Myocarditis medical therapy: Difference between revisions
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As [[heart failure]] in patients with [[myocarditis]] has poor prognosis, it is important to prevent progression or worsening of cardiac dysfunction<ref name="pmid16442915">{{cite journal| author=Magnani JW, Danik HJ, Dec GW, DiSalvo TG| title=Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. | journal=Am Heart J | year= 2006 | volume= 151 | issue= 2 | pages= 463-70 | pmid=16442915 | doi=10.1016/j.ahj.2005.03.037 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16442915 }} </ref>. These patients should be treated with low sodium intake, [[diuretics]] and [[ACE inhibitors]]. Few animal studies report that mortality rate is high with [[digoxin]] in comparison to [[beta blocker]] in viral myocarditis<ref name="pmid1674900">{{cite journal| author=Tominaga M, Matsumori A, Okada I, Yamada T, Kawai C| title=Beta-blocker treatment of dilated cardiomyopathy. Beneficial effect of carteolol in mice. | journal=Circulation | year= 1991 | volume= 83 | issue= 6 | pages= 2021-8 | pmid=1674900 | doi= | pmc= | url= }} </ref><ref name="pmid10614837">{{cite journal| author=Matsumori A, Igata H, Ono K, Iwasaki A, Miyamoto T, Nishio R et al.| title=High doses of digitalis increase the myocardial production of proinflammatory cytokines and worsen myocardial injury in viral myocarditis: a possible mechanism of digitalis toxicity. | journal=Jpn Circ J | year= 1999 | volume= 63 | issue= 12 | pages= 934-40 | pmid=10614837 | doi= | pmc= | url= }} </ref>. Studies have also demonstrated that usage of [[carvedilol]] during recovery phase decreases expression of several histochemicals and subsequently myocardial inflammation and there by improving survival<ref name="pmid15923319">{{cite journal| author=Wang JF, Meissner A, Malek S, Chen Y, Ke Q, Zhang J et al.| title=Propranolol ameliorates and epinephrine exacerbates progression of acute and chronic viral myocarditis. | journal=Am J Physiol Heart Circ Physiol | year= 2005 | volume= 289 | issue= 4 | pages= H1577-83 | pmid=15923319 | doi=10.1152/ajpheart.00258.2005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15923319 }} </ref>. The Beta-blockers should however be avoided in the acutely decompensating phase of illness. | As [[heart failure]] in patients with [[myocarditis]] has poor prognosis, it is important to prevent progression or worsening of cardiac dysfunction<ref name="pmid16442915">{{cite journal| author=Magnani JW, Danik HJ, Dec GW, DiSalvo TG| title=Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. | journal=Am Heart J | year= 2006 | volume= 151 | issue= 2 | pages= 463-70 | pmid=16442915 | doi=10.1016/j.ahj.2005.03.037 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16442915 }} </ref>. These patients should be treated with low sodium intake, [[diuretics]] and [[ACE inhibitors]]. Few animal studies report that mortality rate is high with [[digoxin]] in comparison to [[beta blocker]] in viral myocarditis<ref name="pmid1674900">{{cite journal| author=Tominaga M, Matsumori A, Okada I, Yamada T, Kawai C| title=Beta-blocker treatment of dilated cardiomyopathy. Beneficial effect of carteolol in mice. | journal=Circulation | year= 1991 | volume= 83 | issue= 6 | pages= 2021-8 | pmid=1674900 | doi= | pmc= | url= }} </ref><ref name="pmid10614837">{{cite journal| author=Matsumori A, Igata H, Ono K, Iwasaki A, Miyamoto T, Nishio R et al.| title=High doses of digitalis increase the myocardial production of proinflammatory cytokines and worsen myocardial injury in viral myocarditis: a possible mechanism of digitalis toxicity. | journal=Jpn Circ J | year= 1999 | volume= 63 | issue= 12 | pages= 934-40 | pmid=10614837 | doi= | pmc= | url= }} </ref>. Studies have also demonstrated that usage of [[carvedilol]] during recovery phase decreases expression of several histochemicals and subsequently myocardial inflammation and there by improving survival<ref name="pmid15923319">{{cite journal| author=Wang JF, Meissner A, Malek S, Chen Y, Ke Q, Zhang J et al.| title=Propranolol ameliorates and epinephrine exacerbates progression of acute and chronic viral myocarditis. | journal=Am J Physiol Heart Circ Physiol | year= 2005 | volume= 289 | issue= 4 | pages= H1577-83 | pmid=15923319 | doi=10.1152/ajpheart.00258.2005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15923319 }} </ref>. The Beta-blockers should however be avoided in the acutely decompensating phase of illness. | ||
