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1.
Handb Clin Neurol ; 177: 111-123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33632429

RESUMO

Myocarditis, a nonischemic acquired cardiomyopathy, is an uncommon condition with multiple presentation patterns which may be initially difficult to recognize and may simulate other conditions such as acute myocardial infarction, pericarditis, septicemia, etc. There are four distinct clinical presentation patterns that include: (1) low-grade nonspecific symptoms such as fatigue; (2) symptoms that resemble an acute myocardial infarction, especially in younger individuals; (3) a heart failure presentation which may be acute, subacute, or chronic and may be associated with cardiac conduction system defects and arrhythmias; and (4) an arrhythmia presentation that may produce sudden cardiac death, especially in young athletes with minimal or no prodromal symptoms. This chapter will provide a brief overview of various myocarditis etiologies and diagnostic modalities. The ultimate focus will be directed toward neurologic manifestations of myocarditis and its subtypes, complications of specific therapies including extracorporeal membrane oxygenation (ECMO) for refractory heart failure, and review the current literature regarding the appropriate use of therapeutic anticoagulation in myocarditis and heart failure for stroke prevention. Covid-19 infection has been discovered to cause myocarditis. The emerging science will be discussed. Nuances of brain death (BD) determination in patients receiving venoarterial ECMO for heart failure refractory to standard medical therapies will be discussed.


Assuntos
/complicações , Miocardite/complicações , Doenças do Sistema Nervoso/etiologia , Oxigenação por Membrana Extracorpórea , Humanos , Miocardite/etiologia , Miocardite/terapia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/terapia
3.
Stem Cell Res ; 51: 102168, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33485182

RESUMO

COVID-19 caused by a novel coronavirus named SARS-CoV-2, can elites severe acute respiratory syndrome, severe lung injury, cardiac injury, and even death and became a worldwide pandemic. SARS-CoV-2 infection may result in cardiac injury via several mechanisms, including the expression of angiotensin-converting enzyme 2 (ACE2) receptor and leading to a cytokine storm, can elicit an exaggerated host immune response. This response contributes to multi-organ dysfunction. As an emerging infectious disease, there are limited data on the effects of this infection on patients with underlying cardiovascular comorbidities. In this review, we summarize the early-stage clinical experiences with COVID-19, with particular focus on patients with cardiovascular diseases and cardiopulmonary injuries, and explores potential available evidence regarding the association between COVID-19, and cardiovascular complications.


Assuntos
/patologia , Doenças Cardiovasculares/complicações , Cardiopatias/complicações , Animais , /transmissão , Síndrome da Liberação de Citocina/etiologia , Cardiopatias/prevenção & controle , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/prevenção & controle , Humanos , Miocardite/complicações , Miocardite/prevenção & controle , /isolamento & purificação
4.
Am J Cardiol ; 143: 131-134, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33347841

RESUMO

Sudden deaths in young active people and athletes are distinctly uncommon and frequently related to highly visible cardiovascular conditions including hypertrophic cardiomyopathy and congenital coronary anomalies. Myocarditis is also a cause of sudden death in the young, but frequently under-recognized clinically, and therefore deserving of the present analysis. Two large registries were interrogated for cases of myocarditis, and clinical, demographic, and pathologic findings were assessed. Of 97 cases of myocarditis identified, ages were 19.3 ± 6.2 years, 76% male, and 58 were physically active at or near the time of death. Almost one-half of the 97 cases (47%) had a viral prodrome or symptoms (i.e., syncope, malaise, chest pain or palpitations). Nine were evaluated by cardiologists, but in none was a diagnosis of myocarditis established before death. The inflammatory cellular infiltrate was predominantly lymphocytic (67%), was most frequently multifocal (59%) and involved the conduction system (including atrioventricular node), 38%. In conclusion, myocarditis is an important but under-recognized cause of sudden death in young people including competitive athletes. Clinical diagnosis is difficult because symptoms are nonspecific and often ignored, requiring high index of suspicion for diagnosis. Our data support the ACC/AHA consensus guidelines recommending removal of individuals with myocarditis from competitive sports during recovery. Selective examination of conduction systems showed a number of cases with involvement of myocarditis, suggesting a novel mechanism for sudden death.


Assuntos
Atletas , Morte Súbita Cardíaca/etiologia , Sistema de Condução Cardíaco/patologia , Miocardite/complicações , Miocárdio/patologia , Sintomas Prodrômicos , Adolescente , Adulto , Nó Atrioventricular/patologia , Dor no Peito/epidemiologia , Criança , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/patologia , Feminino , Humanos , Linfócitos/patologia , Masculino , Miocardite/epidemiologia , Miocardite/patologia , Sistema de Registros , Esportes , Síncope/epidemiologia , Viroses/epidemiologia , Adulto Jovem
5.
Arkh Patol ; 82(5): 57-62, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33054033

RESUMO

The paper describes 4 autopsy cases of myocarditis in elderly patients with confirmed coronavirus infection. It gives the data of a morphological study of heart specimens and a detailed characterization of a myocardial infiltrate. An immunohistochemical study with cellular infiltrate typing was performed. The fact that lymphocytic viral myocarditis can develop in COVID-19 was morphologically and immunohistochemically confirmed. The features of myocarditis in COVID-19 are the development of the former in the presence of coronaritis and the possibility of its concurrence with lymphocytic endo- and pericarditis.


