Acute hemodynamic effects of metoprolol +/- nitroglycerin in patients with biopsy-proven lymphocytic myocarditis

Clinically Suspected Exercise-Induced Myocarditis in a Patient With Vascular Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome (EDS) is an inherited condition that affects connective tissue structures throughout the body. EDS type IV is a specific subset of EDS that targets vascular structures. Patients with EDS type IV can have a wide range of vascular disorders such as myocarditis and are advised to refrain from participating in contact sports and high-intensity physical exercises to avoid life-threatening cardiovascular conditions such as arterial dissection or rupture. In this report, we present the case of an EDS type IV patient with myocarditis secondary to exercise. The patient received supportive treatment including beta-blockers, bed rest, and refraining from intense physical exertion.

Fulminant cytomegalovirus myocarditis in an infant with concomitant large atrial and ventricular septal defects: medical intervention strategy for functional cardiac regeneration

A cytomegalovirus-associated heart failure in a young infant with atrial and ventricular septal defects is reported in this case report. The patient recovered by an anti-congestive and anti-viral therapy with an extra percutaneous transcatheter treatment strategy. In the context of bi-ventricular predominant right heart failure associated with supra-systemic pulmonary hypertension, the already closed arterial duct was re-opened and stented to unload the right ventricle and thereby augment the systemic blood flow. Either the left-to-right shunting atrial septal defect or bi-directional shunting ventricular septal defect was involved in the disease process and was not able to avoid global heart failure. After clinical improvement, the stented duct was shunted left-to-right and was occluded with an ADO-II-AS. During the same procedure the atrial septal defect was closed with an Amplatzer-ASD occluder, while the peri-membranous ventricular septal defect was closed with an ADO-II occluder 2 months later.

Management of pericarditis and myocarditis: could heart-rate-reducing drugs hold a promise?

Rest is usually recommended in acute pericarditis and acute myocarditis. Given that myocarditis often leads to hospitalization, this task seems easy to carry out in hospital practice; however, it could be a real challenge at home in daily life. Heart rate-lowering treatments (mainly beta-blockers) are usually recommended in case of acute myocarditis, especially in case of heart failure or arrhythmias, but level of proof remains weak. Calcium channel inhibitors and digoxin are sometimes proposed, albeit in limited situations. It is possible that rest or even heart rate-lowering treatments could help to manage these patients by preventing heart failure as well as by limiting "mechanical inflammation" and controlling arrhythmias, especially life-threatening ones. Whether heart rate has an effect on inflammation remains unclear. Several questions remain unsolved, such as the duration of such treatments, especially in light of new heart rate-lowering treatments, such as ivabradine. In this review, we discuss rest and heart-rate lowering medications for the treatment of pericarditis and myocarditis. We also highlight some work in experimental models that indicates the beneficial effects of such treatments for these conditions. Finally, we suggest certain experimental avenues, through the use of animal models and clinical studies, which could lead to improved management of these patients.

Hemodynamic characterization of left ventricular function in experimental coxsackieviral myocarditis: effects of carvedilol and metoprolol

BACKGROUND

Carvedilol, a vasodilating nonselective beta-adrenoceptor antagonist, but not metoprolol, a selective beta1-adrenoceptor antagonist, has been shown to increase the production of cardiac antiinflammatory cytokines in experimental myocarditis. However, the hemodynamic consequences of these differences had not been investigated until today. Therefore, we determined the effects of carvedilol and metoprolol on left ventricular function in a murine model of coxsackievirus B3 (CVB3)-induced myocarditis.

METHODS

BALB/c mice were inoculated with the coxsackie-B3 virus. Four and 10 days after infection, left ventricular function was investigated using a conductance micromanometer system. Additional groups were treated starting 24 h after infection using equipotent doses of carvedilol and metoprolol and studied on day 10.

RESULTS

On day 4, infected mice manifested increased afterload-enhanced contractility and abnormal diastolic function. On day 10, contractile function of untreated mice was impaired. Carvedilol significantly improved cardiac index and most systolic indices, whereas metoprolol was substantially less effective. Diastolic dysfunction was not influenced by either of the beta-adrenoceptor antagonists.

CONCLUSIONS

These hemodynamic data indicate that not only beta1-adrenoceptor blockade but also pleiotropic effects are involved in the cardioprotective effects of carvedilol on the pathophysiology of acute viral myocarditis.