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Malik AA, Lloyd JW, Anavekar NS, Luis SA. Acute and Complicated Inflammatory Pericarditis: A Guide to Contemporary Practice. Mayo Clin Proc 2024; 99:795-811. [PMID: 38702128 DOI: 10.1016/j.mayocp.2024.01.012] [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] [Received: 06/03/2023] [Revised: 11/15/2023] [Accepted: 01/25/2024] [Indexed: 05/06/2024]
Abstract
Inflammatory disease of the pericardium represents a relatively common presentation, especially among the young. For the most part, inflammatory pericardial disease can be expeditiously and effectively managed without significant sequelae. However, some individuals present with severe and recurrent illness, representing significant therapeutic challenges. During the past decade, there have been great strides made in developing an evidence-based approach to management of inflammatory pericardial disease, the result of which has been the development of (1) a systematic, protocoled approach to initial care; (2) targeted therapeutics; and (3) specialized, collaborative, and integrated care pathways. Herein we present a review of the current state of the art as it pertains to the diagnostic evaluation and therapeutic considerations in inflammatory pericardial disease with a focus on acute and complicated pericarditis.
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Affiliation(s)
- Awais A Malik
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - James W Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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2
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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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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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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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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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6
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Nisson C, Hernandez Mato Y, Lingappa N, Abraham J. Type I Spontaneous Coronary Artery Dissection in a 33-Year-Old Male With Clinically Suspected Myopericarditis. Cureus 2023; 15:e38570. [PMID: 37288237 PMCID: PMC10241664 DOI: 10.7759/cureus.38570] [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: 05/05/2023] [Indexed: 06/09/2023] Open
Abstract
We report a 33-year-old male with uncontrolled type II diabetes, and tobacco and marijuana use who presented with chest pain after a night of binge drinking and vomiting. ECG changes were consistent with acute pericarditis. Troponin levels were found to be significantly elevated and rising. The patient was immediately treated with acetylsalicylic acid (ASA), morphine, nitroglycerin drip, and heparin drip. Echocardiogram showed preserved ejection fraction (EF) without effusion. Coronary angiography demonstrated a type I spontaneous coronary artery dissection (SCAD) of the mid-left anterior descending artery (LAD) without significant coronary artery disease. Diagnostic intravenous ultrasound (IVUS) confirmed a type I SCAD with penumbra and a minimal luminal area of 10 mm2 of the mid-LAD without significant luminal narrowing. Percutaneous intervention was performed with ultrasound-guided penumbra aspiration thrombectomy. Medical therapy was started with aspirin and ticagrelor, high-intensity statin, metoprolol tartrate, lisinopril, colchicine, and insulin. A biopsy or cardiac MRI was not performed due to the resolution of the patient's symptoms. We conclude that the development of a type I SCAD in this patient was multifactorial in nature, including clinically suspected acute myopericarditis, uncontrolled type II diabetes mellitus, and binge drinking associated with vomiting.
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Affiliation(s)
- Cullen Nisson
- Internal Medicine, Health Corporation of America (HCA) Florida Brandon Hospital, Brandon, USA
| | | | - Nimisha Lingappa
- Psychology, University of Florida, Gainesville, USA
- Biomedical Sciences, Barry University, Hollywood, USA
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - James Abraham
- Internal Medicine, Health Corporation of America (HCA) Florida Brandon Hospital, Brandon, USA
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Tei Index Is a Useful Adjunctive Tool in the Diagnostic Workup of Patients with Acute Myocarditis. J Cardiovasc Dev Dis 2022; 9:jcdd9080283. [PMID: 36005447 PMCID: PMC9409993 DOI: 10.3390/jcdd9080283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Tei index (TI) is a combined myocardial performance index, which was found to be more sensitive for overall cardiac dysfunction than systolic or diastolic parameters alone. Currently, there is only limited evidence for this measure in the context of myocarditis. Thus, TI could add additional benefits to conventional diagnostic workup. Methods: TI of patients with myocarditis (n = 40), acute coronary syndrome (n = 29) and controls (n = 50) was retrospectively analyzed concerning its discriminatory ability for myocarditis. Results: TI was most pathological in patients with myocarditis (median 0.41 vs. 0.35 vs. 0.31, p < 0.0001). Its discriminatory ability was better than that of EF or E/e’ (AUCs: TI: 0.71, p < 0.0001; EF: 0.57, p = 0.112; E/e’: 0.64, p = 0.983), which was also verified in logistic regression analysis (B(SE) = 0.81(0.23), p = 0.0004). The association of TI with myocarditis remained significant even after correction for confounders in propensity score weighted analysis. Conclusions: The TI showed a better discriminatory ability for myocarditis than conventional echocardiographic parameters. Since TI is easily conducted, it might be a helpful adjunctive tool to supplement conventional diagnostic modalities in patients with suspected myocarditis.
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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: 3] [Impact Index Per Article: 1.5] [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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9
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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] [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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A rare case of COVID-19 vaccine-induced myopericarditis in a young adult. Radiol Case Rep 2022; 17:1916-1920. [PMID: 35401904 PMCID: PMC8980502 DOI: 10.1016/j.radcr.2022.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 12/29/2022] Open
Abstract
Although extremely rare, the COVID-19 mRNA vaccine can induce myopericarditis without left ventricular dysfunction, and there have been rare reports of such incidents. However, these prior cases either did not have pericardial effusion without reduced left ventricular ejection fraction or had a more typical presentation of vaccine-induced myopericarditis such as shortness of breath or tactile temperature. We present a rare case of a 25-year-old man who developed myopericarditis following administration of the second dose of COVID-19 mRNA Vaccine. As vaccination plays a significant role in the fight against the COVID-19 pandemic, it is essential to highlight the physical manifestations of the vaccine's potential adverse effects and risk factors to increase the general population's awareness regarding the importance of emergent medical care.
