particles, nucleic acid vaccines, and viral vector vaccines-and the underlying mechanisms.
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Affiliation(s)
- Jen-Hung Huang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Ke-Shiuan Ju
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Wei Liao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Jong-Shiuan Yeh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
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5
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Srivastava A, Nalroad Sundararaj S, Bhatia J, Singh Arya D. Understanding long COVID myocarditis: A comprehensive review. Cytokine 2024; 178:156584. [PMID: 38508059 DOI: 10.1016/j.cyto.2024.156584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
Infectious diseases are a cause of major concern in this twenty-first century. There have been reports of various outbreaks like severe acute respiratory syndrome (SARS) in 2003, swine flu in 2009, Zika virus disease in 2015, and Middle East Respiratory Syndrome (MERS) in 2012, since the start of this millennium. In addition to these outbreaks, the latest infectious disease to result in an outbreak is the SARS-CoV-2 infection. A viral infection recognized as a respiratory illness at the time of emergence, SARS-CoV-2 has wreaked havoc worldwide because of its long-lasting implications like heart failure, sepsis, organ failure, etc., and its significant impact on the global economy. Besides the acute illness, it also leads to symptoms months later which is called long COVID or post-COVID-19 condition. Due to its ever-increasing prevalence, it has been a significant challenge to treat the affected individuals and manage the complications as well. Myocarditis, a long-term complication of coronavirus disease 2019 (COVID-19) is an inflammatory condition involving the myocardium of the heart, which could even be fatal in the long term in cases of progression to ventricular dysfunction and heart failure. Thus, it is imperative to diagnose early and treat this condition in the affected individuals. At present, there are numerous studies which are in progress, investigating patients with COVID-19-related myocarditis and the treatment strategies. This review focuses primarily on myocarditis, a life-threatening complication of COVID-19 illness, and endeavors to elucidate the pathogenesis, biomarkers, and management of long COVID myocarditis along with pipeline drugs in detail.
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Affiliation(s)
- Arti Srivastava
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | | | - Jagriti Bhatia
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Dharamvir Singh Arya
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Collini V, De Martino M, Andreis A, De Biasio M, Gaspard F, Paneva E, Tomat M, Deferrari GM, Isola M, Imazio M. Efficacy and safety of colchicine for the treatment of myopericarditis. Heart 2024; 110:735-739. [PMID: 38238076 PMCID: PMC11103299 DOI: 10.1136/heartjnl-2023-323484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/18/2023] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE Clinical trials have evaluated the efficacy and safety of colchicine only in simple pericarditis, excluding cases of concomitant myocarditis. The aim of this paper is to evaluate the efficacy and safety of colchicine for the treatment of the first attack of acute pericarditis with concomitant myocardial involvement. METHODS Double-centre retrospective cohort study analysing consecutive patients admitted for first attack of pericarditis with myocarditis and treated with or without colchicine. The primary efficacy end point was the time to the first recurrence. Propensity score matching was used to generate two groups of patients with similar baseline characteristics. Colchicine-associated side effects were analysed as safety end-point. RESULTS A total of 175 patients (mean age 46.2±20.1 years, 25.1% females, 88.6% with idiopathic/viral aetiology) were included. Seventy-nine (45.1%) patients were treated with colchicine. After a median follow-up of 25.3 (IQR 8.3-45.6) months, 58 (33.1%) patients had recurrences. The propensity score generated two groups of 73 patients with similar baseline characteristics but the use of colchicine. Patients treated with colchicine had a lower incidence of recurrences (respectively, 19.2% vs 43.8%; p=0.001) and a longer event-free survival (p=0.005). In multivariable analysis, women (HR 1.97, 95% CI 1.04 to 3.73; p=0.037) and corticosteroid use (HR 2.27, 95% CI 1.15 to 4.47; p=0.018) were independent risk factors for recurrences. Colchicine-associated side effects were mild and occurred in 3 (1.7%) patients. CONCLUSION In patients with first attack of pericarditis associated with myocardial involvement, colchicine was safe and efficacious for the reduction of recurrences.
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Affiliation(s)
- Valentino Collini
- Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Alessandro Andreis
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marzia De Biasio
- Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesca Gaspard
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elena Paneva
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mariacristina Tomat
- Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Gaetano Maria Deferrari
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Miriam Isola
- University of Udine, Udine, Friuli-Venezia Giulia, Italy
| | - Massimo Imazio
- Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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7
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Okorie IJ, Atere M, Fernando A, Ugwendum D, Nfonoyim J, Nfonoyim J. Re-enforcing High-Risk Acute Pericarditis Requiring Hospital Admission: An Unusual Case of Critical Idiopathic Acute Pericarditis Presenting As Tamponade and Pleuro-Pericardial Complications in a Patient Presenting With Flu-Like Symptoms. Cureus 2024; 16:e58147. [PMID: 38741856 PMCID: PMC11089582 DOI: 10.7759/cureus.58147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Pericarditis is an inflammatory process that affects the pericardium, the fibrous sac surrounding the heart. Acute pericarditis accounts for approximately 0.1% of inpatient admissions and 5% of non-ischemic chest pain visits to the emergency departments (EDs). Most patients who present with acute pericarditis have a benign course and good prognosis. However, a rare percent of the patients develop complicated pericarditis. Examples of complications include pericardiac effusion, cardiac tamponade, constrictive pericarditis, effusive and constrictive pericarditis and, even more rarely, large pleural effusion The occurrence of complicated pericarditis can lead to high morbidity and mortality if not urgently managed in most patients. Our case presents a 60-year-old male that presented to the emergency room with flu-like symptoms. However, the viral panel test was negative. He initially got discharged with supportive care but was brought back to the ED by his wife in a critical, life-threatening state due to pericarditis symptoms complicated by tamponade and shock. His condition required urgent intervention and critical level of care. The patient's course was also complicated by myopericarditis and recurrent bilateral pleural effusions, which required therapeutic interventions. This unique case presents the patient group that develop multiple life-threatening complications of acute pericarditis, including cardiac tamponade and shock, affecting several end organs. This case also highlights clues to the predisposing factors to complications of acute pericarditis. Patients who present with high-risk signs and symptoms indicating poorer prognosis warrant further observation and admission. This will also add to the literature reviews regarding the risk factors associated with development of complicated acute pericarditis. This will also serve as a review of pathophysiology, etiology, current diagnosis and available novel treatment for such patients.
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Affiliation(s)
| | - Muhammed Atere
- Cardiology, Richmond University Medical Center, New York, USA
| | - Annmarie Fernando
- Internal Medicine, Richmond University Medical Center, New York, USA
| | - Derek Ugwendum
- Internal Medicine, Richmond University Medical Center, New York, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, New York, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, New York, USA
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8
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Ediger DS, Brady WJ, Koyfman A, Long B. High risk and low prevalence diseases: Myocarditis. Am J Emerg Med 2024; 78:81-88. [PMID: 38241774 DOI: 10.1016/j.ajem.2024.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Myocarditis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of myocarditis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Myocarditis is an inflammatory syndrome of myocardium, most often resulting from a viral infection, that can cause life-threatening cardiovascular collapse. It has a highly variable presentation and no widely available specific diagnostic test, making it a challenging diagnosis. Emergency clinicians should obtain an electrocardiogram and perform bedside ultrasound to assess cardiac function. Treatment in the ED is largely supportive, focusing on resuscitation, cardiovascular support, cardiology specialist consultation, and appropriate disposition. CONCLUSIONS An understanding of myocarditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- David S Ediger
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - William J Brady
- Professor, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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9
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Mohamad AA, Mohamed NA. A Rare Presentation of Probable Training-Related Chronic Myopericarditis in an Endurance Cyclist: A Case Report. Korean J Fam Med 2024; 45:116-120. [PMID: 38351744 DOI: 10.4082/kjfm.23.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/03/2023] [Indexed: 03/27/2024] Open
Abstract
We report a rare case of high-volume training-related myopericarditis. A male, 18 years old, elite road bicycle racing cyclist with high-volume training of 1,000 km per week for >7 years, presented with progressively worsening exertional breathlessness, reduced effort tolerance, and one episode of cardiac syncope. The symptoms were present prior to the coronavirus disease 2019 pandemic but made worse with the sudden increase in the volume of training after lockdown periods in preparation for competition. He exhibited multiple premature ventricular ectopic beats during his resting electrocardiogram, with a normal echocardiogram and non-elevated cardiac enzyme. The exercise stress test revealed similar multiple premature ventricular beats, warranting further investigation using cardiac magnetic resonance imaging (MRI). The findings of the cardiac MRI were suggestive of myopericarditis. He was instructed to refrain from training and initially started with a short course of colchicine. However, his symptoms deteriorated, and cardiac MRI revealed a decrease in the left ventricular ejection fraction from 59% to 50%. His treatment was escalated to a short course of tapered dose steroid, anti-failure medication and gradual, supervised, return to sports program. This case report highlights the discussion of return to play in athletes with myopericarditis.
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Affiliation(s)
- Azwan Aziz Mohamad
- Sports Medicine Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Nahar Azmi Mohamed
- Sports Medicine Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
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10
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Arshad K, Egbe Bessong Tabot A, Latif R, El Gammal A, Foglesong A. Myopericarditis Mimicking an Acute MI. Cureus 2023; 15:e51069. [PMID: 38269221 PMCID: PMC10807456 DOI: 10.7759/cureus.51069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 01/26/2024] Open
Abstract
Chest pain with focal ST elevation in the presence of elevated cardiac markers is usually believed to be secondary to an acute myocardial infarction. Moreover, widespread ST elevation is believed to be a hallmark sign of acute pericarditis. However, we present the case of a young male who presented with chest pain, elevated troponins, and focal ST elevations; however, left heart catheterization showed patent coronary arteries. The patient was treated for acute myo-pericarditis with ibuprofen and colchicine. This case illustrates the fact that focal ST elevation in a patient with chest pain and elevated markers of cardiac injury is not always secondary to an acute myocardial infarction.
