Cases reported "Myocarditis"

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1/63. myocarditis of mixed connective tissue disease: favourable outcome after intravenous pulsed cyclophosphamide.

    A 30-year-old woman with mixed connective tissue disease was admitted with Wernicke's aphasia and progressive dyspnoea with chest pain. Multiple brain infarcts on a computed tomographic scan were compatible with a thromboembolic aetiology. echocardiography showed marked hypokinesia of the posterior wall, biventricular dilatation and a decreased left-ventricle ejection fraction (40%). A diagnosis of myocarditis was made on myocardial biopsies disclosing interstitial lymphocytic infiltrates and myocardial fibre necrosis. A treatment with steroids and monthly pulsed cyclophosphamide was introduced. The heart function rapidly improved as assessed by a left-ventricle ejection fraction of 55% and remained stable 17 months thereafter.
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2/63. Doppler aortic flow pattern in the recovering heart treated by cardiac extracorporeal membrane oxygenation International Society for artificial organs.

    A 39-year-old man was admitted to our hospital because of chest pain and was diagnosed with severe heart failure due to viral myocarditis. Intraaortic balloon pumping (IABP) and cardiac extracorporeal membrane oxygenation (ECMO) were employed. Using Doppler echocardiography, we evaluated the descending aortic blood flow pattern. When cardiac ECMO was initiated from the right femoral artery, a strong backflow of blood generated by the pump was observed in the abdominal aorta because the forward flow from the native heart was weak. Two days later, the blood flow was reversed from the thoracic to abdominal aorta; the natural flow was strengthened because the native heart had improved. The observation of this phenomenon is helpful for determining the recovery of cardiac function under cardiac ECMO support.
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3/63. borrelia burgdorferi as a cause of Morgagni-adams-stokes syndrome. Long time follow-up study.

    According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-adams-stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.
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4/63. Varicella myocarditis in an adult.

    A 24 year old male with varicella myocarditis was admitted with chest pain and fever up to 39 degrees C. The ECG showed J point and ST elevation in leads V2-V4, and inverted T waves in leads V5 and V6. creatine kinase (CK) was raised to 435 U/l (CK-MB 36 U/l), troponin i was 63.4 microgram/l, and lactate dehydrogenase was 359 U/l, suggesting cardiac involvement of varicella infection. The left ventricle was dilated (58 mm) and left ventricular ejection fraction was globally reduced (ejection fraction 45%). myocarditis was confirmed by endomyocardial biopsy. The patient was treated with specific varicella hyperimmunoglobulins, aciclovir, and a non-steroidal anti-inflammatory drug. During two months follow up the patient recovered completely. This case report is a reminder that a varicella infection can cause myocarditis in adults. early diagnosis and appropriate treatment of this rare form of myocarditis may lead to complete recovery.
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5/63. Pseudo-myocardial infarction during an episode of herpes zoster.

    The patient arrived at the emergency unit with a history of acute myocardial infarction, for which she was treated. Without improvement in the pain, the patient developed heart failure and underwent a hemodynamic study, which showed normal coronary arteries and extensive ventricular impairment. During evolution, the clinical findings improved and herpes zoster appeared on the right shoulder. In a few months the clinical findings subsided, and the findings of the electrocardiogram, chest X-ray, and ventricular function were normal. The patient is currently asymptomatic.
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keywords = chest
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6/63. Acute myopericarditis after diphtheria, tetanus, and polio vaccination.

    We report the first case of myopericarditis after triple vaccination against diphtheria, tetanus, and poliovirus in a young adult. He presented with fever, acute chest pain, and diffuse ST-segment elevation 2 days after vaccination. Two-dimensional echocardiography findings were normal. Endomyocardial biopsy showed interstitial edema with diapedesis of erythrocytes. Laboratory findings showed inflammatory syndrome and elevated circulating immune complexes. He recovered within a few days with high-dose aspirin treatment and was without complications at 3-month follow-up. We discuss the different hypotheses for infective or hypersensitivity myocarditis.
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7/63. Calcified left ventricular aneurysm and non-atherosclerotic myocardial infarction in a child.

    A 14-year-old boy, admitted with intractable chest pain, was found to have an enlarged heart and calcification in the apical region, with electrocardiographic features of massive inferolateral myocardial infarction. Left ventricular angiography revealed a large left ventricular aneurysm. He died following resection of the aneurysm and post mortem examination showed changes of a non-specific chronic myocarditis. A vasculitis involving small coronary arterioles was also found in the vicinity of the aneurysm, and the possibility of a rheumatic vasculitis was suggested by a transient episode of an erythema marginatum-like eruption. It is concluded that the association of infarction pattern on the electrocardiogram together with calcification of the heart in children is highly suggestive of a ventricular aneurysm secondary to a myocarditis or a vasculitis involving small, intramyocardial branches of the coronary arteries.
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8/63. myocarditis associated with campylobacter infection.

    We describe the case of a young man with fever, chest pain and enteric symptoms. He developed myocarditis and campylobacter was isolated in faeces.
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9/63. Cases from the aerospace medicine residents' teaching file. Case report of an aviator with focal myocarditis mimicking myocardial infarction with normal coronaries.

    A military aviator was initially diagnosed with myocardial infarction following a viral syndrome. confusion about recurrence of chest pain versus gastritis led to his continued cardiac patient status until this was clarified diagnostically. He was presumed to have had coronary vasospasm, and was treated with a calcium channel blocker. Absent his strong desire to return to flying duties, he may have continued in that diagnostic pathway indefinitely. After thorough aeromedical evaluation, resolved focal viral myocarditis was felt to be the most likely diagnosis and he was returned to military flying duties.
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10/63. Surgical management of localized left ventricular aneurysm associated with acute myocarditis.

    We present a case of a localized left ventricular (LV) aneurysm in a 72-year-old woman with sudden onset of severe chest pain. A left ventriculogram revealed a small saccular outpouching protruding from the apex accompanied with narrow neck connection to the ventricular cavity. Both coronary arteries and global function were normal. We preoperatively diagnosed her as having an impending rupture in the congenital LV diverticulum because no inflammatory myocardial disease was suggested by general laboratory tests. After successful surgical treatment, microscopic examination for the myocardial specimens was performed and revealed diffuse lymphocytic infiltration associated with focal necrosis of myocardium. Histological findings were consistent with those of acute lymphocytic myocarditis. Without histological confirmation, an aneurysm caused by silent myocarditis might be misdiagnosed as a diverticulum.
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