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11
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Lazaros G, Lazarou E, Tsioufis P, Soulaidopoulos S, Iliakis P, Vlachopoulos C, Tsioufis C. Chronic pericardial effusion: current concepts and emerging trends. Expert Rev Cardiovasc Ther 2022; 20:363-376. [PMID: 35524164 DOI: 10.1080/14779072.2022.2075346] [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: 10/18/2022]
Abstract
INTRODUCTION Pericardial effusion (PEF) is a common and challenging pericardial syndrome with a variety of clinical manifestations ranging from asymptomatic, incidentally uncovered small PEFs, to life-threatening cardiac tamponade. AREAS COVERED : This review focuses on the pathophysiology, epidemiology, etiology, classification, clinical findings, diagnostic work-up, management and outcome of PEFs. Particular emphasis has been given on the most recent evidence concerning the contribution of imaging for the detection, differential diagnosis and evaluation of the hemodynamic impact of PEFs on the diastolic filling of the heart. Moreover, simplified algorithms for PEF triage and management have been included. EXPERT OPINION The management of patients with PEFs is mainly based on four parameters namely hemodynamic impact on diastolic function, elevation of inflammatory markers, presence of a specific underlying condition known to be associated with PEF and finally size and duration of the effusion. Novel data have contributed to change our view towards large, asymptomatic, "idiopathic" PEFs and dictated a rather conservative approach in most cases. It is also stressed that there is a compelling need for additional research, which is essential for tailored treatments aiming at the improvement of quality of life and containment of health care costs.
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Affiliation(s)
- George Lazaros
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Emilia Lazarou
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagιotis Iliakis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
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12
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Daloya J, Ashraf A, Kaell A, Perera R, Korlipara G. Acute Myopericarditis in the Setting of Crohn’s Colitis: Challenging Management Decisions. Cureus 2022; 14:e22794. [PMID: 35399407 PMCID: PMC8980245 DOI: 10.7759/cureus.22794] [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: 03/02/2022] [Indexed: 11/05/2022] Open
Abstract
Myopericarditis is a rare extraintestinal manifestation of Crohn’s disease (CD). Myopericarditis has also been attributed to treatment with mesalamine and heart failure to tumor necrosis factor inhibitor (TNFi) use. When a patient with CD, controlled on these medications, presents with myopericarditis and/or heart failure, it can confound both the differential diagnosis and management of such patients. Our case is acute myopericarditis in a 34-year-old male, with a history of CD controlled with mesalamine and infliximab, who had been off TNFi therapy for over six months due to loss of insurance coverage and had been intermittently using leftover mesalamine. He presented to the ED complaining of a one-day history of abdominal pain with bloody diarrheal stools, chest discomfort, and fever. A colonoscopy performed two days back had demonstrated active colonic CD. Findings included ECG evidence of pericarditis, elevated cardiac biomarkers, and reduced left ventricular function on ventriculography consistent with myopericarditis. We present the differential, diagnostic and management challenges encountered in this situation, review the pertinent literature, and discuss decision making in what appears to be myopericarditis attributed to an extraintestinal manifestation of active GI Crohn’s.
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13
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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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14
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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: 44] [Impact Index Per Article: 22.0] [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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15
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Mirna M, Schmutzler L, Topf A, Boxhammer E, Sipos B, Hoppe UC, Lichtenauer M. Treatment with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Does Not Affect Outcome in Patients with Acute Myocarditis or Myopericarditis. J Cardiovasc Dev Dis 2022; 9:jcdd9020032. [PMID: 35200686 PMCID: PMC8880264 DOI: 10.3390/jcdd9020032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Previous animal studies reported an association of non-steroidal anti-inflammatory drugs (NSAIDs) with adverse outcomes in acute myocarditis, which is why these drugs are currently not recommended in affected patients. In this retrospective case-control study, we sought to investigate the effects of NSAID treatment in patients with acute myocarditis and myopericarditis to complement the available evidence. Method: A total of 114 patients with acute myocarditis were retrospectively enrolled. Demographical, clinical and laboratory data were extracted from hospital records. Patients who received NSAIDs (n = 39, 34.2%) were compared to controls. Follow-up on all-cause mortality was acquired for two years. Propensity score matching was additionally conducted to account for covariate imbalances between groups. Results: Treatment with NSAIDs was neither associated with a worse outcome (p = 0.115) nor with significant differences in left ventricular systolic function (p = 0.228) or in-hospital complications (p = 0.507). Conclusion: Treatment with NSAIDs was not associated with adverse outcomes in our study cohort. Together with the findings of previous studies, our results indicate that these drugs could be safely administered in patients with myocarditis and myopericarditis.
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16
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Vera-Lastra O, Lucas-Hernández A, Ruiz-Montiel JE, Gonzalez-Rodriguez VR, Pineda-Galindo LF. Myopericarditis as a Manifestation of Long COVID Syndrome. Cureus 2021; 13:e19449. [PMID: 34912599 PMCID: PMC8664614 DOI: 10.7759/cureus.19449] [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] [Accepted: 11/09/2021] [Indexed: 11/05/2022] Open
Abstract
The main presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is respiratory. However, there are extrapulmonary manifestations such as myocardial and pericardial injury. The term long COVID syndrome describes the persistence of symptoms in patients who have recovered from the infection. A 31-year-old man presented with mild coronavirus disease 2019 (COVID-19) symptoms for three days. Two weeks later, he developed chest pain, pericardial rub, and pericardial effusion; he underwent echocardiography showing pericarditis and an MRI which revealed inferoseptal hypokinesia and mild global myocardial hyperintensity, cardiac scintigraphy with Ga-67, and an inflammatory process in the myocardium. He was treated with methylprednisolone pulse (1g IV/day) and tapering prednisone (5 mg/day), with gradual evolution of symptoms for one year. In conclusion, this is a patient without comorbidities with clinical, laboratory, and imaging diagnosis of myopericarditis as a manifestation of long COVID syndrome.