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Affiliation(s)
| | | | - Rabia Latif
- Internal Medicine, Mclaren Flint Hospital, Flint, USA
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11
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Singh RB, Zaman M, Glidden AM, Banerjee S, Azhar A, Koya HH, Gambhir HS. Pneumonitis and Myopericarditis After Booster COVID-19 mRNA Vaccination. Am J Ther 2023; 30:e555-e559. [PMID: 35383584 DOI: 10.1097/mjt.0000000000001492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ravi B Singh
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Muizz Zaman
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Alanna M Glidden
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Sanchari Banerjee
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Atika Azhar
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Hayas H Koya
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Harvir S Gambhir
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
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12
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Moreno M, Yee B, Haque L, Lei K. Myopericarditis as a Delayed Complication of COVID-19 Infection: A Case Report. Cureus 2023; 15:e46655. [PMID: 37942379 PMCID: PMC10627796 DOI: 10.7759/cureus.46655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Pericarditis is the inflammation of the pericardial layers. Myopericarditis is diagnosed when this inflammation involves the myocardium, which is marked by elevated serum cardiac enzymes. With these two pathologies sharing overlaps in etiology, we present a case of a young patient with a recent history of COVID-19 infection who presented with pleuritic and positional chest pain with troponin I elevation and serial ECG changes attributed to myopericarditis as a post-viral sequela of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection. This case demonstrates the importance of identifying and managing the potential cardiac complications in coronavirus disease 2019 (COVID-19) patients, regardless of age or symptom onset.
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Affiliation(s)
- Marvi Moreno
- Medical School, Kirk Kerkorian School of Medicine at the UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Brianna Yee
- Internal Medicine, Kirk Kerkorian School of Medicine at the UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Lubaba Haque
- Internal Medicine, Kirk Kerkorian School of Medicine at the UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Kachon Lei
- Cardiology, Kirk Kerkorian School of Medicine at the UNLV (University of Nevada, Las Vegas), Las Vegas, USA
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13
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Lazaros G, Vlachakis PK, Theofilis P, Dasoula FE, Imazio M, Lazarou E, Vlachopoulos C, Tsioufis C. D-dimer as a diagnostic and prognostic plasma biomarker in patients with a first episode of acute pericarditis. Eur J Intern Med 2023; 116:58-64. [PMID: 37357033 DOI: 10.1016/j.ejim.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES The impact of plasma biomarkers on diagnosis and prognosis of patients with acute pericarditis (AP) has been poorly investigated. This study aims to assess the diagnostic and prognostic role of d-dimer (DD), an easily obtainable biomarker, in patients with AP. PATIENTS AND METHODS This is a prospective clinical study enrolling 265 consecutive patients hospitalized between September 2010 and May 2019 with a first episode of AP. At baseline, demographics, clinical features, laboratory and imaging findings were recorded. All patients were followed-up for a minimum of 18 months. Endpoints included cardiac tamponade, new-onset atrial fibrillation, pericardial drainage, recurrent/constrictive pericarditis and death. RESULTS DD was measured in 165 out of 265 patients (62.3%, median levels 1456 ng/mL) Among them, 121 patients (73.3%) presented with elevated age-adjusted DD levels. Patients with elevated DD depicted a higher rate of pleural (69.4%, vs 38.6%, p<0.001) and pericardial effusions (89.3% vs 72.7%, p = 0.009). Elevated DD correlated with admission (rho=0.37) and peak (rho=0.36) C-reactive protein values. Patients with elevated DD depicted a trend towards a greater prevalence of pericardial tamponade vs those without (14.9% vs 4.5% respectively, p = 0.07). In the 43.8% of patients with elevated DD who underwent computed tomography pulmonary angiography (CTPA), no case of pulmonary embolism or aortic syndrome was unveiled. CONCLUSION DD elevation is detected in the majority of AP cases at presentation and may herald cardiac tamponade. In patients with chest pain not attributable to alternative causes, elevated DD denotes an inflammatory condition and should not prompt unnecessary investigations, such as CTPA.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece.
| | - Panagiotis K Vlachakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Foteini E Dasoula
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
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14
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Saxon C, Freeman S, Burke J. Cardiac tamponade-mediated generalized coronary vasospasm presenting as an inferior ST-segment elevation myocardial infarction: a case report. Eur Heart J Case Rep 2023; 7:ytad220. [PMID: 37193072 PMCID: PMC10182336 DOI: 10.1093/ehjcr/ytad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2022] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
Background Coronary vasospasm is a rare cause of ST-segment elevation myocardial infarction (STEMI) and can be precipitated by numerous inciting factors including endogenous catecholamines. Differentiating coronary vasospasm from an acute atherothrombotic event is diagnostically challenging and requires a careful clinical history combined with electrocardiographic and angiographic abnormalities to make the diagnosis and guide therapy. Case Summary We report a case of cardiogenic shock secondary to cardiac tamponade leading to an endogenous catecholamine surge resulting in profound arterial vasospasm and STEMI. The patient presented with chest pain and inferior ST segment elevations prompting emergent coronary angiography, demonstrating subtotal occlusion of the right coronary artery, severe proximal left anterior descending coronary artery stenosis, and diffusely stenosed aortoiliac vessels. Emergent transthoracic echocardiogram revealed a large pericardial effusion and hemodynamics consistent with cardiac tamponade. Pericardiocentesis resulted in dramatic hemodynamic improvement with immediate normalization of ST segments. Repeat coronary angiography performed one day later showed no angiographically significant coronary or peripheral arterial stenosis. Discussion This is the first reported case of simultaneous coronary and peripheral arterial vasospasm presenting as inferior STEMI caused by endogenous catecholamines from cardiac tamponade. Several clues suggest coronary vasospasm including the discordant electrocardiography (ECG) and coronary angiographic findings as well as diffusely stenosed aortoiliac vessels. Diffuse vasospasm was confirmed when repeat angiography performed after pericardiocentesis demonstrated angiographic resolution of coronary and peripheral arterial stenosis. Though rare, circulating endogenous catecholamines resulting in diffuse coronary vasospasm may present as STEMI and should be considered based on the clinical history, ECG findings, and coronary angiography.
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Affiliation(s)
- Cara Saxon
- Corresponding author. Tel: 303-724-1784,
| | - Scott Freeman
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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15
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Cherukuri ASS, Belay NF, Nasereldin DS, Mohammed DO, Mohamed S, Elkhazeen A, Ghobriel NG, Alatta L, Alsafi W, Abdalla Y, Brry G, Abdelrahman N. Varicella-Zoster Virus Myocarditis: Early Clinical Diagnosis and Outcome. Cureus 2023; 15:e38015. [PMID: 37223180 PMCID: PMC10204613 DOI: 10.7759/cureus.38015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/25/2023] Open
Abstract
Varicella-zoster virus (VZV) is a viral infection that causes chickenpox and shingles. Although it is usually self-limiting, it can lead to severe complications, especially in pediatric and immunocompromised patients. VZV was first discovered as a cause of myocarditis in 1953. In this review article, we aim to investigate the early clinical diagnosis of myocarditis in VZV infections and the efficacy of the VZV vaccine in preventing myocarditis. The literature search was done using PubMed, Google Scholar, and Sci-Hub databases. A high VZV mortality rate was noted among adults, infants, and immunocompromised patients. The early diagnosis and treatment of VZV myocarditis can reduce mortality.
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Affiliation(s)
| | - Naod F Belay
- Geriatrics, Michigan State University, East Lansing, USA
| | | | | | - Suzan Mohamed
- Geriatrics, Michigan State University, East Lansing, USA
| | | | | | - Lina Alatta
- Geriatrics, Michigan State University, East Lansing, USA
| | - Wail Alsafi
- Geriatrics, Michigan State University, East Lansing, USA
| | - Yaseen Abdalla
- Geriatrics, Michigan State University, East Lansing, USA
| | - Gamila Brry
- Geriatrics, Michigan State University, East Lansing, USA
| | - Nadir Abdelrahman
- Family Medicine - Geriatrics, Michigan State University College of Human Medicine, East Lansing, USA
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16
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Franczuk P, Tkaczyszyn M, Kulak M, Domenico E, Ponikowski P, Jankowska EA. Cardiovascular Complications of Viral Respiratory Infections and COVID-19. Biomedicines 2022; 11:71. [PMID: 36672579 PMCID: PMC9856218 DOI: 10.3390/biomedicines11010071] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Paweł Franczuk
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Michał Tkaczyszyn
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Maria Kulak
- Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Esabel Domenico
- Faculty of Medicine, Wroclaw Medical University, 50-345 Wroclaw, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
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17
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Rivera JA, Aragon D, Gomez J, Arredondo H, Thomas PM, Dominici P, Akala OO, Menowsky M. Acute Hypersensitivity Reaction After Casirivimab/Imdevimab Infusion in a COVID-19-Positive Young Male: Myopericarditis or Kounis Syndrome? Cureus 2022; 14:e31125. [DOI: 10.7759/cureus.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/06/2022] Open
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18
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An ZY, Peng D, Shi YJ, Zhang CH. Dyspnoea with diffuse T wave inversion. BMJ 2022; 378:e070894. [PMID: 36109047 DOI: 10.1136/bmj-2022-070894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Zhuo-Yu An
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Ding Peng
- Department of Electrocardiography, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China
| | - Ya-Juan Shi
- Qidong People's Hospital/Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China
| | - Chuan-Hai Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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19
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Eiros R, Barreiro-Pérez M, Martín-García A, Almeida J, Villacorta E, Pérez-Pons A, Merchán S, Torres-Valle A, Sánchez-Pablo C, González-Calle D, Pérez-Escurza O, Toranzo I, Díaz-Peláez E, Fuentes-Herrero B, Macías-Álvarez L, Oliva-Ariza G, Lecrevisse Q, Fluxa R, Bravo-Grande JL, Orfao A, Sánchez PL. [Pericardial and myocardial involvement after SARS-CoV-2 infection: a cross-sectional descriptive study in healthcare workers]. Rev Esp Cardiol 2022; 75:735-747. [PMID: 35039707 PMCID: PMC8755423 DOI: 10.1016/j.recesp.2021.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
Introduction and objectives The cardiac sequelae of SARS-CoV-2 infection are still poorly documented. We conducted a cross-sectional study in healthcare workers to report evidence of pericardial and myocardial involvement after SARS-CoV-2 infection. Methods We studied 139 healthcare workers with confirmed past SARS-CoV-2 infection. Participants underwent clinical assessment, electrocardiography, and laboratory tests, including immune cell profiling and cardiac magnetic resonance (CMR). Clinically suspected pericarditis was diagnosed when classic criteria were present and clinically suspected myocarditis was based on the combination of at least 2 CMR criteria. Results Median age was 52 (41-57) years, 71.9% were women, and 16.5% were previously hospitalized for COVID-19 pneumonia. On examination (10.4 [9.3-11.0] weeks after infection-like symptoms), participants showed hemodynamic stability. Chest pain, dyspnea or palpitations were present in 41.7% participants, electrocardiographic abnormalities in 49.6%, NT-proBNP elevation in 7.9%, troponin in 0.7%, and CMR abnormalities in 60.4%. A total of 30.9% participants met criteria for either pericarditis and/or myocarditis: isolated pericarditis was diagnosed in 5.8%, myopericarditis in 7.9%, and isolated myocarditis in 17.3%. Most participants (73.2%) showed altered immune cell counts in blood, particularly decreased eosinophil (27.3%; P < .001) and increased cytotoxic T cell numbers (17.3%; P < .001). Clinically suspected pericarditis was associated (P < .005) with particularly elevated cytotoxic T cells and decreased eosinophil counts, while participants diagnosed with clinically suspected myopericarditis or myocarditis had lower (P < .05) neutrophil counts, natural killer-cells, and plasma cells. Conclusions Pericardial and myocardial involvement with clinical stability are frequent after SARS-CoV-2 infection and are associated with specific immune cell profiles.Full English text available from:www.revespcardiol.org/en.
