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1.
Kardiologiia ; 60(7): 4-10, 2020 Jun 19.
Artigo em Russo | MEDLINE | ID: mdl-33155934

RESUMO

Aim      Despite the regular heart damage in patients with coronavirus pneumonia caused by SARS-Cov-2, a possibility of developing lymphocytic myocarditis as a part of COVID-19 remains unsubstantiated. The aim of this study was to demonstrate a possibility of lymphocytic myocarditis and to study its morphological features in patients with the novel coronavirus infection (COVID-19) with a severe course.Material and methods   Postmortem data were studied for 5 elderly patients (74.8±4.4 years; 3 men and 2 women) with the novel coronavirus infection and bilateral, severe polysegmental pneumonia (stage 3-4 by computed tomography). COVID-19 was diagnosed based on the typical clinical presentation and positive polymerase chain reaction test in nasopharyngeal swabs. All patients were treated in different hospitals repurposed for the treatment of patients with COVID-19. A standard histological study was performed with hematoxylin and eosin, toluidine blue, and van Gieson staining. Serial paraffin slices were studied immunohistochemically with antibodies to CD3, СD68, CD20, perforin, and toll-like receptors (TLR) 4 and 9.Results In none of the cases, myocarditis was suspected clinically, added to the diagnosis or indicated as a possible cause of death. IHD and acute myocardial infarction were mentioned as error diagnoses not confirmed by the postmortem examination. The morphological examination of the heart identified signs of lymphocytic myocarditis consistent with Dallas criteria for this diagnosis. Myocardial infiltrate was characterized in detail, and a combined inflammatory damage of endocardium and pericardium was described. The immunohistochemical study with cell infiltrate typing confirmed the presence of CD3-positive Т lymphocytes and the increased expression of TLR-4. A picture of coronaritis, including that with microvascular thrombosis, was found in all cases.Conclusion      A possibility for development of lymphocytic viral myocarditis in COVID-19 was confirmed morphologically and immunohistochemically. Specific features of myocarditis in COVID-19 include the presence of coronaritis and a possible combination of myocarditis with lymphocytic endo- and pericarditis.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Miocardite , Pandemias , Pneumonia Viral , Idoso , Feminino , Humanos , Masculino , Miocardite/diagnóstico
5.
BMC Infect Dis ; 20(1): 730, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028242

RESUMO

BACKGROUND: The incidence of Lyme disease (LD) in North America has increased substantially in the past two decades. Concomitant with the increased incidence of infection has been an enhancement in the recognition of LD complications. Here, we report a case of Lyme carditis complicated by heart block in a pediatric patient admitted to our children's hospital. What is unique about this case is that the complaint of chest palpitations is an infrequent presentation of LD, and what it adds to the scientific literature is an improved understanding of LD in the pediatric population. CASE PRESENTATION: The patient was a 16-year-old male who presented with the main concerns of acute onset of palpitations and chest pain. An important clinical finding was Erythema migrans (EM) on physical exam. The primary diagnoses were LD with associated Lyme carditis, based on the finding of 1st degree atrioventricular heart block (AVB) and positive IgM and IgG antibodies to Borrelia burgdorferi. Interventions included echocardiography, electrocardiography (EKG), and intravenous antibiotics. The hospital course was further remarkable for transition to 2nd degree heart block and transient episodes of complete heart block. A normal sinus rhythm and PR interval were restored after antibiotic therapy and the primary outcome was that of an uneventful recovery. CONCLUSIONS: Lyme carditis occurs in < 5% of LD cases, but the "take-away" lesson of this case is that carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients. Any patient with suspected Lyme carditis manifesting cardiac symptoms such as syncope, chest pain, or EKG changes should be admitted for parenteral antibiotic therapy and cardiac monitoring. The most common manifestation of Lyme carditis is AVB. AVB may manifest as first-degree block, or may present as high-grade second or third-degree block. Other manifestations of Lyme carditis may include myopericarditis, left ventricular dysfunction, and cardiomegaly. Resolution of carditis is typically achieved through antibiotic administration, although pacemaker placement should be considered if the PR interval fails to normalize or if higher degrees of heart block, with accompanying symptoms, are encountered. With the rising incidence of LD, providers must maintain a high level of suspicion in order to promptly diagnose and treat Lyme carditis.


Assuntos
Borrelia burgdorferi/isolamento & purificação , Doença de Lyme/diagnóstico , Administração Intravenosa , Adolescente , Antibacterianos/uso terapêutico , Borrelia burgdorferi/imunologia , Eletrocardiografia , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/etiologia , Humanos , Imunoglobulina M/sangue , Doença de Lyme/complicações , Doença de Lyme/tratamento farmacológico , Doença de Lyme/microbiologia , Masculino , Miocardite/diagnóstico
6.
Pediatr Clin North Am ; 67(5): 855-874, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888686

RESUMO

Myocarditis in the pediatric population can be a challenging diagnosis to make and often requires utilization of multiple diagnostic modalities. The cause is often due to a viral infection with activation of the innate and acquired immune response with either recovery or disease progression. Laboratory testing often includes inflammatory markers, cardiac troponin levels, and natriuretic peptides. Noninvasive testing should include electrocardiogram, echocardiogram, and possibly an MRI. Treatment of myocarditis remains controversial with most providers using immune modulators with intravenous immunoglobulin and corticosteroids.