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Affiliation(s)
- Olga Vera-Lastra
- Internal Medicine, Hospital de Especialidades Dr. Antonio Fraga Mouret, Instituto Mexicano del Seguro Social, Mexico City, MEX.,Division of Post-graduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, MEX
| | - Abihai Lucas-Hernández
- Internal Medicine, Hospital de Especialidades Dr. Antonio Fraga Mouret, Instituto Mexicano del Seguro Social, Mexico City, MEX.,Division of Post-graduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, MEX
| | - Jose E Ruiz-Montiel
- Internal Medicine, Hospital de Especialidades Dr. Antonio Fraga Mouret, Instituto Mexicano del Seguro Social, Mexico City, MEX.,Division of Post-graduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, MEX
| | - Viviana R Gonzalez-Rodriguez
- Internal Medicine, Hospital de Especialidades Dr. Antonio Fraga Mouret, Instituto Mexicano del Seguro Social, Mexico City, MEX.,Multidisciplinary Academic Division of Comalcalco, Universidad Juárez Autónoma de Tabasco, Tabasco, MEX
| | - Luis F Pineda-Galindo
- Internal Medicine, Hospital de Especialidades Dr. Antonio Fraga Mouret, Instituto Mexicano del Seguro Social, Mexico City, MEX.,Division of Post-graduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, MEX
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17
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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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18
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ω-3 fatty acid alleviates virus-induced myocardial injury by regulating TLR4 and TLR3 expression. Int Immunopharmacol 2021; 99:107973. [PMID: 34298398 DOI: 10.1016/j.intimp.2021.107973] [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] [Received: 04/27/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
The specific pathogenesis of viral-induced myocardial injury is unclear. TLR regulation plays an important role in virus-induced myocardial injury. The therapeutic effect and possible mechanism of omega-3 fatty acids in patients with viral-induced myocardial injury must be investigated. The study population was randomly divided into three groups: a healthy control group (n = 50); general treatment group (n = 40); and general treatment with ω-3 polyunsaturated fatty acid group (n = 36). We detected the mRNA levels of TLR3 and TLR4, downstream signal pathway proteins, inflammatory factors, oxidative stress markers, and myocardial enzymes in patients and healthy controls. ω-3 fatty acid therapy in patients with virus-induced myocardial injury significantly regulates the expression of TLR3 and TLR4 and their downstream signal protein, increases antioxidant expression, reduces the secretion of inflammatory factors, alleviates myocardial injury, and improves cardiac function. This provides a new strategy to treat virus-induced myocardial injury.
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19
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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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20
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Compagnucci P, Volpato G, Falanga U, Cipolletta L, Conti MA, Grifoni G, Ciliberti G, Stronati G, Fogante M, Bergonti M, Sommariva E, Guerra F, Giovagnoni A, Dello Russo A, Casella M. Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update. ACTA ACUST UNITED AC 2021; 57:medicina57030277. [PMID: 33802881 PMCID: PMC8002711 DOI: 10.3390/medicina57030277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
Myocardial inflammation is an important cause of cardiovascular morbidity and sudden cardiac death in athletes. The relationship between sports practice and myocardial inflammation is complex, and recent data from studies concerning cardiac magnetic resonance imaging and endomyocardial biopsy have substantially added to our understanding of the challenges encountered in the comprehensive care of athletes with myocarditis or inflammatory cardiomyopathy (ICM). In this review, we provide an overview of the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of myocarditis, ICM, and myopericarditis/perimyocarditis in athletes, with a special emphasis on arrhythmias, patient-tailored therapies, and sports eligibility issues.
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
- Correspondence:
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Umberto Falanga
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Manuel Antonio Conti
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Gino Grifoni
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Marco Fogante
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.F.); (A.G.)
| | - Marco Bergonti
- Department of Clinical Sciences and Community Health, University of Milan, 20138 Milan, Italy;
| | - Elena Sommariva
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.F.); (A.G.)
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
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Ata F, Chaudhry HS, Bilal ABI, Lopez MDNM. Myopericarditis Presenting as Acute ST-Elevation Myocardial Infarction with Atrioventricular Dissociation. Heart Views 2021; 21:284-288. [PMID: 33986929 PMCID: PMC8104326 DOI: 10.4103/heartviews.heartviews_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/03/2020] [Indexed: 11/04/2022] Open
Abstract
Myopericarditis, which is an inflammatory process involving the myocardium and pericardium, is not a rare condition encountered in cardiac emergencies. Rarely though, it can give an acute myocardial infarction picture on electrocardiogram (ECG), leading to urgent angiography. More rarely, it can be associated with atrioventricular (AV) dissociation, which is a condition of dyssynchrony of electrical activity between atria and ventricles. We present the case of a young female, who presented with severe chest pain, associated with ST elevation in anterior leads of ECG and raised troponins, necessitating urgent coronary angiography. Normal coronaries led to further evaluation, including cardiac magnetic resonance imaging, which established the diagnosis of myopericarditis. The patient had AV dissociation secondary to myopericarditis. With the treatment of myopericarditis and transvenous pacing, the patient stabilized and was subsequently discharged asymptomatic.