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Affiliation(s)
- Rocío Eiros
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Manuel Barreiro-Pérez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Ana Martín-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Facultad de Medicina, Universidad de Salamanca, Salamanca, España
| | - Julia Almeida
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Facultad de Medicina, Universidad de Salamanca, Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Eduardo Villacorta
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Facultad de Medicina, Universidad de Salamanca, Salamanca, España
| | - Alba Pérez-Pons
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Soraya Merchán
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Alba Torres-Valle
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Clara Sánchez-Pablo
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - David González-Calle
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Oihane Pérez-Escurza
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Inés Toranzo
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Elena Díaz-Peláez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Blanca Fuentes-Herrero
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Laura Macías-Álvarez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Guillermo Oliva-Ariza
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Quentin Lecrevisse
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Rafael Fluxa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Facultad de Medicina, Universidad de Salamanca, Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - José L Bravo-Grande
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Servicio de Prevención de Riesgos Laborales, Hospital Universitario de Salamanca, Salamanca, España
| | - Alberto Orfao
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Facultad de Medicina, Universidad de Salamanca, Salamanca, España
- Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, España
- Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Pedro L Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
- Facultad de Medicina, Universidad de Salamanca, Salamanca, España
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20
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Eiros R, Barreiro-Pérez M, Martín-García A, Almeida J, Villacorta E, Pérez-Pons A, Merchán S, Torres-Valle A, Sánchez-Pablo C, González-Calle D, Pérez-Escurza O, Toranzo I, Díaz-Peláez E, Fuentes-Herrero B, Macías-Álvarez L, Oliva-Ariza G, Lecrevisse Q, Fluxa R, Bravo-Grande JL, Orfao A, Sánchez PL. Pericardial and myocardial involvement after SARS-CoV-2 infection: a cross-sectional descriptive study in healthcare workers. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:734-746. [PMID: 34866030 PMCID: PMC8570413 DOI: 10.1016/j.rec.2021.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/22/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES The cardiac sequelae of SARS-CoV-2 infection are still poorly documented. We conducted a cross-sectional study in healthcare workers to report evidence of pericardial and myocardial involvement after SARS-CoV-2 infection. METHODS We studied 139 healthcare workers with confirmed past SARS-CoV-2 infection. Participants underwent clinical assessment, electrocardiography, and laboratory tests, including immune cell profiling and cardiac magnetic resonance (CMR). Clinically suspected pericarditis was diagnosed when classic criteria were present and clinically suspected myocarditis was based on the combination of at least 2 CMR criteria. RESULTS Median age was 52 (41-57) years, 71.9% were women, and 16.5% were previously hospitalized for COVID-19 pneumonia. On examination (10.4 [9.3-11.0] weeks after infection-like symptoms), participants showed hemodynamic stability. Chest pain, dyspnea or palpitations were present in 41.7% participants, electrocardiographic abnormalities in 49.6%, NT-proBNP elevation in 7.9%, troponin in 0.7%, and CMR abnormalities in 60.4%. A total of 30.9% participants met criteria for either pericarditis and/or myocarditis: isolated pericarditis was diagnosed in 5.8%, myopericarditis in 7.9%, and isolated myocarditis in 17.3%. Most participants (73.2%) showed altered immune cell counts in blood, particularly decreased eosinophil (27.3%; P<.001) and increased cytotoxic T cell numbers (17.3%; P <.001). Clinically suspected pericarditis was associated (P <.005) with particularly elevated cytotoxic T cells and decreased eosinophil counts, while participants diagnosed with clinically suspected myopericarditis or myocarditis had lower (P <.05) neutrophil counts, natural killer-cells, and plasma cells. CONCLUSIONS Pericardial and myocardial involvement with clinical stability are frequent after SARS-CoV-2 infection and are associated with specific immune cell profiles.
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Affiliation(s)
- Rocío Eiros
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Manuel Barreiro-Pérez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Ana Martín-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Julia Almeida
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Eduardo Villacorta
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Alba Pérez-Pons
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Soraya Merchán
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Alba Torres-Valle
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Clara Sánchez-Pablo
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - David González-Calle
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Oihane Pérez-Escurza
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Inés Toranzo
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Elena Díaz-Peláez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Blanca Fuentes-Herrero
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Laura Macías-Álvarez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Guillermo Oliva-Ariza
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Quentin Lecrevisse
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Rafael Fluxa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - José L Bravo-Grande
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Servicio de Prevención de Riesgos Laborales, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain; Centro de Investigación del Cáncer, Universidad de Salamanca-CSIC, Salamanca, Spain; Servicio de Citometría, Nucleus - Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Pedro L Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain.
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21
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Brendel JM, Klingel K, Kübler J, Müller KAL, Hagen F, Gawaz M, Nikolaou K, Greulich S, Krumm P. Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis. J Clin Med 2022; 11:jcm11175113. [PMID: 36079039 PMCID: PMC9457022 DOI: 10.3390/jcm11175113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/12/2022] [Accepted: 08/28/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. (2) Objectives: To systematically evaluate non-invasive CMR imaging parameters in acute and subacute myocarditis. (3) Methods: 48 patients (age 37 (IQR 28−55) years; 52% female) with clinically suspected myocarditis were consecutively included. Patients with onset of symptoms ≤2 weeks prior to 1.5T CMR were assigned to the acute group (n = 25, 52%), patients with symptom duration >2 to 6 weeks were assigned to the subacute group (n = 23, 48%). CMR protocol comprised morphology, function, 3D-strain, late gadolinium enhancement (LGE) imaging and mapping (T1, ECV, T2). (4) Results: Highest diagnostic performance in the detection of subacute myocarditis was achieved by ECV evaluation either as single parameter or in combination with T1 mapping (applying a segmental or global increase of native T1 > 1015 ms and ECV > 28%), sensitivity 96% and accuracy 91%. Compared to subacute myocarditis, acute myocarditis demonstrated higher prevalence and extent of LGE (AUC 0.76) and increased T2 (AUC 0.66). (5) Conclusions: A comprehensive CMR approach allows reliable diagnosis of clinically suspected subacute myocarditis. Thereby, ECV alone or in combination with native T1 mapping indicated the best performance for diagnosing subacute myocarditis. Acute vs. subacute myocarditis is difficult to discriminate by CMR alone, due to chronological connection and overlap of pathologic findings.
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Affiliation(s)
- Jan M. Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University of Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany
| | - Jens Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Karin A. L. Müller
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
- Correspondence:
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
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22
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Fulminant Influenza a Myocarditis Complicated by Transient Ventricular Wall Thickening and Cardiac Tamponade. Infect Dis Rep 2022; 14:600-608. [PMID: 36005267 PMCID: PMC9408225 DOI: 10.3390/idr14040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Myocarditis is an infrequent complication of influenza infection that is most often diagnosed clinically in the setting of confirmed influenza infection and elevated cardiac enzymes. Pericarditis can also occur in cases of influenza myocarditis and may require pericardiocentesis for tamponade. Patients with fulminant myocarditis have cardiogenic shock; however, echocardiographic findings may be subtle, showing a preserved ejection fraction and diffuse left ventricular wall thickening (compared to baseline) due to inflammatory edema. Recognizing these echocardiographic findings in the appropriate clinical setting facilitates the early recognition of fulminant myocarditis. Therefore, we report a case of fulminant influenza A myocarditis in healthy 37-year-old women complicated by transient left ventricular wall thickening and tamponade, highlighting the importance of early diagnosis and supportive management for a successful outcome.