Assuntos
Infecções por Coronavirus/complicações , Linfócitos/patologia , Miocardite/complicações , Miocardite/virologia , Pneumonia Viral/complicações , Idoso , Autopsia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Humanos , Imuno-Histoquímica , Miocardite/patologia , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/virologia
6.
Reumatol. clín. (Barc.) ; 16(5,pt.1): 359-361, sept.-oct. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-195894

RESUMO

We report a case of acute left ventricular dysfunction due to myocarditis, in the setting of a scleroderma renal crisis. The case is particularly intriguing for the favorable outcome of both symptoms and heart function following immunosuppressive therapy. We also highlight the changes observed over time with image techniques as well as in electrocardiograms


Presentamos un caso de disfunción ventricular izquierda secundaria a miocarditis en el contexto de una crisis renal esclerodérmica. Su principal atracción reside en la gran mejoría experimentada por el paciente, no solo en lo que a los síntomas se refiere sino también en su función cardiaca, tras el inicio del tratamiento inmunosupresor. Es muy llamativa la evolución radiológica y electrocardiográfica documentada


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/complicações , Nefropatias/complicações , Nefropatias/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/diagnóstico , Ciclofosfamida/uso terapêutico , Imunossupressores/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Nefropatias/diagnóstico por imagem , Eletrocardiografia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Imunossupressão
7.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 48-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965356

RESUMO

INTRODUCTION: In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature. METHODS: We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane. RESULTS: 16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy. CONCLUSION: Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Miocardite/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Função Ventricular Esquerda/fisiologia , Doença Aguda , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Eletrocardiografia , Humanos , Miocardite/complicações , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Volume Sistólico
8.
Circ J ; 84(11): 2027-2031, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-32981925

RESUMO

BACKGROUND: SARS-CoV-2 infection is associated with myocardial injury, but there is a paucity of experimental platforms for the condition.Methods and Results:Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) infected by SARS-CoV-2 for 3 days ceased beating and exhibited cytopathogenic changes with reduced viability. Active viral replication was evidenced by an increase in supernatant SARS-CoV-2 and the presence of SARS-CoV-2 nucleocaspid protein within hiPSC-CMs. Expressions of BNP, CXCL1, CXCL2, IL-6, IL-8 and TNF-α were upregulated, while ACE2 was downregulated. CONCLUSIONS: Our hiPSC-CM-based in-vitro SARS-CoV-2 myocarditis model recapitulated the cytopathogenic effects and cytokine/chemokine response. It could be exploited as a drug screening platform.


Assuntos
Betacoronavirus/metabolismo , Infecções por Coronavirus/complicações , Células-Tronco Pluripotentes Induzidas/virologia , Miocardite/complicações , Miócitos Cardíacos/virologia , Pneumonia Viral/complicações , Betacoronavirus/genética , Sobrevivência Celular , Células Cultivadas , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/virologia , Citocinas/metabolismo , Efeito Citopatogênico Viral , Avaliação Pré-Clínica de Medicamentos/métodos , Humanos , Células-Tronco Pluripotentes Induzidas/metabolismo , Miocardite/metabolismo , Miocardite/virologia , Miócitos Cardíacos/metabolismo , Proteínas do Nucleocapsídeo/metabolismo , Pandemias , Peptidil Dipeptidase A/metabolismo , Fosfoproteínas , Pneumonia Viral/metabolismo , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Replicação Viral
10.
Epidemiol Infect ; 148: e189, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32843127

RESUMO

Despite SARS-CoV-19 infection has a stereotypical clinical picture, isolated cases with unusual manifestations have been reported, some of them being well-known to be triggered by viral infections. However, the real frequency in COVID-19 is unknown. Analysing data of 63 822 COVID patients attending 50 Spanish emergency department (ED) during the COVID outbreak, before hospitalisation, we report frequencies of (myo)pericarditis (0.71‰), meningoencephalitis (0.25‰), Guillain-Barré syndrome (0.13‰), acute pancreatitis (0.71‰) and spontaneous pneumothorax (0.57‰). Compared with general ED population, COVID patients developed more frequently Guillain-Barré syndrome (odds ratio (OR) 4.55, 95% confidence interval (CI) 2.09-9.90), spontaneous pneumothorax (OR 1.98, 95% CI 1.40-2.79) and (myo)pericarditis (OR 1.45, 95% CI 1.07-1.97), but less frequently pancreatitis (OR 0.44, 95% CI 0.33-0.60).