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Affiliation(s)
- Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hammad Shabir Chaudhry
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ammara Bint I Bilal
- Department of Radiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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22
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Su JR, McNeil MM, Welsh KJ, Marquez PL, Ng C, Yan M, Cano MV. Myopericarditis after vaccination, Vaccine Adverse Event Reporting System (VAERS), 1990-2018. Vaccine 2021; 39:839-845. [PMID: 33422381 DOI: 10.1016/j.vaccine.2020.12.046] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Myopericarditis after vaccination has been sporadically reported in the medical literature. Here, we present a thorough descriptive analysis of reports to a national passive vaccine safety surveillance system (VAERS) of myopericarditis after vaccines licensed for use in the United States. METHODS We identified U.S. reports of myopericarditis received by VAERS during 1990-2018 that met a published case definition for myopericarditis or were physician-diagnosed. We stratified analysis by age group (<19, 19-49, ≥50 years), describing reports by serious/non-serious status, sex, time to symptom onset after vaccination, vaccine(s) administered, and exposure to other known causes of myopericarditis. We used Empirical Bayesian data mining to detect disproportionate reporting of myopericarditis after vaccination. RESULTS VAERS received 620,195 reports during 1990-2018: 708 (0.1%) met the case definition or were physician-diagnosed as myopericarditis. Most (79%) myopericarditis reports described males; 69% were serious; 72% had symptom onset ≤ 2 weeks postvaccination. Overall, smallpox (59%) and anthrax (23%) vaccines were most commonly reported. By age, among persons aged < 19 years, Haemophilus influenzae type b (22, 22%) and hepatitis B (18, 18%); among persons aged 19-49 years smallpox (387, 79%); among persons aged ≥ 50 years inactivated influenza (31, 36%) and live attenuated zoster (19, 22%) vaccines were most commonly reported. The vaccines most commonly reported remained unchanged when excluding 138 reports describing other known causes of myopericarditis. Data mining revealed disproportionate reporting of myopericarditis only after smallpox vaccine. CONCLUSIONS Despite the introduction of new vaccines over the years, myopericarditis remains rarely reported after vaccines licensed for use in the United States. In this analysis, myopericarditis was most commonly reported after smallpox vaccine, and less commonly after other vaccines.
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Affiliation(s)
- John R Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kerry J Welsh
- Center for Biologicals Evaluation and Research, Food and Drug Administration (FDA), United States
| | - Paige L Marquez
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carmen Ng
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ming Yan
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Maria V Cano
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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23
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Al-Zakhari R, Upadhya G, Galligan S, Shehaj F. The Myth of Colchicine in Treating Myopericarditis: Case Report and Literature Review. Cureus 2020; 12:e8933. [PMID: 32760633 PMCID: PMC7392355 DOI: 10.7759/cureus.8933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Myopericarditis is inflammation of the pericardium with concurrent myocardial involvement. The clinical presentation of myopericarditis is often with varying degrees of cardiac symptomatology. Its etiology is often idiopathic, but it may also be related to infectious and inflammatory prodrome. Symptoms are proportional to the extent and pattern of myocardial involvement. Many are diagnosed sub-clinically during the management of other systemic illnesses. Echocardiography and cardiac magnetic resonance imaging are important tools in the evaluation of myopericarditis, as the diagnosis of left ventricular dysfunction greatly affects the management, follow-up, and prognosis of these patients. The acute management of myopericarditis remains without clear direction and focuses on symptom control. The use of NSAIDs is often cautioned, as it has been described to actually accelerate the myocarditic process in animal models, possibly increasing mortality. Colchicine, a well-established anti-inflammatory agent, may have a role in the management of acute myopericarditis. We present two cases, each involving a young male, without underlying medical conditions, who presented to the emergency room with acute onset chest pain. Both were found to have elevated cardiac biomarkers and electrocardiographic (EKG) changes, admitted as in-patients and eventually diagnosed with acute myopericarditis. They made full recoveries and were eventually discharged home. Both were started on colchicine during hospitalization, which were continued for several months upon discharge. Overall, there is limited published data regarding the medical management of myopericarditis. There need to be prospective studies and registries to further our knowledge in the management of this illness.
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Affiliation(s)
- Rana Al-Zakhari
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Gautham Upadhya
- Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Sean Galligan
- Cardiology, Richmond University Medical Center, Staten Island, USA
| | - Fiona Shehaj
- Cardiology, Richmond University Medical Center, Staten Island, USA
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Ying W, Pinilla-Vera M, Zakaria S. Acute myopericarditis as a cause of isolated right ventricular failure. Future Cardiol 2020; 16:171-178. [DOI: 10.2217/fca-2019-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Myopericarditis is characterized by pericardial and myocardial inflammation and is a known cause of chest pain and heart failure. It is primarily associated with biventricular or left ventricular dysfunction. We describe an unusual case of a 57-year-old woman with myopericarditis causing isolated right ventricular (RV) failure. She initially presented with chest pain and cardiogenic shock and was found to have acute RV dysfunction with a normally functioning left ventricle. After excluding more common causes of RV failure, she was diagnosed with acute myopericarditis. In this report, we discuss the differential diagnoses and work-up of acute RV failure, as well as review prior cases of RV-predominant myocarditis/myopericarditis. We highlight the importance of recognizing isolated RV failure as a possible, but rare, presentation of myopericarditis.
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Affiliation(s)
- Wendy Ying
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Miguel Pinilla-Vera
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Montrief T, Davis WT, Koyfman A, Long B. Mechanical, inflammatory, and embolic complications of myocardial infarction: An emergency medicine review. Am J Emerg Med 2019; 37:1175-1183. [DOI: 10.1016/j.ajem.2019.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022] Open
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Perez-Brandão C, Trigo C, F Pinto F. Pericarditis - Clinical presentation and characteristics of a pediatric population. Rev Port Cardiol 2019; 38:97-101. [PMID: 30876791 DOI: 10.1016/j.repc.2018.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/01/2018] [Accepted: 05/13/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow-up of children diagnosed with pericarditis at our center. METHODS We performed a retrospective analysis of all children admitted to our pediatric cardiology unit with pericarditis between 2003 and 2015. Patient characteristics were summarized using frequencies and percentages for categorical variables and medians with percentiles for continuous variables. RESULTS Fifty patients were analyzed (40 male, 10 female) with a median age of 14 years. The most common diagnosis was acute pericarditis (80%). Thirty-five patients (70%) presented with chest pain and 26% reported fever. Cardiomegaly was identified on chest X-ray in 11 patients (22%), 30 patients (60%) had an abnormal ECG and 44 patients (80%) had alterations on the transthoracic echocardiogram. In 17 cases (34%) there was myocardial involvement. Forty-eight percent of patients presented with infectious pericarditis and the pathologic agent was identified in half of them. Postpericardiotomy syndrome was diagnosed in five cases. The first-line therapy was aspirin in 50% of cases. Pericardiocentesis was performed in 12 patients. The median length of stay was nine days. There was symptom recurrence in seven children. CONCLUSIONS In this study, acute infectious pericarditis was the most common presentation and about one third of patients also had myocarditis. The symptom recurrence rate was not negligible and is probably related to the type of therapy employed.