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23
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Soluble low density lipoprotein receptor-related protein-1 levels in the differential diagnosis of myopericarditis versus acute coronary syndrome. Am J Emerg Med 2022; 60:15-23. [PMID: 35878570 DOI: 10.1016/j.ajem.2022.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Differential diagnosis of myopericarditis (MPC) versus acute coronary syndromes (ACS) can be difficult in the emergency room (ER). Low density lipoprotein receptor-related protein-1 (LRP-1) is a transmembrane receptor with diverse biological functions. LRP-1 is increased after viral infections as a defense mechanism. sLRP-1 (soluble form) can be measured in the serum. We study the diagnostic sLRP-1 levels in patients with MPC, ACS and healthy controls. METHODS The study included consecutive patients who were admitted between the dates of 1.1.2018 and 1.1.2019 with the diagnosis of MPC or ACS. All patients reported to the ER with chest pain (CP) and elevated cardiac troponin levels. Control group (n = 61) was selected from healthy subjects. In addition to routine laboratory work up, serum sLRP-1 concentrations were measured on admission. RESULTS sLRP-1 levels were significantly higher in MPC, compared to controls (p = 0.005) and ACS (p = 0.001). Median (IQR) sLRP-1 levels in MPC, controls and ACS were 7.39 (22.42), 2.27 (1.74), 2.41 (0.98) μg/ml, respectively (p = 0.004). Among the covariates: sLRP-1, age, gender, HDL-C and LDL-C; only sLRP-1 differentiated a diagnosis of MPC versus ACS (OR = 1684, p = 0,046, CI for OR (1008-2812). The area under the curve (AUC) was measured as 0.79 [CI 0.62-0.95] in ROC analysis, p = 0.001; sLRP-1 had 69% sensitivity and 85% specificity for diagnosis of MPC with a cut-off value of 4.3 μg/ml. CONCLUSION sLRP-1 is a potential biomarker in the differential diagnosis of MPC versus ACS in ER. Future studies are needed to evaluate and develop the utility of sLRP-1 as a diagnostic and prognostic biomarker in MPC.
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24
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Influenza Myopericarditis and Pericarditis: A Literature Review. J Clin Med 2022; 11:jcm11144123. [PMID: 35887887 PMCID: PMC9316162 DOI: 10.3390/jcm11144123] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/26/2022] Open
Abstract
Myopericarditis is a rare complication of influenza infection. The presentation may range from mild and frequently unrecognized, to fulminant and potentially complicated by cardiogenic and/or obstructive shock (tamponade), which is associated with high mortality. We performed a review of literature on all influenza pericarditis and myopericarditis cases according to PRISMA guidelines using the PubMed search engine of the Medline database. Seventy-five cases of influenza myopericarditis and isolated pericarditis were identified from 1951 to 2021. Influenza A was reported twice as often as influenza B; however, influenza type did not correlate with outcome. Men and elderly patients were more likely to have isolated pericarditis, while women and younger patients were more likely to have myopericarditis. All included patients had pericardial effusion, while 36% had tamponade. Tamponade was more common in those with isolated pericarditis (41.2%) than myopericarditis (13.8%). Cardiogenic shock was more common in patients with myopericarditis (64%), with an overall mortality rate of 14.7%. Nearly 88% of the recovered patients remained without long-term complications reported. Conclusion: Influenza A appears a more common cause of pericarditis and myopericarditis. Isolated pericarditis was more commonly associated with tamponade but without reported deaths, whereas myopericarditis was more commonly associated with cardiogenic shock and death (19%).
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25
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Montera MW, Marcondes-Braga FG, Simões MV, Moura LAZ, Fernandes F, Mangine S, Oliveira Júnior ACD, Souza ALADAGD, Ianni BM, Rochitte CE, Mesquita CT, de Azevedo Filho CF, Freitas DCDA, Melo DTPD, Bocchi EA, Horowitz ESK, Mesquita ET, Oliveira GH, Villacorta H, Rossi Neto JM, Barbosa JMB, Figueiredo Neto JAD, Luiz LF, Hajjar LA, Beck-da-Silva L, Campos LADA, Danzmann LC, Bittencourt MI, Garcia MI, Avila MS, Clausell NO, Oliveira NAD, Silvestre OM, Souza OFD, Mourilhe-Rocha R, Kalil Filho R, Al-Kindi SG, Rassi S, Alves SMM, Ferreira SMA, Rizk SI, Mattos TAC, Barzilai V, Martins WDA, Schultheiss HP. Brazilian Society of Cardiology Guideline on Myocarditis - 2022. Arq Bras Cardiol 2022; 119:143-211. [PMID: 35830116 PMCID: PMC9352123 DOI: 10.36660/abc.20220412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Fabiana G Marcondes-Braga
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Fabio Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Sandrigo Mangine
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Bárbara Maria Ianni
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil
- Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Evandro Tinoco Mesquita
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil
- Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Imbroise Bittencourt
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - Marcelo Iorio Garcia
- Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Monica Samuel Avila
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University,Cleveland, Ohio - EUA
| | | | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | - Silvia Moreira Ayub Ferreira
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Stéphanie Itala Rizk
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio Libanês, São Paulo, SP - Brasil
| | | | - Vitor Barzilai
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brasil
| | - Wolney de Andrade Martins
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil
- DASA Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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26
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Sozzi FB, Gherbesi E, Faggiano A, Gnan E, Maruccio A, Schiavone M, Iacuzio L, Carugo S. Viral Myocarditis: Classification, Diagnosis, and Clinical Implications. Front Cardiovasc Med 2022; 9:908663. [PMID: 35795363 PMCID: PMC9250986 DOI: 10.3389/fcvm.2022.908663] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Myocarditis is an inflammatory disease of the myocardium with focal or diffuse involvement. Viral infections are the most common cause of myocarditis, especially in Western countries. A recent viral illness with gastroenteric or upper respiratory symptoms often precedes myocarditis. The absence of specific pathognomonic features in conjunction with the wide spectrum of clinical manifestations that range from subclinical cases to sudden cardiac death (SCD) makes myocarditis diagnosis particularly challenging. Moreover, myocarditis might represent a cause of initially unexplained dilated cardiomyopathy (DCM) and heart failure (HF), especially among children and young adults. Cardiac magnetic resonance imaging (CMR) is crucial for myocarditis diagnosis, because of its ability to detect interstitial edema during acute inflammation. Assessment of subepicardial or mid-myocardial fibrosis by late gadolinium enhancement (LGE) is typical for myocarditis. Cardiac arrhythmias are frequent events that may arise especially in more severe myocarditis cases. The most common form of arrhythmia is atrial fibrillation, followed by ventricular tachycardia. Documented arrhythmias have been reported more commonly with HIV myocarditis than other more common infections such as Adenovirus, Parvovirus B19, human Herpes virus 6, and Enterovirus. The mechanisms of arrhythmogenesis in myocardial inflammation are not fully understood; in the acute phase, the spectrum of arrhythmogenesis ranges from a direct effect on cardiomyocytes that leads to electrical instability and ion channel impairment to ischemia from coronary macro- or microvascular disease. In chronic myocarditis, instead, myocardial replacement with fibrosis promotes scar-mediated re-entrant ventricular arrhythmias. Observational data suggested the important role of CMR, with LGE being the strongest independent predictor of SCD, cardiac, and all-cause mortality. In acute myocarditis, the most common localization of subepicardial LGE dwells in the lateral wall. Patients with myocarditis that develop HF and arrhythmias usually show a larger LGE distribution involving several myocardial segments. Moreover, a mid-layer LGE in the interventricular septum is more frequent in acute myocarditis than in acute coronary syndromes cases. The risk of SCD in patients with wide areas of LGE is significant, and a shared decision-making approach is warranted. Nevertheless, there is no formal consensus about the extension of LGE to justify implantable cardioverter defibrillator (ICD) implantation in primary prevention.
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Affiliation(s)
- Fabiola B. Sozzi
- Cardiology Unit, Internal Medicine Department, Fondazione Ospedale Maggiore Policlinico IRCCS Cà Granda, University of Milan, Milan, Italy
| | - Elisa Gherbesi
- Cardiology Unit, Internal Medicine Department, Fondazione Ospedale Maggiore Policlinico IRCCS Cà Granda, University of Milan, Milan, Italy
| | - Andrea Faggiano
- Cardiology Unit, Internal Medicine Department, Fondazione Ospedale Maggiore Policlinico IRCCS Cà Granda, University of Milan, Milan, Italy
| | - Eleonora Gnan
- Cardiology Unit, Internal Medicine Department, Fondazione Ospedale Maggiore Policlinico IRCCS Cà Granda, University of Milan, Milan, Italy
| | - Alessio Maruccio
- Cardiology Unit, Internal Medicine Department, Fondazione Ospedale Maggiore Policlinico IRCCS Cà Granda, University of Milan, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Stefano Carugo
- Cardiology Unit, Internal Medicine Department, Fondazione Ospedale Maggiore Policlinico IRCCS Cà Granda, University of Milan, Milan, Italy
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27
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Bôtto-Menezes CHA, Safe IP, da Cunha Ferreira AC, do Nascimento Couceiro K, Neto AM, Franca RFO, Calvet GA, de Filippis AMB, Kara EO, da Costa Castilho M, Bastos MS, de Brito CAA, Modjarrad K, Broutet NJN, Brasil P, Hajjar LA, de Lacerda MVG. Myopericarditis associated with acute Zika virus infection: a case report. BMC Infect Dis 2022; 22:508. [PMID: 35641901 PMCID: PMC9158386 DOI: 10.1186/s12879-022-07454-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zika virus infection is commonly described as a mild and self-limiting illness. However, cardiac complications were associated with acute Zika virus infection. CASE PRESENTATION A 46-year-old woman without previous comorbidities with a 1-day history of symptoms tested positive for ZIKV by real time reverse transcriptase polymerase chain reaction (rRT-PCR). She was admitted two days after with clinical worsening, cardiac enzymes elevated, and cardiac imaging findings, and the diagnosis of myopericarditis was made. The patient was treated and presented significant clinical improvement after one year. CONCLUSIONS Cardiac complication following ZIKV infection appears to be infrequent. Here, we report a rare case of viral myopericarditis caused by ZIKV infection.