Assuntos
Gerenciamento Clínico , Miocardite/diagnóstico , Criança , Diagnóstico Diferencial , Progressão da Doença , Saúde Global , Humanos , Incidência , Miocardite/epidemiologia , Miocardite/terapia
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.
Echocardiography ; 37(10): 1673-1677, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32986881

RESUMO

We report the case of a healthy 35-year-old woman who had experienced a flu-like syndrome during the week before childbirth and heart failure symptoms 10 days before the current hospitalization and presented to our emergency department with clinical signs of congestive heart failure, echocardiographic evidence of a severely dilated and hypokinetic heart, laboratory evidence of SARS-CoV-2 disease, and radiologic findings consistent with both virus-related pneumonia and heart failure. Early cardiac magnetic resonance was crucial for the diagnosis of postpartum cardiomyopathy and for the exclusion of virus-related myocarditis, allowing us to decide on a prudent and supportive clinical approach.


Assuntos
Betacoronavirus , Cardiomiopatias/diagnóstico , Infecções por Coronavirus/complicações , Eletrocardiografia/métodos , Miocardite/diagnóstico , Período Periparto , Pneumonia Viral/complicações , Complicações Cardiovasculares na Gravidez/diagnóstico , Doença Aguda , Adulto , Cardiomiopatias/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Tomografia Computadorizada por Raios X
9.
Pan Afr Med J ; 36: 167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32952811

RESUMO

Coronavirus disease 2019 (COVID-19) has been reported as the possible cause of acute myocarditis. Myocarditis is an inflammatory heart disease mostly caused by viral infections. Cytomegalovirus (CMV) primary infection is often not suspected as a cause of myocarditis in immune-competent adults. We report the case of a 37-year-old male admitted with fever, cough and dyspnea. Chest CT showed typical ground-glass changes indicative of viral pneumonia. He was tested negative for COVID-19 but had biological markers that made us still suspect it. He had elevated troponin I level (up to 111.5 ng/mL) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF). He was diagnosed with CMV myocarditis with cardiac insufficiency and totally recovered without antiviral therapy. During the COVID-19 pandemic patients may develop myocarditis, still every myocarditis is not a COVID infection. Myocarditis linked to CMV infection may be rare, but life-threatening.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Miocardite/diagnóstico , Pneumonia Viral/diagnóstico , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Tosse/etiologia , Infecções por Citomegalovirus/virologia , Diagnóstico Diferencial , Dispneia/etiologia , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Miocardite/virologia , Pandemias , Pneumonia Viral/epidemiologia , Tomografia Computadorizada por Raios X
10.
Br J Sports Med ; 54(19): 1157-1161, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32878870

RESUMO

SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Miocardite/diagnóstico , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Transtornos Respiratórios/diagnóstico , Volta ao Esporte/normas , Atletas , Biomarcadores/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Humanos , Miocardite/sangue , Miocardite/etiologia , Miocárdio/patologia , Necrose/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Transtornos Respiratórios/etiologia , Medicina Esportiva/normas , Avaliação de Sintomas , Troponina/sangue
12.
Am J Cardiol ; 132: 147-149, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32762961

RESUMO

The cardiac involvement in Coronavirus disease (COVID-19) is still under evaluation, especially in severe COVID-19-related Acute Respiratory Distress Syndrome (ARDS). The cardiac involvement was assessed by serial troponin levels and echocardiograms in 28 consecutive patients with COVID-19 ARDS consecutively admitted to our Intensive Care Unit from March 1 to March 31. Twenty-eight COVID-19 patients (aged 61.7 ± 10 years, males 79%). The majority was mechanically ventilated (86%) and 4 patients (14%) required veno-venous extracorporeal membrane oxygenation. As of March 31, the Intensive Care Unit mortality rate was 7%, whereas 7 patients were discharged (25%) with a length of stay of 8.2 ±5 days. At echocardiographic assessment on admission, acute core pulmonale was detected in 2 patients who required extracorporeal membrane oxygenation support. Increased systolic arterial pressure was detected in all patients. Increased Troponin T levels were detectable in 11 patients (39%) on admission. At linear regression analysis, troponin T showed a direct relationship with C-reactive Protein (R square: 0.082, F: 5.95, p = 0.017). In conclusions, in COVID-19-related ARDS, increased in Tn levels was common but not associated with alterations in wall motion kinesis, thus suggesting that troponin T elevation is likely to be multifactorial, mainly linked to disease severely (as inferred by the relation between Tn and C-reactive Protein). The increase in systolic pulmonary arterial pressures observed in all patients may be related to hypoxic vasoconstriction. Further studies are needed to confirm our findings in larger cohorts.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Miocardite/etiologia , Pneumonia Viral/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Biomarcadores/sangue , Infecções por Coronavirus/epidemiologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/sangue , Miocardite/diagnóstico , Pandemias , Pneumonia Viral/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/sangue , Troponina I/sangue
14.
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.
Methodist Debakey Cardiovasc J ; 16(2): 146-154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670475

RESUMO

Since early 2020, the world has been facing a pandemic caused by the novel coronavirus SARS-CoV-2. Although this positive single-stranded RNA virus primarily causes pulmonary infection and failure, it has been associated with multiple cardiovascular diseases including troponin elevation, myocarditis, and cardiac arrhythmias. Cardiac patients are susceptible to developing more severe infection from SARS-COV-2, making management complicated. In this review we discuss the cardiac manifestations of COVID-19 infections as well as considerations for the management of primary cardiac pathologies during this pandemic.


