11/63. myocarditis related to campylobacter jejuni infection: a case report.BACKGROUND: myocarditis can develop as a complication of various infections and is most commonly linked to enterovirus infections. myocarditis is rarely associated with bacterial infections; salmonellosis and shigellosis have been the most frequently reported bacterial cause. We report a case of myocarditis related to campylobacter jejuni enteritis. CASE PRESENTATION: A 30-year-old previously healthy man presented with a history of prolonged chest pain radiating to the jaw and the left arm. Five days prior to the onset of chest pain, he developed bloody diarrhea, fever and chills. creatine kinase (CK) and CK-MB were elevated to 289 U/L and 28.7 microg/L. troponin i was 30.2 microg/L. The electrocardiogram (ECG) showed T wave inversion in the lateral and inferior leads. The chest pain resolved within 24 hours of admission. The patient had a completely normal ECG stress test. The patient was initiated on ciprofloxacin 500 mg po bid when campylobacter jejuni was isolated from the stool. diarrhea resolved within 48 hours of initiation of ciprofloxacin. The diagnosis of Campylobacter enteritis and related myocarditis was made based on the clinical and laboratory results and the patient was discharged from the hospital in stable condition. CONCLUSION: myocarditis can be a rare but severe complication of infectious disease and should be considered as a diagnosis in patients presenting with chest pain and elevated cardiac enzymes in the absence of underlying coronary disease. It can lead to cardiomyopathy and congestive heart failure. There are only a few reported cases of myocarditis associated with Campylobacter infection.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
12/63. Acute parvovirus B19 infection associated with myocarditis in an immunocompetent adult.Inflammatory heart disease is causally linked with progressive left ventricular dysfunction and congestive heart failure. In childhood, infection with parvovirus B19 (PVB19) is usually benign, causing erythema infectiosum. However, severe fetal PVB19 infection may be associated with hydrops fetalis and fetal death caused by myocarditis. Here we report a PVB19-induced myocarditis in a previously healthy 37-year-old patient admitted to the hospital because of chest pain and dyspnea due to left ventricular dysfunction. Four weeks after the onset of symptoms, we found lymphocytic infiltrates and PVB19 genome in left ventricular endomyocardial biopsy specimens. Consistently, acute PVB19 infection was indicated serologically by elevated IgM titers and the presence of PVB19 genome in peripheral blood lymphocytes. In conclusion, PVB19 infection may be complicated by acute myocarditis in immunocompetent adults. Because PVB19 myocarditis may progress to chronic dilated cardiomyopathy, early diagnosis by endomyocardial biopsy is important to initiate anti-inflammatory treatment.- - - - - - - - - - ranking = 0.25keywords = chest pain, chest (Clic here for more details about this article) |
13/63. parvovirus B19 infection mimicking acute myocardial infarction.BACKGROUND: Enteroviruses (EVs) and adenoviruses (ADVs) have been considered common causes of myocarditis and dilated cardiomyopathy. In the present study, we report on the association of parvovirus B19 (PVB19) genomes in the clinical setting of acute myocarditis. methods AND RESULTS: This study included 24 consecutive patients admitted to our hospital within 24 hours after onset of chest pain. Acute myocardial infarction had been excluded in all patients by coronary angiography. Endomyocardial biopsies were analyzed by nested polymerase chain reaction/reverse transcriptase-polymerase chain reaction for EV, ADV, PVB19, human cytomegalovirus, Epstein-Barr virus, chlamydia pneumoniae, influenza virus A and B, and borrelia burgdorferi genomes, respectively, followed by direct sequencing of the amplification products. All patients presented with acute onset of angina pectoris and ST-segment elevations or T-wave inversion mimicking acute myocardial infarction. Mean baseline peak creatinine kinase and creatine kinase-isoenzyme fraction were 342 /-241 U/L and 32 /-20 U/L, respectively. Mean troponin t was increased to 7.5 /-15.0 ng/mL and c-reactive protein to 91 /-98 mg/mL. Eighteen patients had global or regional wall motion abnormalities (ejection fraction 62.5 /-15.5%). Histological analysis excluded the presence of active or borderline myocarditis in all but one patient. PVB19, EV, and ADV genomes were detected in the myocardium of 12, 3, and 2 patients, respectively (71%). Follow-up biopsies of virus-positive patients (11 of 17) demonstrated persistence of PVB19 genomes in 6 of 6 patients, EV genomes in 2 of 3 patients, and ADV genomes in 1 of 2 patients, respectively. CONCLUSIONS: Virus genomes can be demonstrated in 71% of patients with normal coronary anatomy, clinically mimicking acute myocardial infarction. In addition to EVs and ADVs, PVB19 was the most frequent pathogen.- - - - - - - - - - ranking = 0.25keywords = chest pain, chest (Clic here for more details about this article) |