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Affiliation(s)
- Camila Helena Aguiar Bôtto-Menezes
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, 69040-000 Brazil
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus, 69065-001 Brazil
| | - Izabella Picinin Safe
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, 69040-000 Brazil
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus, 69065-001 Brazil
| | | | | | | | | | - Guilherme Amaral Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-360 Brazil
| | | | - Edna Oliveira Kara
- Department of Sexual and Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland
| | | | - Michele Souza Bastos
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, 69040-000 Brazil
| | | | - Kayvon Modjarrad
- Walter Reed Army Institute of Research, Silver Spring, 20910 USA
| | | | - Patrícia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-360 Brazil
| | | | - Marcus Vinícius Guimarães de Lacerda
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, 69040-000 Brazil
- Laboratory of Territory, Environment, Health and Sustainability, Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, 69057-07 Brazil
| | - ZIKABRA Study Team
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, 69040-000 Brazil
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus, 69065-001 Brazil
- Getúlio Vargas University Hospital, Federal University of Amazonas, Manaus, 69020-170 Brazil
- Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, 50740-465 Brazil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-360 Brazil
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-360 Brazil
- Department of Sexual and Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland
- Walter Reed Army Institute of Research, Silver Spring, 20910 USA
- Heart Institute, Medical School, University of São Paulo, São Paulo, 05403-900 Brazil
- Laboratory of Territory, Environment, Health and Sustainability, Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, 69057-07 Brazil
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28
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Elhouderi E, Elsawalhy E, Kabbani M. Myopericarditis After mRNA COVID-19 Vaccine in a Patient With Recent History of COVID-19. Cureus 2022; 14:e25264. [PMID: 35755512 PMCID: PMC9224764 DOI: 10.7759/cureus.25264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Myopericarditis has been identified as a potential adverse event of several vaccines in the medical literature. Here we present a case of a 30-year-old male who had myopericarditis a week after receiving the second booster dose of the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine. The patient's clinical course was not severe and had a full recovery after a week of treatment.
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29
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Castillo AV, Ivsic T. Overview of pediatric myocarditis and pericarditis. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Wu L, Fiet MD, Raaijmakers DR, Woudstra L, van Rossum AC, Niessen HWM, Krijnen PAJ. Transient atrial inflammation in a murine model of Coxsackievirus B3-induced myocarditis. Int J Exp Pathol 2022; 103:149-155. [PMID: 35363404 PMCID: PMC9264345 DOI: 10.1111/iep.12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 12/02/2022] Open
Abstract
Atrial dysfunction is a relatively common complication of acute myocarditis, although its pathophysiology is unclear. There is limited information on myocarditis‐associated histological changes in the atria and how they develop in time. The aim of this study therefore was to investigate inflammation, fibrosis and viral genome in the atria in time after mild CVB3‐induced viral myocarditis (VM) in mice. C3H mice (n = 68) were infected with 105 PFU of Coxsackievirus B3 (CVB3) and were compared with uninfected mice (n = 10). Atrial tissue was obtained at days 4, 7, 10, 21, 35 or 49 post‐infection. Cellular infiltration of CD45+ lymphocytes, MAC3+ macrophages, Ly6G+ neutrophils and mast cells was quantified by (immuno)histochemical staining. The CVB3 RNA was determined by in situ hybridization, and fibrosis was evaluated by elastic van Gieson (EvG) staining. In the atria of VM mice, the numbers of lymphocytes on days 4 and 7 (p < .05) and days 10 (p < .01); macrophages on days 7 (p < .01) and 10 (p < .05); neutrophils on days 4 (p < .05); and mast cells on days 4 and 7 (p < .05) increased significantly compared with control mice and decreased thereafter to basal levels. No cardiomyocyte death was observed, and the CVB3 genome was detected in only one infected mouse on Day 4 post‐infection. No significant changes in the amount of atrial fibrosis were found between VM and control mice. A temporary increase in inflammation is induced in the atria in the acute phase of CVB3‐induced mild VM, which may facilitate the development of atrial arrhythmia and contractile dysfunction.
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Affiliation(s)
- Linghe Wu
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mitchell D Fiet
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Daan R Raaijmakers
- Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Linde Woudstra
- Department of Reproductive Medicine, Reinier de Graaf Hospital, Voorburg, The Netherlands
| | - Albert C van Rossum
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiac Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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31
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Fraser M, Agdamag ACC, Maharaj VR, Mutschler M, Charpentier V, Chowdhury M, Alexy T. COVID-19-Associated Myocarditis: An Evolving Concern in Cardiology and Beyond. BIOLOGY 2022; 11:biology11040520. [PMID: 35453718 PMCID: PMC9025425 DOI: 10.3390/biology11040520] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023]
Abstract
Simple Summary Coronavirus disease-2019 (COVID-19) affects many organs in the body, including the heart. One complication of particular concern is inflammation of the heart muscle, called myocarditis. This paper presents updated research data on COVID-19-associated myocarditis. Specifically, we review the incidence, potential mechanisms, blood and imaging tests that can be used to detect the disease. We emphasize that, in contrast with early reports, recent data suggest that myocarditis in the setting of COVID-19 is relatively uncommon, yet infected individuals are at a substantially increased risk for poor outcomes. It is important to continue research in this area. Abstract The direct and indirect adverse effects of SARS-CoV-2 infection on the cardiovascular system, including myocarditis, are of paramount importance. These not only affect the disease course but also determine clinical outcomes and recovery. In this review, the authors aimed at providing an update on the incidence of Coronavirus disease-2019 (COVID-19)-associated myocarditis. Our knowledge and experience relevant to this area continues to evolve rapidly since the beginning of the pandemic. It is crucial for the scientific and medical community to stay abreast of current information. Contrasting early reports, recent data suggest that the overall incidence of SARS-CoV-2-associated myocarditis is relatively low, yet infected individuals are at a substantially increased risk. Therefore, understanding the pathophysiology and diagnostic evaluation, including the use of serum biomarkers and imaging modalities, remain important. This review aims to summarize the most recent data in these areas as they relate to COVID-19-associated myocarditis. Given its increasing relevance, a brief update is included on the proposed mechanisms of myocarditis in COVID-19 vaccine recipients.
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Affiliation(s)
- Meg Fraser
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Arianne Clare C. Agdamag
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Valmiki R. Maharaj
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Melinda Mutschler
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | | | | | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
- Correspondence: ; Tel.: +1-612-625-9100
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32
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Myopericarditis in children and adolescent: is the elevated troponin and chest pain as alarming as we thought? Cardiol Young 2022; 32:420-424. [PMID: 34165066 DOI: 10.1017/s1047951121002304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM When encountering adolescents with chest pain and a high troponin level but with no underlying coronary artery illness, it is advisable to consider myopericarditis. Though myopericarditis is a self-limiting, benign condition, it nevertheless causes anxiety in the patient and the family. METHODS Thirty-nine patients diagnosed with myopericarditis were included. We retrospectively analysed the demographic and clinical features, laboratory tests, echocardiography, electrocardiograms, MRI findings, coronary CT angiography, and conventional angiography findings in these patients. RESULTS Of the 39 patients (female/male = 4/35) aged 7-17 years, 66.6% had viral infection in the 2 weeks preceding presentation. Eleven patients were tested for high-sensitivity cardiac troponin I, 28 for high-sensitivity cardiac troponin T, and 10 patients were tested for both biomarkers. The median hs-TnI and hs-TnT values were 6.3 (0.05-29.9) ng/mL and 586 (51-9398) ng/L, respectively. Twenty-three patients showed ST changes on electrocardiography, of whom 11 had ST-elevation in the leads supporting left ventricular involvement. Coronary CT angiography and catheter angiography evaluations performed for differential diagnosis of coronary anomaly and acute coronary syndrome were normal. Cardiac MRI was conducted on 28 patients, and the results in 10 (35.7%) were suggestive of myopericarditis. CONCLUSIONS Myopericarditis is common in the adolescent age group and is generally benign but should be carefully monitored for differential diagnosis and possible complications. Cardiac MRI, which has been used more frequently in recent years, has an important role in differential diagnosis and the follow-up of patients.
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33
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Hana D, Patel K, Roman S, Gattas B, Sofka S. Clinical Cardiovascular Adverse Events Reported Post-COVID-19 Vaccination: Are They a Real Risk? Curr Probl Cardiol 2022; 47:101077. [PMID: 34902392 PMCID: PMC8662957 DOI: 10.1016/j.cpcardiol.2021.101077] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022]
Abstract
Given the urgent need to control the spread of the novel COVID-19 virus, 13 vaccines have been approved for emergency use before completing all 3 phases of the clinical trials. Thereby a careful monitor of the adverse effects postvaccination is essential. We searched through PubMed and other reporting systems like VAERS for the reported cardiovascular adverse events post-COVID-19 vaccination. Through our review, we determined that the incidence of all the reported cardiovascular events is very rare. Additionally, the vaccine was initially given to the elderly and high-risk populations in which cardiovascular events such as myocardial infarction and arrhythmias are already more prevalent, while other cardiovascular events such as myocarditis or vaccine-induced thrombotic thrombocytopenia were more common in younger populations. Moreover, a direct causal relationship, if any, between vaccination and adverse events is yet to be fully elucidated. Thus, at this time point, the benefits of vaccination far outweigh the risk.