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Affiliation(s)
- Catarina Perez-Brandão
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal.
| | - Conceição Trigo
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
| | - Fátima F Pinto
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
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McNamara N, Ibrahim A, Satti Z, Ibrahim M, Kiernan TJ. Acute pericarditis: a review of current diagnostic and management guidelines. Future Cardiol 2019; 15:119-126. [DOI: 10.2217/fca-2017-0102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This review examined the relevance of chest pain, pericardial friction rub, pericardial effusion and ECG changes in regard to the diagnosis of acute pericarditis. It also assessed the evidence for the management and therapeutic guidelines, specifically nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids. Overall, there appears to be a lack of research into pericarditis. The bulk of high-quality research seems to have been carried out prior to the publication of the European Society of Cardiology guidelines of 2015. Diagnostically, the current combination of symptoms, clinical signs and investigations offer reasonable criteria for diagnosis, but they are not a gold standard. Research into its therapeutic treatment options is required to address the effects of specific nonsteroidal anti-inflammatory drugs (NSAIDs).
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Affiliation(s)
- Nicholas McNamara
- Cardiology department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Abdalla Ibrahim
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Zahir Satti
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Munir Ibrahim
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Thomas J Kiernan
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Perez-Brandão C, Trigo C, Pinto FF. Pericarditis – clinical presentation and characteristics of a pediatric population. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bruno KA, Mathews JE, Yang AL, Frisancho JA, Scott AJ, Greyner HD, Molina FA, Greenaway MS, Cooper GM, Bucek A, Morales-Lara AC, Hill AR, Mease AA, Di Florio DN, Sousou JM, Coronado AC, Stafford AR, Fairweather D. BPA Alters Estrogen Receptor Expression in the Heart After Viral Infection Activating Cardiac Mast Cells and T Cells Leading to Perimyocarditis and Fibrosis. Front Endocrinol (Lausanne) 2019; 10:598. [PMID: 31551929 PMCID: PMC6737078 DOI: 10.3389/fendo.2019.00598] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/14/2019] [Indexed: 01/17/2023] Open
Abstract
Myocarditis is an inflammatory heart disease that leads to dilated cardiomyopathy (DCM) and heart failure. Sex hormones play an important role in the development of myocarditis with testosterone driving disease in males and estrogen being cardioprotective in females. The human population is widely exposed to the endocrine disruptor bisphenol A (BPA) from plastics such as water bottles, plastic food containers, copy paper, and receipts. Several clinical and numerous animal studies have found an association between elevated BPA levels and cardiovascular disease. A recent report found elevated levels of BPA in the serum of patients with DCM compared to healthy controls. In this study we examined whether exposure to BPA for 2 weeks prior to viral infection and leading up to myocarditis at day 10 altered inflammation in female BALB/c mice housed in standard plastic cages/water bottles with soy-free food and bedding. We found that a human relevant dose of BPA (25 μg/L) in drinking water, with an estimated exposure of 5 μg BPA/kg BW, significantly increased myocarditis and pericarditis compared to control water without altering viral genome levels in the heart. BPA exposure activated ERα and ERβ in the spleen 24 h after infection and phosphorylated ERα and ERβ during myocarditis, but decreased ERα and increased ERβ mRNA in the heart as measured by qRT-PCR. Exposure to BPA significantly increased CD4+ T cells, IFNγ, IL-17A, TLR4, caspase-1, and IL-1β in the heart. BPA exposure also increased cardiac fibrosis compared to controls. Mast cells, which are associated with cardiac remodeling, were found to increase in number and degranulation, particularly along the pericardium. Interestingly, plastic caging/water bottle exposure alone led to increased mast cell numbers, pericardial degranulation and fibrosis in female BALB/c mice compared to animals housed in glass cages/water bottles with soy-free food and bedding. These data suggest that BPA exposure may increase the risk of developing myocarditis after a viral infection in women.
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Affiliation(s)
- Katelyn Ann Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center for Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
- Department of Immunology, Mayo Clinic, Jacksonville, FL, United States
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Alex Lingyun Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - J. Augusto Frisancho
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ashley Jennie Scott
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Henry David Greyner
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Frank Anthony Molina
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Merci Shekinah Greenaway
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George Maxwell Cooper
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adriana Bucek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Anneliese Ruth Hill
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Anna Alisa Mease
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Damian Nicolas Di Florio
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center for Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
| | - John Michael Sousou
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Allison Ray Stafford
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center for Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
- Department of Immunology, Mayo Clinic, Jacksonville, FL, United States
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- *Correspondence: DeLisa Fairweather
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Tuck BC, Townsley MM. Clinical Update in Pericardial Diseases. J Cardiothorac Vasc Anesth 2019; 33:184-199. [DOI: 10.1053/j.jvca.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 01/15/2023]
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Bailey JR, Loftus A, Allan RJC. Myopericarditis: recognition and impact in the military population. J ROY ARMY MED CORPS 2018; 165:451-453. [PMID: 30429297 DOI: 10.1136/jramc-2018-001056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 01/02/2023]
Abstract
We present a case of a fit and well British Army officer with sudden-onset chest pain following a viral illness, on a background of arduous skiing over an 8-week period. This resulted in a 6-month downgrade with no clearly defined plan for return to full fitness and deployability. The diagnosis and differentiation of myopericarditis from other causes of chest pain is reviewed. The treatment and management of myopericarditis is summarised and commentary is made on the paucity of evidence underpinning the return to fitness guidelines. The impact of this condition primarily affecting young fit individuals, commonly exacerbated by viral illness and arduous activity, is discussed in the context of individual employability and operational capability in a military setting.