14/63. churg-strauss syndrome with myocarditis manifesting as acute myocardial infarction with cardiogenic shock: case report and review of the literature.A patient with a two-year history of worsening asthma presented with chest pain and shortness of breath. She developed cardiogenic shock. Analysis of blood chemistry detected increased troponin i concentration. Her electrocardiographic changes were consistent with a diagnosis of anteroseptal myocardial infarction. However, angiography showed normal coronary arteries. Left ventriculography showed severe mitral regurgitation and global hypokinesis. Peripheral eosinophilia was detected. Subsequent endomyocardial biopsy showed myocarditis with prominent eosinophil and plasma cell components. churg-strauss syndrome was diagnosed based on her history of asthma, evidence of peripheral eosinophilia and results of endomycardial biopsy. Treatment with a high dose of corticosteroids was initiated. As symptoms of heart failure improved - without recurrence of cardiac and respiratory symptoms - the dose of corticosteroids was gradually reduced. Eight months after her original presentation, she developed urticarial lesions on her abdomen and legs, with muscle soreness but no other associated symptoms. She was treated with a combination of prednisone and dapsone. After the diagnosis of churg-strauss syndrome, the patient remained symptom free with a normal ejection fraction for 15 months while taking prednisone.- - - - - - - - - - ranking = 0.25keywords = chest pain, chest (Clic here for more details about this article) |
15/63. Phaeochromocytoma-induced myocarditis mimicking acute myocardial infarction.A 44-year-old woman presented with sudden onset of chest pain, headache and nausea. physical examination was remarkable for mild hypotension and tachycardia. ECG demonstrated sinus tachycardia with poor R wave progression in precordial leads and T wave inversion in leads V1-3. Cardiac enzymes were raised. Echocardiographic examination revealed normal cavity diameters with basal and mid left ventricular hypokinesia and an ejection fraction of 45%. A diagnosis of non-ST elevation myocardial infarction was made. A few orthostatic hypotensive attacks occurred at follow-up. A coronary angiogram showed normal coronary arteries. Within a few days, the echocardiographic findings, ECG and all cardiac markers had returned to normal. Two months later she presented with headache, palpitation, fever, neck swelling, flushing and hypertensive attacks. Phaeochromocytoma was diagnosed on the basis of increased metanephrine on urinalysis and a left suprarenal mass on CT scan.- - - - - - - - - - ranking = 0.25keywords = chest pain, chest (Clic here for more details about this article) |
16/63. Late bleeding from right internal mammary artery after HeartMate left ventricular assist device implantation.Postoperative bleeding is one of the major complications after implantation of left ventricular assist devices. We experienced 5 unusual cases, which had bleeding from the right internal mammary artery between 5 and 69 days after implantation of a HeartMate (Thoratec Corporation, Pleasanton, CA) device. It was evident that the outflow graft had eroded through the vessel. Sudden decreases in device flow, hypotension, bleeding from the driveline or chest tube sites, and a drop in hematocrit were the initial manifestations. Chest roentgenogram and transthoracic echocardiography were effective in identifying hemothorax and cardiac tamponade. Four out of 5 patients survived to heart transplantation and were discharged from the hospital. When identified and treated appropriately, this complication does not impair patient outcome.- - - - - - - - - - ranking = 0.0085225889887413keywords = chest (Clic here for more details about this article) |