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Affiliation(s)
- David Hana
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV.
| | - Kevin Patel
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sherif Roman
- Department of Medicine, St Joseph's University Medical Center, Paterson, NJ
| | - Boula Gattas
- Department of Medicine, St Mary Medical Center, Langhorne, PA
| | - Sarah Sofka
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
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34
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Babbitt CJ, Babbitt MJ, Byrne F, Morphew T. Pediatric Myopericarditis Presenting to the Emergency Department as Chest Pain: A Comparative Study With Myocarditis. Pediatr Emerg Care 2022; 38:e761-e765. [PMID: 35100774 DOI: 10.1097/pec.0000000000002376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS A database query was performed and identified patients over a 9-year period, and clinical data, laboratory data, and cardiac studies were extracted and analyzed from the electronic health record. RESULTS A total of 36 patients were identified with the discharge diagnosis of myopericarditis and 22 with myocarditis. The median age for myopericarditis patients was 16.2 years, and 97% were male. The median initial troponin was 7.1 ng/mL, the peak was at 16.6 ng/mL, and 58% had ST changes on electrocardiogram. The median length of stay for myopericarditis patients was 1.7 days, and 50% were discharged home on nonsteroidal anti-inflammatory medication. Compared with myocarditis, myopericarditis patients were older, had a higher incidence of chest pain, and were less likely to have fever, vomiting, abdominal pain, upper respiratory infection symptoms, chest radiograph abnormalities, or T-wave inversion (P < 0.05). Myopericarditis patients also had lower Pediatric Risk of Mortality version 3 scores, B-type natriuretic peptide levels, and higher left ventricular ejection fractions on admission (67% vs 41%; P < 0.05). A classification model incorporating initial left ventricular ejection fraction, B-type natriuretic peptide, electrocardiogram, and chest radiograph findings distinguished myopericarditis from myocarditis with correct classification in 95% of patients. CONCLUSIONS Myopericarditis is a relatively common cause of chest pain for patients admitted to the pediatric intensive care unit, presents differently than true myocarditis, and carries a good prognosis.
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Affiliation(s)
- Christopher J Babbitt
- From the Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach
| | | | - Francesca Byrne
- Pediatric Cardiology, Miller Children's and Women's Hospital of Long Beach, Long Beach, CA
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35
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Sexson Tejtel SK, Munoz FM, Al-Ammouri I, Savorgnan F, Guggilla RK, Khuri-Bulos N, Phillips L, Engler RJM. Myocarditis and pericarditis: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:1499-1511. [PMID: 35105494 DOI: 10.1016/j.vaccine.2021.11.074] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023]
Abstract
Myocarditis and/or pericarditis (also known as myopericarditis) are inflammatory diseases involving the myocardium (with non-ischemic myocyte necrosis) and/or the pericardial sac. Myocarditis/pericarditis (MPC) may present with variable clinical signs, symptoms, etiologies and outcomes, including acute heart failure, sudden death, and chronic dilated cardiomyopathy. Possible undiagnosed and/or subclinical acute myocarditis, with undefined potential for delayed manifestations, presents further challenges for diagnosing an acute disease and may go undetected in the setting of infection as well as adverse drug/vaccine reactions. The most common causes of MPC are viral, with non-infectious, drug/vaccine associated hypersensitivity and/or autoimmune causes being less well defined and with potentially different inflammatory mechanisms and treatment responses. Potential cardiac adverse events following immunization (AEFIs) encompass a larger scope of diagnoses such as triggering or exacerbating ischemic cardiac events, cardiomyopathy with potential heart failure, arrhythmias and sudden death. The current published experience does not support a potential causal association with vaccines based on epidemiologic evidence of relative risk increases compared with background unvaccinated incidence. The only evidence supporting a possible causal association of MPC with a vaccine comes from case reports. Hypersensitivity MPC as a drug/vaccine induced cardiac adverse event has long been a concern for post-licensure safety surveillance, as well as safety data submission for licensure. Other cardiac adverse events, such as dilated cardiomyopathy, were also defined in the CDC definitions for adverse events after smallpox vaccination in 2006. In addition, several groups have attempted to develop and improve the definition and adjudication of post-vaccination cardiovascular events. We developed the current case definitions for myocarditis and pericarditis as an AEFI building on experience and lessons learnt, as well as a comprehensive literature review. Considerations of other etiologies and causal relationships are outside the scope of this document.
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Affiliation(s)
| | - Flor M Munoz
- Departments of Pediatrics, Section of Infectious Diseases, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Iyad Al-Ammouri
- Pediatric Cardiology, The University of Jordan. Amman, Jordan
| | - Fabio Savorgnan
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rama K Guggilla
- Department of Population Medicine and Lifestyle Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Poland
| | - Najwa Khuri-Bulos
- Pediatric Infectious Diseases, Vaccines, The University of Jordan, Amman, Jordan
| | - Lee Phillips
- Pharmaco-epidemiology, Cardiovascular Drug Safety, USA
| | - Renata J M Engler
- Allergy-Immunology-Immunizations, Department of Medicine, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, and Immunization Healthcare Division, Defense Health Agency, Bethesda, MD, USA
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36
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Narang VK, Bowen J, Masarweh O, Burnette S, Valdez M, Moosavi L, Joolhar F, Win TT. Acute Pericarditis Leading to a Diagnosis of SLE: A Case Series of 3 Patients. J Investig Med High Impact Case Rep 2022; 10:23247096221077832. [PMID: 35240889 PMCID: PMC8905201 DOI: 10.1177/23247096221077832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In systemic lupus erythematosus (SLE), cardiac manifestations are known to be present in up to 50% of patients. However, it is rare for acute pericarditis to be the leading symptom at the time of diagnosis of SLE occurring in up to 1% of patients. We present a case series in which 3 patients with no prior history of SLE presented with acute pericarditis. This was found to be the leading manifestation of their disease, which ultimately led to the diagnosis of SLE. These patients were initially treated with nonsteroidal anti-inflammatory drugs and colchicines; however, steroids and disease-modifying anti-rheumatologic agents were ultimately added to their medical therapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Theingi Tiffany Win
- Kern Medical, Bakersfield, CA, USA
- Theingi Tiffany Win, MD, FACC, Division of Cardiology, Department of Internal Medicine, Kern Medical, 1700 Mount Vernon Avenue, Bakersfield, CA 93306, USA.
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37
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Lazarou E, Lazaros G, Antonopoulos AS, Imazio M, Vasileiou P, Karavidas A, Toutouzas K, Vassilopoulos D, Tsioufis C, Tousoulis D, Vlachopoulos C. A risk score for pericarditis recurrence. Eur J Clin Invest 2021; 51:e13602. [PMID: 34050527 DOI: 10.1111/eci.13602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/10/2021] [Accepted: 05/11/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Currently, we remain uncertain about which patients are at increased risk for recurrent pericarditis. We developed a risk score for pericarditis recurrence in patients with acute pericarditis. MATERIALS AND METHODS We prospectively recruited 262 patients with a first episode of acute pericarditis. Baseline patients' demographics, clinical, imaging and laboratory data were collected. Patients were followed up for a median of 51 months (interquartile range 21-71) for recurrence. Variables with <10% missingness were entered into multivariable logistic regression models with stepwise elimination to explore independent predictors of recurrence. The final model performance was assessed by the c-index whereas model's calibration and optimism-corrected c-index were evaluated after 10-fold cross-validation. RESULTS We identified six independent predictors for pericarditis recurrence, that is age, effusion size, platelet count (negative predictors) and reduced inferior vena cava collapse, in-hospital use of corticosteroids and heart rate (positive predictors). The final model had good performance for recurrence, c-index 0.783 (95% CI 0.725-0.842), while the optimism-corrected c-index after cross-validation was 0.752. Based on these variables, we developed a risk score point system for recurrence (0-22 points) with equally good performance (c-index 0.740, 95% CI 0.677-0.803). Patients with a low score (0-7 points) had 21.3% risk for recurrence, while those with high score (≥12 points) had a 69.8% risk for recurrence. The score was predictive of recurrence among most patient subgroups. CONCLUSIONS A simple risk score point system based on 6 variables can be used to predict the individualized risk for pericarditis recurrence among patients with a first episode of acute pericarditis.
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Affiliation(s)
- Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios S Antonopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department,, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | | | - Apostolos Karavidas
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Second Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, School of Medicine, Hippokration General Hospital, National and Kapodistrian University, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Jolly G, Dacosta Davis S, Ali S, Bitterman L, Saunders A, Kazbour H, Parwani P. Cardiac involvement in hydrocarbon inhalant toxicity — role of cardiac magnetic resonance imaging: A case report. World J Cardiol 2021; 13:593-598. [PMID: 34754404 PMCID: PMC8554358 DOI: 10.4330/wjc.v13.i10.593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/07/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report a patient who was diagnosed with toxic myopericarditis secondary to hydrocarbon abuse using cardiac magnetic resonance imaging (CMR).
CASE SUMMARY A 25-year-old male presented to emergency department with chest pain for 3 d. Patient also reported sniffing hydrocarbon containing inhalant for the last 1 year. Labs showed elevated troponin and electrocardiography was suggestive of acute pericarditis. Echocardiogram showed left ventricular (LV) ejection fraction (EF) of 40%. Given patient’s troponin elevation and reduced EF, cardiac catheterization was performed which showed normal coronaries. CMR was performed for myocardial infarction with non-obstructive coronary arteries evaluation. CMR showed borderline LV function with edema in mid and apical LV suggestive of myocarditis.
CONCLUSION CMR can be used to diagnose toxic myopericarditis secondary to hydrocarbon abuse.
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Affiliation(s)
- George Jolly
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Shevel Dacosta Davis
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Saif Ali
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Lauren Bitterman
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Ashley Saunders
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Hana Kazbour
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Purvi Parwani
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
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39
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Pommier T, Leclercq T, Guenancia C, Tisserand S, Lairet C, Carré M, Lalande A, Bichat F, Maza M, Zeller M, Cochet A, Cottin Y. More than 50% of Persistent Myocardial Scarring at One Year in "Infarct-like" Acute Myocarditis Evaluated by CMR. J Clin Med 2021; 10:jcm10204677. [PMID: 34682800 PMCID: PMC8541248 DOI: 10.3390/jcm10204677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) has emerged as a reference tool for the non-invasive diagnosis of myocarditis. However, its role in follow-up (FU) after the acute event is unclear. The objectives were to assess the evolution of CMR parameters between the acute phase of infarct-like myocarditis and 12 months thereafter and to identify the predictive factors of persistent myocardial scarring at one year. METHODS All patients with infarct-like acute myocarditis confirmed by CMR were included. CMR was performed within 8 days following symptom onset, at 3 months and at one year. One-year FU included ECG, a cardiac stress test, Holter recording, biological assessments, medical history and a quality-of-life questionnaire. Patients were classified according to the presence or absence of complete recovery at one year based on the CMR evaluation. RESULTS A total of 174 patients were included, and 147 patients had three CMR. At one year, 79 patients (54%) exhibited persistent myocardial scarring on CMR. A multivariate analysis showed that high peak troponin at the acute phase (OR: 3.0-95%CI: 1.16-7.96-p = 0.024) and the initial extent of late gadolinium enhancement (LGE) (OR: 1.1-95%CI: 1.03-1.19-p = 0.006) were independent predictors of persistent myocardial scarring. Moreover, patients with myocardial scarring on the FU CMR were more likely to have premature ventricular contractions during the cardiac stress test (25% versus 9%, p = 0.008). CONCLUSION Less than 50% of patients with infarct-like acute myocarditis showed complete recovery at one year. Although major adverse cardiac events were rare, ventricular dysrhythmias at one year were more frequent in patients with persistent myocardial scarring.
