1/13. The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients.This report describes the evaluation of 1,278 patients referred to The Johns Hopkins Hospital with dilated cardiomyopathy. After a careful history and physical examination, selected laboratory tests, and endomyocardial biopsy, a specific diagnosis was made in 49% of cases. In 16% of cases the biopsy demonstrated a specific histologic diagnosis. myocarditis and coronary artery disease were the most frequent specific diagnoses; 51% of patients were classified as idiopathic. Thus a rigorous and systematic search can demonstrate an underlying cause for approximately one-half of patients with unexplained cardiomyopathy. Endomyocardial biopsy plays a crucial role in this evaluation. Six cases are presented which demonstrate the utility of endomyocardial biopsy in specific clinical situations. In addition to its routine use in monitoring rejection in heart transplant recipients, endomyocardial biopsy is indicated in the evaluation of possible infiltrative cardiomyopathy, in differentiating restrictive cardiomyopathy from constrictive pericarditis, and in diagnosing and monitoring doxorubicin cardiotoxicity. The importance of diagnosing myocarditis remains controversial, and disagreement persists about the utility of immunosuppressive therapy in these patients. A combination of clinical and histologic features can divide patients with myocarditis into 4 subgroups--acute, fulminant, chronic active, and chronic persistent. This classification provides prognostic information and may identify those patients who may respond to immunosuppression, as well as those likely to have adverse outcomes from such treatment. The continued development of novel molecular techniques may allow endomyocardial biopsy to provide greater prognostic and therapeutic information in the future.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/13. myocarditis and cardiomyopathy associated with clozapine.BACKGROUND: clozapine is effective for resistant schizophrenia. After two sudden deaths in physically well young men soon after starting clozapine, we investigated the cardiovascular complications for this drug. methods: From January, 1993, to March, 1999, 8000 patients started clozapine treatment in australia, and were registered with a mandatory monitoring service. We identified cases of myocarditis and cardiomyopathy from voluntary reports to the Australian Adverse Drug Reaction Committee and sought details of the relevant diagnostic studies, necropsies that had been done in suspicious cases, or both. FINDINGS: 23 cases (20 men, three women, mean age 36 years [SD 9]) were identified: 15 of myocarditis and eight of cardiomyopathy associated with clozapine treatment. Six patients died. All cases of myocarditis (five deaths) occurred within 3 weeks of starting clozapine. Cardiomyopathy (one death) was diagnosed up to 36 months after clozapine was started. Necropsy results showed mainly eosinophilic infiltrates with myocytolysis, consistent with an acute drug reaction. INTERPRETATION: clozapine therapy may be associated with potentially fatal myocarditis and cardiomyopathy in physically healthy young adults with schizophrenia.- - - - - - - - - - ranking = 0.16326446217504keywords = physical (Clic here for more details about this article) |
3/13. Diagnosis and management of myocarditis in athletes.myocarditis is a pathologic entity that has serious potential consequences for competitive athletes. myocarditis is an inflammation of the myocardium accompanied by myocellular necrosis. Cardiotropic viruses, in particular the Coxsackie B virus, have been implicated as the most common cause of acute myocarditis in the united states. A thorough history, physical examination, electrocardiogram, echocardiogram, elevated cardiac enzymes, and an elevated sedimentation rate help make the diagnosis. athletes recovering from acute myocarditis should abstain from moderate to vigorous activity for 6 months, have normal cardiac function, and have no demonstrable arrhythmia before returning to sports.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/13. Bridge-to-recovery from acute myocarditis in a 12-year-old child.Fulminant myocarditis causes substantial morbidity and mortality, especially in children and young adults. Mechanical circulatory support has become the standard therapy to bridge patients with intractable heart failure to either transplantation or myocardial recovery. Yet, successful weaning from biventricular support with full recovery is extremely rare in the pediatric population. This report describes the successful use of the MEDOS HIA ventricular assist device to bridge a 12-year-old girl to myocardial recovery in a biventricular bypass configuration. The left and right ventricle were completely off-loaded by the pumps and the device provided sufficient cardiac output to normalize end-organ function. Anticoagulation was maintained with i.v. heparin infusion. No neurological complications were detectable and the pump system was free of any macroscopic thrombi. After 19 days of support, cardiac function had recovered and the patient was successfully weaned from the device. Following physical rehabilitation, the patient was discharged home.- - - - - - - - - - ranking = 0.081632231087522keywords = physical (Clic here for more details about this article) |
5/13. hypereosinophilic syndrome associated with acute necrotizing myocarditis and cardiomyopathy.We report the rare case of a 55-year-old female with massive eosinophilic myocarditis and severe, however reversible, impairment of left ventricular function. The patient presented with reduced physical condition, progressive dyspnea on exertion and peripheral edema. The white blood count revealed a leukocytosis and markedly elevated peripheral blood eosinophilics (48.8%). An endomyocardial biopsy demonstrated massive myocardial infiltration with eosinophilic granulocytes and necrosis. The symptoms and laboratory parameters indicate the presence of a hypereosinophilic syndrome. The differential diagnosis of a churg-strauss syndrome is discussed. Medical heart failure treatment according to international guidelines and an immunosuppressive treatment with prednisolone (Decortin H) 1.5 mg/kgBW) were initiated. This therapy led to a dramatic reduction of the eosinophilic granulocyte count and normalization of the peripheral blood count, which correlated with a significant improvement of clinical symptoms. Consistently, an increase of left-ventricular function was observed. Upon successive dose reduction to a maintenance dosage of 10 mg prednisolone, the patient's clinical status and peripheral blood count remained stable.- - - - - - - - - - ranking = 0.081632231087522keywords = physical (Clic here for more details about this article) |