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Affiliation(s)
- Jessica R Bailey
- Department of Critical Care, University Hospital Southampton NHS Trust Foundation, Southampton, UK
| | - A Loftus
- Royal Naval Medical Service, Institute of Naval Medicine, Gosport, UK
| | - R J C Allan
- Royal Army Medical Corps, Aldershot Garrison, Aldershot, UK
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Mei R, Raschi E, Forcesi E, Diemberger I, De Ponti F, Poluzzi E. Myocarditis and pericarditis after immunization: Gaining insights through the Vaccine Adverse Event Reporting System. Int J Cardiol 2018; 273:183-186. [PMID: 30236504 DOI: 10.1016/j.ijcard.2018.09.054] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/23/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Riccardo Mei
- Dept. of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.
| | - Emanuel Raschi
- Dept. of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.
| | - Emanuele Forcesi
- Dept. of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.
| | - Igor Diemberger
- Dept. of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.
| | - Fabrizio De Ponti
- Dept. of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.
| | - Elisabetta Poluzzi
- Dept. of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.
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Batton KA, Austin CO, Bruno KA, Burger CD, Shapiro BP, Fairweather D. Sex differences in pulmonary arterial hypertension: role of infection and autoimmunity in the pathogenesis of disease. Biol Sex Differ 2018; 9:15. [PMID: 29669571 PMCID: PMC5907450 DOI: 10.1186/s13293-018-0176-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 04/09/2018] [Indexed: 01/14/2023] Open
Abstract
Registry data worldwide indicate an overall female predominance for pulmonary arterial hypertension (PAH) of 2–4 over men. Genetic predisposition accounts for only 1–5% of PAH cases, while autoimmune diseases and infections are closely linked to PAH. Idiopathic PAH may include patients with undiagnosed autoimmune diseases based on the relatively high presence of autoantibodies in this group. The two largest PAH registries to date report a sex ratio for autoimmune connective tissue disease-associated PAH of 9:1 female to male, highlighting the need for future studies to analyze subgroup data according to sex. Autoimmune diseases that have been associated with PAH include female-dominant systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren’s syndrome, and thyroiditis as well as male-dominant autoimmune diseases like myocarditis which has been linked to HIV-associated PAH. The sex-specific association of PAH to certain infections and autoimmune diseases suggests that sex hormones and inflammation may play an important role in driving the pathogenesis of disease. However, there is a paucity of data on sex differences in inflammation in PAH, and more research is needed to better understand the pathogenesis underlying PAH in men and women. This review uses data on sex differences in PAH and PAH-associated autoimmune diseases from registries to provide insight into the pathogenesis of disease.
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Affiliation(s)
- Kyle A Batton
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Katelyn A Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Charles D Burger
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Brian P Shapiro
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA.
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Combination Therapy With Coenzyme Q10 and Trimetazidine in Patients With Acute Viral Myocarditis. J Cardiovasc Pharmacol 2017; 68:150-4. [PMID: 27046339 DOI: 10.1097/fjc.0000000000000396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acute viral myocarditis is an inflammatory disease with global impact. Although it may resolve spontaneously, its course is not easily predicted, and there is a paucity of specific treatment options available with proven efficacy. Coenzyme Q10 (CQ10) and trimetazidine possess antioxidant and antiinflammatory effects. METHODS We examined the therapeutic efficacy of these agents in acute viral myocarditis both individually and in combination. Patients were blinded and randomized to receive CQ10 (n = 42), trimetazidine (n = 39), or CQ10 + trimetazidine (n = 43) treatment. RESULTS Serum inflammatory and oxidative stress marker and myocardial enzyme levels, and heart function were measured. Both CQ10 and trimetazidine decreased inflammatory and oxidative stress biomarker levels compared with baseline measurements. However, combination therapy with CQ10 and trimetazidine showed a significantly more powerful effect not only on markers of inflammation and oxidative stress, but also on left ventricular systolic function and troponin, compared with either treatment alone. CONCLUSION This study confirmed the beneficial effect of CQ10 and trimetazidine individually, but demonstrated a superior effect of combining the therapies on cardiac left ventricular ejection fraction, and biochemical markers of myocardial damage in acute viral myocarditis.
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Banks AZ, Corey GR. Myocarditis and Pericarditis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00050-2] [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: 11/24/2022] Open
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Lazaros G, Oikonomou E, Tousoulis D. Established and novel treatment options in acute myocarditis, with or without heart failure. Expert Rev Cardiovasc Ther 2016; 15:25-34. [PMID: 27858465 DOI: 10.1080/14779072.2017.1262764] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Acute myocarditis is a disorder characterized by an unpredictable clinical course which ranges from asymptomatic, incidentally discovered forms, to cases with fulminant course and adverse outcome. The most challenging issues in the context of acute myocarditis are the appearance of difficult to treat heart failure in the acute phase and the potential progression in the long-term to dilated cardiomyopathy. Areas covered: With respect to available treatment options in acute myocarditis, in the absence of specific guidelines, management is supportive and overall empirical, especially for the oligo- or asymptomatic patients with preserved ejection fraction. Haemodynamically instable patients should be treated in referral centers with capability of advanced cardiopulmonary support. Patients with heart failure but without haemodynamic impairment should be treated according to the heart failure guidelines. Endomyocardial biopsy may be performed in an individualized basis both for diagnostic purposes and to guide treatment, based on the detection or not of viral genome. Expert commentary: Apart from the already established treatments, novel therapies against several targets are currently investigated and are expected to contribute to a more efficacious management options in the future. Increased awareness among medical professionals is essential for the early diagnosis and best care of acute myocarditis patients.