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Affiliation(s)
- Thibaut Pommier
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
- Correspondence: ; Tel.: +33-6-2645-6190; Fax: +33-3-8039-3333
| | - Thibault Leclercq
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
| | - Charles Guenancia
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Simon Tisserand
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
| | - Céline Lairet
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Max Carré
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Alain Lalande
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
- Laboratory ImVIA, EA 7535, University of Burgundy, 21000 Dijon, France
| | - Florence Bichat
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Maud Maza
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Marianne Zeller
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Alexandre Cochet
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
- Laboratory ImVIA, EA 7535, University of Burgundy, 21000 Dijon, France
| | - Yves Cottin
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
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Kim D, Choi JH, Jang JY, So O, Cho E, Choi H, Hong KS, Park KT. A Case Report for Myopericarditis after BNT162b2 COVID-19 mRNA Vaccination in a Korean Young Male. J Korean Med Sci 2021; 36:e277. [PMID: 34636504 PMCID: PMC8506415 DOI: 10.3346/jkms.2021.36.e277] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
Abstract
Mass vaccination with the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine (BNT162b2) in Korea has resulted in many reported adverse effects. These side effects are the object of much scrutiny in the medical community. We report the case of a 29-year-old male who was diagnosed with myopericarditis after his second dose of Pfizer-BioNTech COVID-19 vaccine. This patient is the second recognized case of Pfizer-BioNTech COVID-19 vaccine induced myopericarditis in Korea and the first to have recovered from it. He originally presented with chest discomfort and exertional chest pain. Lab tests revealed elevated cardiac marker levels and echocardiographic findings displayed minimal pericardial effusion, prompting diagnosis as myopericarditis. We decided on two weeks of outpatient treatment with non-steroidal anti-inflammatory drugs (NSAIDs) due to the patient's mild symptoms and his occupation in the military. When this proved insufficient, we shifted to combination therapy with low dose corticosteroids and NSAIDs. After two weeks of treatment, the patient's symptoms and pericardial effusion had improved, and he was recovered completely 37 days after the onset.
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Affiliation(s)
- Dongwon Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jun Hyung Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jun Young Jang
- Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Ouiyeon So
- Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - EunJeong Cho
- Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyunhee Choi
- Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung Soon Hong
- Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyu Tae Park
- Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
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Established and Emerging Techniques for Pericardial Imaging with Cardiac Magnetic Resonance. Curr Cardiol Rep 2021; 23:169. [PMID: 34622359 DOI: 10.1007/s11886-021-01595-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Pericardial diseases include a wide range of pathologies and their diagnosis can often be challenging. The goal of this review is to describe the established and emerging CMR imaging techniques used in the assessment of common pericardial diseases and explain the role of pericardial characterization in their diagnosis and management. RECENT FINDINGS CMR is indicated in cases of diagnostic uncertainty and for a comprehensive evaluation of the pericardium and its impact on the heart. This includes assessment of pericardial anatomy and associated cardiac hemodynamics, quantification and characterization of an effusion, disease staging, tissue characterization, guiding management, and even prognostication in some diseases of the pericardium. An emerging technique, pericardial characterization, utilizes various sequences to diagnose and stage pericardial inflammation, act as a biomarker in recurrent pericarditis, and guide management in inflammatory pericardial conditions. Beyond imaging, it has ushered in an era of tailored therapy for patients with pericardial diseases. Future directions should aim at exploring the role of tissue characterization in various pericardial diseases.
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Piccioni A, Saviano A, Cicchinelli S, Franza L, Rosa F, Zanza C, Santoro MC, Candelli M, Covino M, Nannini G, Amedei A, Franceschi F. Microbiota and Myopericarditis: The New Frontier in the Car-Diological Field to Prevent or Treat Inflammatory Cardiomyo-Pathies in COVID-19 Outbreak. Biomedicines 2021; 9:1234. [PMID: 34572420 PMCID: PMC8468627 DOI: 10.3390/biomedicines9091234] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023] Open
Abstract
Myopericarditis is an inflammatory heart condition involving the pericardium and myocardium. It can lead to heart failure, dilated cardiomyopathy, arrhythmia and sudden death. Its pathogenesis is mainly mediated by viral infections but also can be induced by bacterial infections, toxic substances and immune mediated disorders. All these conditions can produce severe inflammation and myocardial injury, often associated with a poor prognosis. The specific roles of these different pathogens (in particular viruses), the interaction with the host, the interplay with gut microbiota, and the immune system responses to them are still not completely clear and under investigation. Interestingly, some research has demonstrated the contribution of the gut microbiota, and its related metabolites (some of which can mimic the cardiac myosin), in cardiac inflammation and in the progression of this disease. They can stimulate a continuous and inadequate immune response, with a subsequent myocardial inflammatory damage. The aim of our review is to investigate the role of gut microbiota in myopericarditis, especially for the cardiovascular implications of COVID-19 viral infection, based on the idea that the modulation of gut microbiota can be a new frontier in the cardiological field to prevent or treat inflammatory cardiomyopathies.
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Affiliation(s)
- Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Sara Cicchinelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Laura Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Federico Rosa
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Christian Zanza
- Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, Foundation Nuovo-Ospedale Alba-Bra, 12060 Verduno, Italy;
| | - Michele Cosimo Santoro
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
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Ramírez P, Cuevas E, Cornejo JA, Olvera S, Aceituno J, Meléndez G, Baeza L. Myopericarditis Complicated With Cardiac Tamponade Due to Campylobacter fetus Infection. CJC Open 2021; 3:1189-1191. [PMID: 34712944 PMCID: PMC8531223 DOI: 10.1016/j.cjco.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
About 90% of cases of acute pericarditis have an idiopathic or viral etiology. In some cases, it is possible to identify high-risk patients for whom hospital admission and specific etiology research are mandatory for adequate treatment. Bacterial pericarditis is uncommon and responsible for less than 1% of cases. Only 10 cases of pericarditis due to Campylobacter fetus have been documented worldwide. This case highlights the importance of good cardiac imaging, with the right clinical and microbiology-integrated approach in high-risk cases of pericardial disease.
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Affiliation(s)
- Pamela Ramírez
- Cardiology Department. Ignacio Chávez National Institute of Cardiology, Mexico City, Tlalpan, Mexico
| | - Eric Cuevas
- Interventional Cardiology (Fellow), Ignacio Chávez National Institute of Cardiology, Mexico City, Tlalpan, Mexico
| | - José Antonio Cornejo
- Interventional Cardiology (Fellow), Ignacio Chávez National Institute of Cardiology, Mexico City, Tlalpan, Mexico
| | - Sergio Olvera
- Cardiology Department. Ignacio Chávez National Institute of Cardiology, Mexico City, Tlalpan, Mexico
| | - Jorge Aceituno
- Echocardiography (Fellow), Ignacio Chávez National Institute of Cardiology, Mexico City, Tlalpan, Mexico
| | - Gabriela Meléndez
- Cardiac Resonance Imaging Department, Ignacio Chávez National Institute of Cardiology, Mexico City, Tlalpan, Mexico
| | - Luis Baeza
- Cardiovascular Intensive Care Unit (Fellow), Ignacio Chávez National Institute of Cardiology, Mexico City, Tlalpan, Mexico
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Hasnie AA, Hasnie UA, Patel N, Aziz MU, Xie M, Lloyd SG, Prabhu SD. Perimyocarditis following first dose of the mRNA-1273 SARS-CoV-2 (Moderna) vaccine in a healthy young male: a case report. BMC Cardiovasc Disord 2021; 21:375. [PMID: 34348657 PMCID: PMC8334333 DOI: 10.1186/s12872-021-02183-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023] Open
Abstract
Background Half of U.S. adults have received at least one dose of the COVID-19 vaccines produced by either Pfizer, Moderna, or Johnson and Johnson, which represents a major milestone in the ongoing pandemic. Given the emergency use authorizations for these vaccines, their side effects and safety were assessed over a compressed time period. Hence, ongoing monitoring for vaccine-related adverse events is imperative for a full understanding and delineation of their safety profile. Case presentation An 22-year-old Caucasian male presented to our hospital center complaining of pleuritic chest pain. Six months prior he had a mild case of COVID-19, but was otherwise healthy. He had received his first dose of the Moderna vaccine three days prior to developing symptoms. Laboratory analysis revealed a markedly elevated troponin and multiple imaging modalities during his hospitalization found evidence of wall motion abnormalities consistent with a diagnosis of perimyocarditis. He was started on aspirin and colchicine with marked improvement of his symptoms prior to discharge.
Conclusions We present a case of perimyocarditis that was temporally related to COVID-19 mRNA vaccination in an young male with prior COVID-19 infection but otherwise healthy. Our case report highlights an albeit rare but important adverse event for clinicians to be aware of. It also suggests a possible mechanism for the development of myocardial injury in our patient. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02183-3.
