Myocarditis history and symptoms: Difference between revisions
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A history of a recent (within the preceding 2-4 weeks) viral illness is often elicited in a large number of patients with myocarditis. Cardiac specific symptoms may become apparent usually in the subacute virus-clearing phase. | A history of a recent (within the preceding 2-4 weeks) viral illness is often elicited in a large number of patients with myocarditis. Cardiac specific symptoms may become apparent usually in the subacute virus-clearing phase. | ||
In myocarditis due to [[drug hypersensitivity]], patients may give a history of ingesting the offending drug. | In myocarditis due to [[drug hypersensitivity]], patients may give a history of ingesting the offending drug. Drugs associated with myocarditis include [[Amphetamines]], [[Benzodiazepines]], [[Carbamazepine]], [[Chloramphenicol]], [[Clozapine]]<ref name="pmid17194170">{{cite journal| author=Haas SJ, Hill R, Krum H, Liew D, Tonkin A, Demos L et al.| title=Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993-2003. | journal=Drug Saf |year= 2007 | volume= 30 | issue= 1 | pages= 47-57 | pmid=17194170 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17194170 }} </ref>, [[Cocaine]], [[Cyclophosphamide]], [[Dobutamine]]<ref name="pmid7578186">{{cite journal| author=Spear GS|title=Eosinophilic explant carditis with eosinophilia: ?Hypersensitivity to dobutamine infusion. | journal=J Heart Lung Transplant | year= 1995 | volume= 14 | issue= 4 | pages= 755-60 | pmid=7578186 | doi= | pmc= | url= }} </ref><ref name="pmid15090985">{{cite journal| author=Johnson MR| title=Eosinophilic myocarditis in the explanted hearts of cardiac transplant recipients: Interesting pathologic finding or pathophysiologic entity of clinical significance? | journal=Crit Care Med | year= 2004 | volume= 32 | issue= 3 | pages= 888-90 | pmid=15090985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15090985 }} </ref>, [[Methyldopa]], [[Penicillin]], [[Phenytoin]], [[Spironolactone]], [[Streptomycin]], [[Sulfonamides]], [[Tricyclic antidepressants]]. | ||
==Symptoms== | ==Symptoms== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:: Varun Kumar, M.B.B.S.
Overview
The symptoms and the intensity of symptoms associated with myocarditis are variable. Patients may present with chest pain as a result of the inflammatory process involving the myocardium or with symptoms of congestive heart failure. Patients may complain of palpitations, a racing heart or syncope. In fulminant myocarditis, patients present with the abrupt onset of flu-like symptoms and the abrupt onset of heart failure symptoms. In chronic and acute myocarditis, the onset of symptoms may be more insidious.
History
Myocarditis should be suspected in a patient with acute decompensation of cardiac function who is at low risk of ischemic heart disease.
A history of a recent (within the preceding 2-4 weeks) viral illness is often elicited in a large number of patients with myocarditis. Cardiac specific symptoms may become apparent usually in the subacute virus-clearing phase.
In myocarditis due to drug hypersensitivity, patients may give a history of ingesting the offending drug. Drugs associated with myocarditis include Amphetamines, Benzodiazepines, Carbamazepine, Chloramphenicol, Clozapine[1], Cocaine, Cyclophosphamide, Dobutamine[2][3], Methyldopa, Penicillin, Phenytoin, Spironolactone, Streptomycin, Sulfonamides, Tricyclic antidepressants.
Symptoms
Symptoms of myocarditis include:[4]
- Chest pain is often described as stabbing, pleuritic or sharp in character. In a series, 78% of patients were diagnosed with myocarditis when they presented with chest pain[5].
- Pedal edema in volume overload states.
- Breathlessness
- Dyspnea on exertion
- Orthopnea in pulmonary congestion.
- Palpitations
- Syncope in setting of high grade AV block
- Fever (especially when infectious, e.g. in rheumatic fever)
- Joint pains, and fatigue as seen in viral illness.
- Cynosis may also be seen in severe cases.
- Sudden death (in young adults, myocarditis causes up to 20% of all cases of sudden death)[6]. This probably can be attributed to ventricular tachycardia or fibrillation.
References
- ↑ Haas SJ, Hill R, Krum H, Liew D, Tonkin A, Demos L; et al. (2007). "Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993-2003". Drug Saf. 30 (1): 47–57. PMID 17194170.
- ↑ Spear GS (1995). "Eosinophilic explant carditis with eosinophilia: ?Hypersensitivity to dobutamine infusion". J Heart Lung Transplant. 14 (4): 755–60. PMID 7578186.
- ↑ Johnson MR (2004). "Eosinophilic myocarditis in the explanted hearts of cardiac transplant recipients: Interesting pathologic finding or pathophysiologic entity of clinical significance?". Crit Care Med. 32 (3): 888–90. PMID 15090985.
- ↑ Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000;343:1388-98. PMID 11070105.
- ↑ Sarda L, Colin P, Boccara F, Daou D, Lebtahi R, Faraggi M; et al. (2001). "Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms". J Am Coll Cardiol. 37 (3): 786–92. PMID 11693753.
- ↑ Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004;141:829-34. PMID 15583223.