17/63. Fulminant myocarditis demonstrating uncommon morphology--a report of two autopsy cases.Two autopsy cases of fulminant myocarditis demonstrating uncommon morphology were studied. Subjects included two male patients: a 42-year-old (case 1) and a 39-year-old (case 2). Both cases had fever, chest or epigastric pain, electrocardiographic abnormalities, prominent elevation of serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase and creatine phosphokinase. They were treated with intra-aortic balloon pumping and percutaneous cardiopulmonary support, and they died at 3 days and 4 days after admission (total course of 10 days and 9 days), respectively. Case 1 showed focal necrosis, severe myocardial dystrophic calcification positive for Kossa stain, inflammatory edema, lymphocyte and macrophage infiltration and extravasation of erythrocytes. Case 2 showed acute inflammation and severe myocardial necrosis with neutrophilic abscess, lymphocyte and macrophage infiltration, cell debris and purulent exudate. Calcified, degenerative and necrotic cardiac myocytes and macrophages were reacted with anti-Enterovirus antibody (clone 5-D8/1), which recognizes an epitope on the VP1 peptide of most Coxsackievirus, echovirus, poliovirus and enterovirus strains. Therefore, the present two cases may be compatible with fulminant enterovirus-associated myocarditis. Using reverse transcriptase-semi-nested polymerase chain reaction, picornaviral rna was detected in the amplified products extracted from the paraffin-embedded myocardial sample of case 1 but not in case 2.- - - - - - - - - - ranking = 0.0085225889887413keywords = chest (Clic here for more details about this article) |
18/63. Cardiac involvement of Churg Strauss syndrome demonstrated by magnetic resonance imaging.Churg Strauss syndrome (CSS) may lead to cardiac involvement in up to 60% of patients. The myocardium, coronary vasculature, valves and pericardium may be affected. This results in significant morbidity and mortality, accounting for 48% of deaths due to CSS. Cardiac magnetic resonance imaging (CMR) is used to evaluate cardiac structure and function, and is able to evaluate myocardial perfusion and delineate scar tissue. We are the first to demonstrate these features in a 53-year-old CSS patient who presented with palpitations and atypical chest pains, and was found to have myocardial perfusion defects and scar tissue, most likely secondary to vasculitis of the small myocardial vasculature and myocardial infiltration.- - - - - - - - - - ranking = 0.25keywords = chest pain, chest (Clic here for more details about this article) |
19/63. Acute myocarditis associated with cardiac amyloidosis manifesting as transient complete atrioventricular block and slow ventricular tachycardia.This is the first report of conduction system disturbances and slow ventricular tachycardia (VT), related to acute myocarditis associated with cardiac amyloidosis. A 57-year-old female was presented with chest pain and pre-syncope after flu-like symptoms, and was promptly diagnosed with acute myocarditis. The initial electrocardiogram (ECG) revealed complete atrioventricular (AV) block, and transient slow VT was observed after an atropine injection (0.5 mg). This AV conduction disturbance persisted for 12 days, and spontaneously resolved. Left ventricular function was relatively well preserved, and an endomyocardial biopsy revealed acute myocardial inflammation and underlying amyloid deposits. A His-bundle recording, taken 6 weeks after the initial manifestation, indicated normal AV nodal conduction. Endomyocardial biopsies have proven helpful with regard to the diagnosis of acute myocarditis superimposed on amyloidosis, in patients who present with conduction disorder and relatively preserved ventricular function, as was seen in this case.- - - - - - - - - - ranking = 0.25keywords = chest pain, chest (Clic here for more details about this article) |
20/63. Biventricular assist device placement and immunosuppression as therapy for necrotizing eosinophilic myocarditis.BACKGROUND: A previously healthy 47-year-old woman presented reporting nausea, anorexia and light-headedness of 2 weeks' duration, and three episodes of syncope. She also had pleuritic chest pain and rapidly declining cardiac function. The only reported medical history was urinary tract infection and an ankle fracture sustained 5 months before presentation. She was receiving no medication other than estrogen patches for menopause and did not smoke or use illicit drugs. INVESTIGATIONS: electrocardiography, chest radiography, echocardiography, measurement of creatinine phosphokinase and troponin t, coronary angiography and endomyocardial biopsy. DIAGNOSIS: Necrotizing eosinophilic myocarditis. MANAGEMENT: Biventricular assist device implantation, methylprednisolone, prednisolone and mycophenolate mofetil.- - - - - - - - - - ranking = 0.25852258898874keywords = chest pain, chest (Clic here for more details about this article) |
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