6/13. myocarditis: when to suspect and how to diagnose it in athletes.myocarditis should be suspected in athletes with unexplained cardiac arrhythmias and dysfunction, especially if preceded by a flu-like syndrome. An early diagnosis is desirable in order to avoid the risk of fatal consequences, since physical activity can enhance the inflammatory process. Although several diagnostic tools can be useful for the diagnosis of myocarditis, endomyocardial biopsy is still the gold standard. athletes with myocarditis should be withdrawn from all competitive sports for at least 6 months and resume training when ventricular function and cardiac dimensions return to normal and the clinically relevant arrhythmias disappear. In the presence of life-threatening arrhythmias or rapidly progressive cardiac dysfunction an antiviral or an immunosuppressive treatment should be considered depending on whether a viral agent is present or absent, respectively, in the myocardium.- - - - - - - - - - ranking = 0.081632231087522keywords = physical (Clic here for more details about this article) |
7/13. Acute myocarditis simulating myocardial infarction in a child.Pediatric chest pain usually occurs in benign conditions. However, this case portrays the dramatic electrocardiographic appearance of acute myocardial ischemia in a boy with biopsy-proven myocarditis who had only mild chest pain. This underscores the need for eliciting a detailed history when evaluating a patient with chest pain. If the pain cannot be clearly attributed to chest wall phenomena, or if there are historical or physical findings suggestive of an arrhythmia or angina, then further investigation with a chest radiograph and a 12-lead electrocardiogram is recommended. myocarditis must be considered in the differential diagnosis of any child whose electrocardiogram is indistinguishable from an acute myocardial infarction. Finally, endomyocardial biopsy allows early diagnosis and institution of therapy, which may have beneficial effect on decreasing morbidity and mortality. Further follow-up and research is still needed to evaluate the effect of early treatment of myocarditis on long-term myocardial function and the development of chronic cardiomyopathy.- - - - - - - - - - ranking = 0.081632231087522keywords = physical (Clic here for more details about this article) |
8/13. Perimyocarditis. Report on an unusual cause.A 29-year-old man had a febrile illness accompanied by chest pain and tachycardia. The ECG suggested either myocarditis or acute ischemia. Heart muscle enzymes were normal, the peripheral blood count showed absolute and relative lymphocytosis, and an echocardiogram disclosed a small pericardial effusion. After defervescence, splenomegaly was noted and the SGPT level was elevated to four times normal. There was a greater than fourfold rise in titer of IgM antibodies to cytomegalovirus. This is only the second report in detail of perimyocarditis caused by cytomegalovirus mononucleosis. An interesting aspect of the case was an afebrile prodrome that lasted for more than one week, during which prostration, palpitations, and breathlessness on exertion were present and the sole physical finding was tachycardia.- - - - - - - - - - ranking = 0.081632231087522keywords = physical (Clic here for more details about this article) |
9/13. Idiopathic myocarditis characterized by marked right ventricular dilatation. Report of two autopsy cases.We encountered two children with chronic idiopathic myocarditis accompanied by marked right ventricular dilatation, who died of progressive right heart failure. A definitive diagnosis was made by histological examination of the myocardium at autopsy. The patients were both boys, aged 7 years and 1 year and 4 months, and a number of identical features were evident upon physical and laboratory examinations. No heart murmur was heard, and gallop rhythm was noted in distant heart sounds. Electrocardiogram revealed intraventricular block, low voltage QRS complex, and ST-T abnormality. Two-dimensional Doppler echocardiogram and right ventriculogram showed marked dilatation and decreased contractility of the right ventricle as well as tricuspid regurgitation. Thinning of the wall and marked dilatation of the right ventricle were confirmed at autopsy. Our observations showed that chronic myocarditis associated with tricuspid regurgitation may readily lead to marked right ventricular dilatation even exceeding the degree of left ventricular dilatation. Idiopathic myocarditis associated with such unusual features is relatively rare, and may present problems in differentiation from other congenital heart diseases causing dilatation and dysfunction of the right ventricle.- - - - - - - - - - ranking = 0.081632231087522keywords = physical (Clic here for more details about this article) |
10/13. Infants with myocarditis presenting with severe respiratory distress and shock.The characteristics of four infants with myocarditis who presented to the emergency department with acute onset of severe respiratory distress and shock are presented. Although history and physical findings were not supportive of hypovolemic shock or bronchospasm, three of the four infants received an intravenous fluid bolus, and two were given bronchodilator therapy. All patients had metabolic acidosis, and three had cardiomegaly on chest x-ray. Two patients survived. Initial recognition and stabilization of the pediatric patient with cardiogenic shock secondary to myocarditis is reviewed.- - - - - - - - - - ranking = 0.081632231087522keywords = physical (Clic here for more details about this article) |
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