Assuntos
Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/complicações , Miocardite/complicações , Pancreatite/complicações , Pericardite/complicações , Pneumonia Viral/complicações , Pneumotórax/complicações , Betacoronavirus , Síndrome de Guillain-Barré/virologia , Humanos , Miocardite/virologia , Pancreatite/virologia , Pandemias , Pericardite/virologia , Pneumotórax/virologia , Espanha/epidemiologia
13.
Am J Case Rep ; 21: e925554, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32606285

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness. However, with rising numbers of cases, multiple reports of cardiovascular manifestations have emerged. We present a case of COVID-19 infection complicated by myopericarditis and tamponade requiring drainage. CASE REPORT An 82-year-old woman with multiple comorbidities presented with five days of productive cough, fever with chills, and intermittent diarrhea. She tested positive for COVID-19. Index EKG revealed new diffuse T-wave inversions and a prolonged QT interval (>500 ms). Troponin was mildly elevated without any anginal symptoms. Hydroxychloroquine and azithromycin were not initiated due to concerns about QT prolongation. The echocardiogram revealed preserved left ventricular (LV) function, a small global pericardial effusion, and apical hypokinesis. Serial echocardiograms revealed an enlarging circumferential pericardial effusion with pacemaker wire reported as 'piercing' the right ventricular (RV) apex alongside early diastolic collapse of the right ventricle, suggesting echocardiographic tamponade. Chest CT revealed extension of the RV pacemaker lead into the pericardial fat. Interestingly, on comparison with a previous chest CT from 2019, similar lead positions were confirmed. Pericardiocentesis was performed with removal of 400 cc exudate. CONCLUSIONS Acute myopericarditis and pericardial effusion can occur in COVID-19 infection, even in the absence of severe pulmonary disease. This case highlights the importance of awareness of rare cardiac manifestations of COVID-19 in the form of acute myopericarditis and cardiac tamponade and their early diagnosis and management.


Assuntos
Betacoronavirus , Tamponamento Cardíaco/etiologia , Diagnóstico Precoce , Miocardite/complicações , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Pericardite/complicações , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Ecocardiografia , Feminino , Humanos , Miocardite/diagnóstico , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/cirurgia , Pericardite/diagnóstico , Função Ventricular Esquerda/fisiologia
15.
Adv Exp Med Biol ; 1207: 229-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32671752

RESUMO

Direct damage and immune responses after viral infection lead to myocarditis. Autophagy is involved in both viral clearance and replication. In this chapter, we will briefly describe the role of autophagy in viral myocarditis. In addition, we will discuss the role of autophagy in dilated cardiomyopathy, hypertrophic cardiomyopathy, and diabetic cardiomyopathy.


Assuntos
Autofagia , Cardiomiopatias , Miocardite , Cardiomiopatia Dilatada , Cardiomiopatia Hipertrófica , Cardiomiopatias Diabéticas , Humanos , Miocardite/complicações , Miocardite/virologia , Viroses/complicações
16.
Circ Heart Fail ; 13(7): e007220, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32500721

RESUMO

The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.


Assuntos
Síndrome Coronariana Aguda/terapia , Arritmias Cardíacas/terapia , Infecções por Coronavirus/terapia , Insuficiência Cardíaca/terapia , Miocardite/terapia , Pneumonia Viral/terapia , Síndrome Coronariana Aguda/complicações , Antibacterianos/efeitos adversos , Antivirais/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/complicações , Azitromicina/efeitos adversos , Betacoronavirus , Cardiotônicos/uso terapêutico , Doença Crônica , Infecções por Coronavirus/complicações , Síndrome da Liberação de Citocina/complicações , Síndrome da Liberação de Citocina/terapia , Inibidores Enzimáticos/efeitos adversos , Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca/etiologia , Coração Auxiliar , Humanos , Hidroxicloroquina/efeitos adversos , Balão Intra-Aórtico , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Miocardite/complicações , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral/complicações , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Tromboembolia
18.
Pediatr Infect Dis J ; 39(8): e204-e205, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32502128

RESUMO

A 17-year-old obese male was admitted to the pediatric intensive care unit after presenting with fluid-responsive septic shock following 7 days of fever, gastrointestinal symptoms and neck pain. Initial workup was positive for SARS-CoV-2 and elevated troponin I and brain natriuretic peptide. Echocardiography and cardiac magnetic resonance imaging confirmed acute myocarditis. One week after discharge, repeat echocardiogram demonstrated improved heart function with only residual myocardial dysfunction.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Miocardite/complicações , Miocardite/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Adolescente , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Ecocardiografia , Coração/fisiopatologia , Humanos , Unidades de Terapia Intensiva , Imagem por Ressonância Magnética , Masculino , Miocardite/diagnóstico , Miocardite/terapia , Peptídeo Natriurético Encefálico , Cidade de Nova Iorque , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Choque Séptico/fisiopatologia
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