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Affiliation(s)
- Ammar A Hasnie
- Department of Internal Medicine, University of Alabama at Birmingham (UAB), 1720 2nd Avenue S, BDB 327, Birmingham, AL, 35233, USA.
| | - Usman A Hasnie
- Department of Internal Medicine, University of Alabama at Birmingham (UAB), 1720 2nd Avenue S, BDB 327, Birmingham, AL, 35233, USA
| | - Nirav Patel
- Department of Internal Medicine, University of Alabama at Birmingham (UAB), 1720 2nd Avenue S, BDB 327, Birmingham, AL, 35233, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muhammad U Aziz
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Min Xie
- Department of Internal Medicine, University of Alabama at Birmingham (UAB), 1720 2nd Avenue S, BDB 327, Birmingham, AL, 35233, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven G Lloyd
- Department of Internal Medicine, University of Alabama at Birmingham (UAB), 1720 2nd Avenue S, BDB 327, Birmingham, AL, 35233, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Sumanth D Prabhu
- Department of Internal Medicine, University of Alabama at Birmingham (UAB), 1720 2nd Avenue S, BDB 327, Birmingham, AL, 35233, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Duran M, Alsancak Y, Ziyrek M. Effects of oral colchicine administration as first-line adjunct therapy in myopericarditis. Herz 2021; 47:166-174. [PMID: 34114046 DOI: 10.1007/s00059-021-05040-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although current guidelines recommend routine use of oral colchicine as a first-line adjunct therapy to aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs) for acute and recurrent pericarditis, there are insufficient data to recommend routine use of colchicine for the initial management of myopericarditis. METHODS The records of 194 patients who were admitted for myopericarditis were investigated retrospectively. Patients receiving oral colchicine (n = 33) as an adjunct to aspirin/NSAIDs comprised the study group and patients who received conventional therapy (n = 31) formed the control group. Plasma C‑reactive protein (CRP) levels, cardiac biomarkers, and several electrocardiographic parameters of atrial activation were evaluated before the start of treatment and at the 6‑month follow-up. RESULTS Assessments before and after treatment with regard to cardiac biomarkers and plasma CRP levels showed improvements in both groups (p > 0.05). There were statistically significant improvements in P wave indices including P wave duration, PR interval length, P wave dispersion, P terminal force, and isoelectric interval in the colchicine therapy group compared with the control group (p < 0.01). CONCLUSION Routine use of colchicine for the initial management of myopericarditis as a first-line adjunct therapy to aspirin/NSAIDs in patients with myopericarditis has favorable effects on electrocardiographic indices of atrial activation parameters.
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Affiliation(s)
- Mustafa Duran
- Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey
| | - Yakup Alsancak
- Meram Medical Faculty Department of Cardiology Meram/Konya, Necmettin Erbakan University, 042065, Meram/Konya, Turkey.
| | - Murat Ziyrek
- Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey
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Park SJ, Jang CW, Kim YK, Seo YH, Kim KH, Kwon TG, Bae JH. Toxocariasis-Associated Acute Perimyocarditis with Cardiogenic Shock: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930573. [PMID: 34043606 PMCID: PMC8165499 DOI: 10.12659/ajcr.930573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Female, 21-year-old Final Diagnosis: Toxocariasis-associated acute perimyocarditis with cardiogenic shock Symptoms: Dizziness • epigastric pain • headache • vomiting Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Se-Jin Park
- Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
| | - Chae-Won Jang
- Department of Cardiology, Konyang University Hospital, Daejeon, South Korea
| | - Yong-Kyun Kim
- Department of Cardiology, Konyang University Hospital, Daejeon, South Korea
| | - Young-Hoon Seo
- Department of Cardiology, Konyang University Hospital, Daejeon, South Korea
| | - Ki-Hong Kim
- Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
| | - Taek-Geun Kwon
- Department of Cardiology, Konyang University Hospital, Daejeon, South Korea
| | - Jang-Ho Bae
- Department of Cardiology, Konyang University Hospital, Daejeon, South Korea
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Meisel SR, Nashed H, Natour R, Abu Fanne R, Saada M, Amsalem N, Levin C, Kobo O, Frimerman A, Levi Y, Mohsen J, Shotan A, Roguin A, Kleiner-Shochat M. Differentiation between myopericarditis and acute myocardial infarction on presentation in the emergency department using the admission C-reactive protein to troponin ratio. PLoS One 2021; 16:e0248365. [PMID: 33886564 PMCID: PMC8062049 DOI: 10.1371/journal.pone.0248365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background The treatment of myopericarditis is different than that of acute myocardial infarction (AMI). However, since their clinical presentation is frequently similar it may be difficult to distinguish between these entities despite a disparate underlying pathogenesis. Myopericarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We hypothesized that evaluation of the CRP/troponin ratio on presentation to the emergency department could improve the differentiation between these two related clinical entities whose therapy is different. Such differentiation should facilitate triage to appropriate and expeditious therapy. Methods We evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large single center registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed on discharge as myopericarditis. CRP and troponin were sampled on admission in all patients and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of myopericarditis against all AMI, STEMI, and NSTEMI patients. Results Median admission CRP/troponin ratios were 84, 65, and 436 mg×ml/liter×ng in STEMI, NSTEMI and myopericarditis groups, respectively (p<0.001) demonstrating good differentiating capability. The Receiver-operator-curve of admission CRP/troponin ratio for diagnosis of myopericarditis against all AMI, STEMI, and NSTEMI patients yielded an area-under-the curve of 0.74, 0.73, and 0.765, respectively. CRP/troponin ratio>500 resulted in specificity exceeding 85%, and for a ratio>1000, specificity>92%. Conclusion The CRP/troponin ratio can serve as an effective tool to differentiate between myopericarditis and AMI. In the appropriate clinical context, the CRP/troponin ratio may preclude further evaluation.
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Affiliation(s)
- Simcha R. Meisel
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
- * E-mail:
| | - Hamuda Nashed
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Randa Natour
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rami Abu Fanne
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Majdi Saada
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Naama Amsalem
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Carmel Levin
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Kobo
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Aaron Frimerman
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Levi
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Jameel Mohsen
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Avraham Shotan
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ariel Roguin
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
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Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:60-67. [PMID: 33868419 PMCID: PMC8039934 DOI: 10.5114/aic.2021.104770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction There is limited data on the long-term follow-up of patients with myocarditis. Aim To investigate the long-term follow-up of patients with myocarditis. Material and methods We performed a retrospective observational analysis on the clinical long-term outcomes of patients with myocarditis over a 10-year period. The primary outcome was mortality. We identified risk factors for mortality and adverse clinical outcomes. We also compared the characteristics and outcomes of patients presenting with fulminant myocarditis to those presenting with non-fulminant myocarditis. Results Between May 2004 and December 2014, 203 patients with myocarditis or perimyocarditis were admitted to our center. Most patients were male (87.7%) with a median age at presentation of 33 years (interquartile range: 25.4–38.9). The median follow-up period was 56.9 months (interquartile range 25.3–87.3 months), during which the overall mortality was 4.4% (9 patients). Fifteen patients presented with fulminant myocarditis. After multivariable analysis, older age (HR = 1.11, 95% CI: 1.05–1.16, p < 0.001) and a poorer New York Heart Association (NYHA) function class (HR = 4.6, 95% CI: 1.18–18, p = 0.028) were found to be independently associated with a higher risk of mortality, whereas higher albumin levels at presentation (HR = 0.2, 95% CI: 0.07–0.56, p = 0.002) were associated with decreased mortality. The group presenting with fulminant myocarditis had a more severe course of disease and a higher in-hospital mortality (13.3% vs. 0%, p = 0.005). Conclusions The overall prognosis of patients with myocarditis is good – in terms of both survival and recovery without residual left ventricular dysfunction.
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Myopericarditis Associated With Smallpox Vaccination Among US Army Personnel - Fort Hood, Texas, 2018. Disaster Med Public Health Prep 2021; 16:1022-1028. [PMID: 33719991 DOI: 10.1017/dmp.2020.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation. METHODS The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates. RESULTS This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7-12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3-8.3). CONCLUSIONS Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.
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50
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Lazaros G, Antonopoulos AS, Lazarou E, Vlachopoulos C, Vogiatzi G, Vassilopoulos D, Tousoulis D. Age- and sex-based differences in patients with acute pericarditis. Eur J Clin Invest 2021; 51:e13392. [PMID: 32857868 DOI: 10.1111/eci.13392] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute pericarditis has a wide spectrum of clinical presentations largely depending on underlying aetiologies. We assessed the role of age and sex in the clinical features and outcome of acute pericarditis. MATERIALS AND METHODS A total of 240 consecutive patients hospitalized with a first episode of acute pericarditis were included. At baseline demographics, clinical features, laboratory and imaging findings and medical therapy were recorded. Patients were followed up for at least 18 months for complications. Data comparisons were performed according to sex and age (≤60 or >60 years). RESULTS The male/female ratio was 1.42, and 56% of patients were >60 years. Younger patients depicted more often chest pain (P = .001), fever and rubs (P < .001 for both), ST elevation and PR depression (P = .032 and .009, respectively), higher CRP values (P = .009) and less often dyspnoea (P = .046) and pericardial effusion (P = .036). Moreover, they received less often glucocorticoids (P < .001) and depicted less atrial fibrillation (P = .003) and a higher rate of recurrent pericarditis (P = .013). After multivariate adjustment for confounders, age >60 years remained an independent predictor for a lower risk of recurrent pericarditis (hazard ratio 0.60, 95% CI: 0.39-0.96, P = .033). Regarding sex, females were older (P = .007), showed less often ST elevation and PR depression (P < .001 and .002, respectively) and had a higher baseline heart rate (P = .02). Sex was not associated with recurrent pericarditis risk. CONCLUSIONS Patients with acute pericarditis have distinct presenting clinical, biochemical and prognostic features according to age and sex. Awareness of such differences is important for clinical decision-making.
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Affiliation(s)
- George Lazaros
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vogiatzi
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinhical Immunology-Rheumatology Unit, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
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