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Affiliation(s)
- George Lazaros
- a First Department of Cardiology, 'Hippokration' Hospital , University of Athens Medical School , Athens , Greece
| | - Evangelos Oikonomou
- a First Department of Cardiology, 'Hippokration' Hospital , University of Athens Medical School , Athens , Greece
| | - Dimitris Tousoulis
- a First Department of Cardiology, 'Hippokration' Hospital , University of Athens Medical School , Athens , Greece
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Imazio M, Brucato A, Badano L, Charron P, Adler Y. Whatʼs new in 2015 ESC guidelines on pericardial diseases? J Cardiovasc Med (Hagerstown) 2016; 17:315-22. [DOI: 10.2459/jcm.0000000000000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ren M, Zhang C, Zhang X, Zhong J. Acute tuberculous myopericarditis mimicking acute myocardial infarction: A case report and literature review. Exp Ther Med 2016; 11:2373-2378. [PMID: 27284323 DOI: 10.3892/etm.2016.3187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/19/2016] [Indexed: 12/14/2022] Open
Abstract
A number of cases of acute myopericarditis mimicking acute myocardial infarction (AMI) have previously been reported in the literature. However, to the best of our knowledge, such a case resulting from Mycobacterium tuberculosis infection has not previously been described. The present study reports the case of a 21-year-old male patient presenting with acute chest pain, in whom focal ST-segment elevation and elevated cardiac enzymes mimicked a diagnosis of AMI. However, acute tuberculous myopericarditis was diagnosed on the basis of a variety of imaging examinations, laboratory tests, as well as the changes observed in electrocardiograms (ECGs) and in the cardiac enzyme levels. The case highlights the importance of a detailed collection of medical history, comprehensive explanations of serial ECGs, thoracic computed tomography, echocardiogram and coronary angiography in the diagnosis and differentiation of acute tuberculous myopericarditis mimicking AMI.
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Affiliation(s)
- Manyi Ren
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Chunsheng Zhang
- Department of Cardiology, Shandong Provincial Chest Hospital, Jinan, Shandong 250013, P.R. China
| | - Xiaojuan Zhang
- Department of Cardiology, Shandong Provincial Chest Hospital, Jinan, Shandong 250013, P.R. China
| | - Jingquan Zhong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921-2964. [PMID: 26320112 PMCID: PMC7539677 DOI: 10.1093/eurheartj/ehv318] [Citation(s) in RCA: 1348] [Impact Index Per Article: 149.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Yehuda Adler
- Corresponding authors: Yehuda Adler, Management, Sheba Medical Center, Tel Hashomer Hospital, City of Ramat-Gan, 5265601, Israel. Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, Tel: +972 03 530 44 67, Fax: +972 03 530 5118,
| | - Philippe Charron
- Corresponding authors: Yehuda Adler, Management, Sheba Medical Center, Tel Hashomer Hospital, City of Ramat-Gan, 5265601, Israel. Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, Tel: +972 03 530 44 67, Fax: +972 03 530 5118,
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Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NAM, Cooper LT, Link MS, Maron MS. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132:e273-80. [PMID: 26621644 DOI: 10.1161/cir.0000000000000239] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NAM, Cooper LT, Link MS, Maron MS. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2015; 66:2362-2371. [PMID: 26542657 DOI: 10.1016/j.jacc.2015.09.035] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Cooper LT, Keren A, Sliwa K, Matsumori A, Mensah GA. The global burden of myocarditis: part 1: a systematic literature review for the Global Burden of Diseases, Injuries, and Risk Factors 2010 study. Glob Heart 2015; 9:121-9. [PMID: 25432122 DOI: 10.1016/j.gheart.2014.01.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Myocarditis contributes to the global burden of cardiovascular disease primarily through sudden death and dilated cardiomyopathy. A systematic approach to identify the cardiovascular mortality and major morbidity attributable to myocarditis has not been performed. A writing group convened by the GBD 2010 (Global Burden of Diseases, Injuries and Risk Factors) Study systematically reviewed the world's literature by a manual review of all titles since 1966 on myocarditis identified using Ovid Medline, development of a disease model, and provision of estimates when possible of the incidence, prevalence, risk of death, and major morbidity for the world regions. Accurate population-based estimates of myocarditis incidence and prevalence are not directly available in any world region. However, a model that quantitates the risk of acute death and chronic heart failure following myocarditis was derived from the published data. Using hospital dismissal data, the burden of myocarditis as a percentage of prevalent heart failure varied by age and region from approximately 0.5% to 4.0%. The novel combination of multiple data sources may provide an estimate of the years of life lost and years of life disabled from myocarditis. Pending the integration of these data sources, the burden of dilated cardiomyopathy and myocarditis were reported together in the 2010 GBD report. The 2013 GBD project may refine these estimates with the inclusion of more comprehensive payor databases and more precise case definitions.