Assuntos
Doenças Cardiovasculares/epidemiologia , Causas de Morte , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Doenças Cardiovasculares/diagnóstico por imagem , China/epidemiologia , Comorbidade , Infecções por Coronavirus/prevenção & controle , Feminino , Saúde Global , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Miocardite/diagnóstico , Miocardite/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevalência , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Troponina T/sangue , Populações Vulneráveis/estatística & dados numéricos
17.
Ann Parasitol ; 66(2): 255-257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32592549

RESUMO

The aim of this study was to recognise the etiological factor of a disease with symptoms of lameness and cardiac failure, which occurred in one dog 4 weeks after invasion by ticks. A serological examination as well as molecular examination (PCR) was done. In the sample of the serum, the presence of antibodies specific to Borrelia burgdorferi were detected. Antibiotic therapy with doxycycline did not cause significant improvement, so the owners of the dog decided about its euthanasia. During the necroscopy, a dilated heart was recognised. In the heart samples, the genetic material of Borrelia was detected. The results of serological and molecular examinations showed that in the discussed case, an etiological factor of the disease was spirochetes. In light of the research, veterinary practitioners should keep in mind the presence of Lyme disease in dogs in Poland and include it in differential diagnoses for lameness and cardiological problems.


Assuntos
Infecções por Borrelia , Doenças do Cão , Miocardite , Infestações por Carrapato , Animais , Anticorpos Antibacterianos/sangue , Infecções por Borrelia/complicações , Infecções por Borrelia/diagnóstico , Doenças do Cão/diagnóstico , Doenças do Cão/etiologia , Doenças do Cão/microbiologia , Doenças do Cão/parasitologia , Cães , Eutanásia Animal , Coração/parasitologia , Miocardite/diagnóstico , Miocardite/etiologia , Polônia , Infestações por Carrapato/complicações , Infestações por Carrapato/microbiologia , Infestações por Carrapato/veterinária
18.
Herz ; 45(7): 645-651, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32533218

RESUMO

Immune checkpoint inhibitor (ICI) therapy induces an immune response against cancer cells. Immune checkpoint inhibitor therapy has tremendously improved the prognosis for a large number of cancers, but is associated with considerable immune-related adverse events (irAEs). Cardiovascular complications from ICI therapy occur in a modest proportion of patients, but show the highest lethality rates of all ICI-related complications. While ICI-related myocarditis is the most dangerous complication, its clinical manifestation varies, e.g., asymptomatic reduction of left ventricular function, isolated increase in cardiac troponins, and arrhythmias. This review delineates current data on cardiovascular complications of ICI therapy. The effects of ICI therapy on the cardiovascular system are classified in the context of preclinical data on the biochemical and immunological function of the immune checkpoint signaling pathways in the heart and the vascular system. Incidence, suspected pathomechanisms, typical symptoms, as well as recommended diagnostics are summarized. Current therapy recommendations for ICI-related cardiotoxicity are outlined and innovative new approaches with high potential for improving outcome in ICI-related myocarditis are delineated. A better understanding of cardiovascular complications is essential for the best possible oncocardiology care of the growing number of patients undergoing ICI therapy.


Assuntos
Antineoplásicos Imunológicos , Sistema Cardiovascular , Miocardite , Neoplasias , Cardiotoxicidade , Humanos , Miocardite/induzido quimicamente , Miocardite/diagnóstico , Miocardite/tratamento farmacológico , Neoplasias/tratamento farmacológico
19.
Rev Med Suisse ; 16(696): 1133-1139, 2020 Jun 03.
Artigo em Francês | MEDLINE | ID: mdl-32496701

RESUMO

Myocarditis is an inflammatory disease of the myocardium caused by various etiologies with a dominance of viral infections and potential post-infectious autoimmunity. The clinical presentation ranges from chest pain to severe complications including cardiogenic shock, ventricular arrhythmias, and progression to dilated cardiomyopathy. The diagnostic approach is challenging and includes several investigations, such as an ECG, an echocardiography, troponin testing and the exclusion of coronary artery disease. Although endomyocardial biopsy remains the gold standard, cardiovascular magnetic resonance is now the most valuable tool to accurately characterize myocardial tissue inflammation. The management is mainly symptomatic and consists in early detection and treatment of complications including heart failure and arrhythmias.


Assuntos
Miocardite , Biópsia , Cardiomiopatia Dilatada , Ecocardiografia , Eletrocardiografia , Humanos , Miocardite/diagnóstico , Miocardite/patologia , Miocárdio/patologia , Troponina
20.
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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