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Affiliation(s)
- Leslie T Cooper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| | - Andre Keren
- Center for Heart Failure & Heart Muscle Diseases, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research University of Cape Town, Cape Town, South Africa
| | - Akira Matsumori
- Non-Profit Organization Asian Pacific Society of Cardiology, Kyoto, Japan
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Imazio M, Brucato A, Spodick DH, Adler Y. Prognosis of myopericarditis as determined from previously published reports. J Cardiovasc Med (Hagerstown) 2015; 15:835-9. [PMID: 24850499 DOI: 10.2459/jcm.0000000000000082] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prognosis of pericarditis with concomitant myocarditis, especially in the setting of troponin elevation, is a reason for concern because it could imply an adverse outcome. METHODS We performed a comprehensive Medline search of all publications from 2000 to 2013 with the MeSH terms 'pericarditis', 'myocarditis' and 'prognosis'. Additional publications were sought using the reference lists of identified papers, the published reviews on this topic, and a search of abstracts from the American Heart Association, American College of Cardiology, and European Society of Cardiology scientific sessions. RESULTS We identified eight major clinical series evaluating the prognosis of myopericarditis. Studies included a total of 389 patients with myopericarditis (mean age 31.7 years, men-to-women ratio 4.0). After a mean follow-up of 31 months, residual left-ventricular dysfunction was reported in 3.5% without cases of heart failure. Recurrences occurred in 13.0% of cases mainly as recurrent pericarditis (>90%), cardiac tamponade and constrictive pericarditis in less than 1% of cases. The overall prognosis seems good (no mortality), with only one single discordant study reporting three deaths: one related to cardiac tamponade and two sudden cardiac deaths during hospitalization, but no out-of-hospital deaths during follow-up. CONCLUSION Myopericarditis has a good overall prognosis. Troponin elevation in this setting does not predict an adverse outcome in most cases. Thus it is important to reassure the patients on their prognosis, explaining the nature of the disease and the likely course. Diagnostic and therapeutic choices should take into account the overall good outcome of these patients, including less invasive diagnostic tools and toxic drugs.
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Affiliation(s)
- Massimo Imazio
- aCardiology Department, Maria Vittoria Hospital, Torino bInternal Medicine Division, Ospedale Papa Giovanni XXIII, Bergamo, Italy cSt Vincent Hospital, Worcester, Massachusetts, USA dChaim Sheba Medical Centre, Tel Hashomer, Israel
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Abstract
Acute viral myocarditis and acute pericarditis are self-limiting conditions that run a benign course and that may not involve symptoms that lead to medical assessment. However, ventricular arrhythmia is frequent in viral myocarditis. Myocarditis is thought to account for a large proportion of sudden cardiac deaths in young people without prior structural heart disease. Identification of acute myocarditis either with or without pericarditis is therefore important. However, therapeutic interventions are limited and nonspecific. Identifying those at greatest risk of a life-threatening arrhythmia is critical to reducing the mortality. This review summarizes current understanding of this challenging area in which many questions remain.
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Affiliation(s)
- A John Baksi
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Imperial College London, Sydney Street, London SW3 6NP, UK; Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - G Sunthar Kanaganayagam
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Imperial College London, Sydney Street, London SW3 6NP, UK; Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Sanjay K Prasad
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Imperial College London, Sydney Street, London SW3 6NP, UK; Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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Probable hydrochlorothiazide-induced myopericarditis: first case reported. Case Rep Med 2015; 2015:319086. [PMID: 25861276 PMCID: PMC4377349 DOI: 10.1155/2015/319086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/07/2015] [Indexed: 11/25/2022] Open
Abstract
Hydrochlorothiazide has never been reported as a reason for myopericarditis. An African American female, with past history of hypertension, coronary artery disease, and sulfa allergy, presented with indolent onset and retrosternal chest pain which was positional, pleuritic, and unresponsive to sublingual nitroglycerin. Her medications included hydrochlorothiazide (HCTZ) which was started three months ago for uncontrolled hypertension. Significant laboratory parameters included erythrocyte sedimentation rate (ESR) of 47 mm/hr and peak troponin of 0.26 ng/mL. Transthoracic echocardiogram (TTE) revealed preserved ejection fraction with no segmental wall motion abnormalities; however, it showed moderate pericardial effusion without tamponade physiology. We hypothesize that this myopericarditis could be due to HCTZ allergic reaction after all other common etiologies have been ruled out. There is a scarcity of the literature regarding HCTZ as an etiology for pericardial disease, with only one case reported as presumed hydrochlorothiazide-induced pericardial effusion. Management involves discontinuation of HCTZ and starting anti-inflammatory therapy.
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Unresolved issues in theories of autoimmune disease using myocarditis as a framework. J Theor Biol 2014; 375:101-123. [PMID: 25484004 DOI: 10.1016/j.jtbi.2014.11.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/10/2014] [Accepted: 11/20/2014] [Indexed: 11/20/2022]
Abstract
Many theories of autoimmune disease have been proposed since the discovery that the immune system can attack the body. These theories include the hidden or cryptic antigen theory, modified antigen theory, T cell bypass, T cell-B cell mismatch, epitope spread or drift, the bystander effect, molecular mimicry, anti-idiotype theory, antigenic complementarity, and dual-affinity T cell receptors. We critically review these theories and relevant mathematical models as they apply to autoimmune myocarditis. All theories share the common assumption that autoimmune diseases are triggered by environmental factors such as infections or chemical exposure. Most, but not all, theories and mathematical models are unifactorial assuming single-agent causation of disease. Experimental and clinical evidence and mathematical models exist to support some aspects of most theories, but evidence/models that support one theory almost invariably supports other theories as well. More importantly, every theory (and every model) lacks the ability to account for some key autoimmune disease phenomena such as the fundamental roles of innate immunity, sex differences in disease susceptibility, the necessity for adjuvants in experimental animal models, and the often paradoxical effect of exposure timing and dose on disease induction. We argue that a more comprehensive and integrated theory of autoimmunity associated with new mathematical models is needed and suggest specific experimental and clinical tests for each major theory that might help to clarify how they relate to clinical disease and reveal how theories are related.
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Imazio M. Pericarditis with troponin elevation: is it true pericarditis and a reason for concern? J Cardiovasc Med (Hagerstown) 2014; 15:73-7. [PMID: 24492355 DOI: 10.2459/jcm.0b013e328365aa52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy
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