If [[heart failure]] or [[cardiogenic shock]] does not respond to medical therapy, circulatory support with an [[intraaortic balloon pump]] should be considered which could be used in fulminant myocarditis as a bridge to spontaneous recovery<ref name="pmid2000764">{{cite journal| author=Rockman HA, Adamson RM, Dembitsky WP, Bonar JW, Jaski BE| title=Acute fulminant myocarditis: long-term follow-up after circulatory support with left ventricular assist device. | journal=Am Heart J | year= 1991 | volume= 121 | issue= 3 Pt 1 | pages= 922-6 | pmid=2000764 | doi= | pmc= | url= }} </ref><ref name="pmid10226900">{{cite journal| author=Chen JM, Spanier TB, Gonzalez JJ, Marelli D, Flannery MA, Tector KA et al.| title=Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance. | journal=J Heart Lung Transplant | year= 1999 | volume= 18 | issue= 4 | pages= 351-7 | pmid=10226900 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10226900 }} </ref>. | If [[heart failure]] or [[cardiogenic shock]] does not respond to medical therapy, circulatory support with an [[intraaortic balloon pump]] should be considered which could be used in fulminant myocarditis as a bridge to spontaneous recovery<ref name="pmid2000764">{{cite journal| author=Rockman HA, Adamson RM, Dembitsky WP, Bonar JW, Jaski BE| title=Acute fulminant myocarditis: long-term follow-up after circulatory support with left ventricular assist device. | journal=Am Heart J | year= 1991 | volume= 121 | issue= 3 Pt 1 | pages= 922-6 | pmid=2000764 | doi= | pmc= | url= }} </ref><ref name="pmid10226900">{{cite journal| author=Chen JM, Spanier TB, Gonzalez JJ, Marelli D, Flannery MA, Tector KA et al.| title=Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance. | journal=J Heart Lung Transplant | year= 1999 | volume= 18 | issue= 4 | pages= 351-7 | pmid=10226900 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10226900 }} </ref>. Implantation of [[ICD]] in severe [[heart failure]] should be deferred for several months to allow sufficient time for recovery of ventricular function. | ||
==References== | ==References== | ||
Revision as of 14:22, 29 August 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.
Treatment
Bacterial infections are treated with antibiotics, dependent on the nature of the pathogen and its sensitivity to antibiotics. As most viral infections cannot be treated with directed therapy, symptomatic treatment is the only form of therapy for those forms of myocarditis, e.g. NSAIDs for the inflammatory component and diuretics and/or inotropes for ventricular failure. ACE inhibitor therapy may aid in left ventricular remodeling after the inflammation has begun to resolve.
According to 2010 HFSA guidelines[1], routine use of immunosuppressive therapies in management of myocarditis is not recommended (Strength of Evidence A)
Heart Failure Treatment
As heart failure in patients with myocarditis has poor prognosis, it is important to prevent progression or worsening of cardiac dysfunction[2]. These patients should be treated with low sodium intake, diuretics and ACE inhibitors. Few animal studies report that mortality rate is high with digoxin in comparison to beta blocker in viral myocarditis[3][4]. Studies have also demonstrated that usage of carvedilol during recovery phase decreases expression of several histochemicals and subsequently myocardial inflammation and there by improving survival[5]. The Beta-blockers should however be avoided in the acutely decompensating phase of illness.
If heart failure or cardiogenic shock does not respond to medical therapy, circulatory support with an intraaortic balloon pump should be considered which could be used in fulminant myocarditis as a bridge to spontaneous recovery[6][7]. Implantation of ICD in severe heart failure should be deferred for several months to allow sufficient time for recovery of ventricular function.
References
- ↑ Heart Failure Society of America. Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA; et al. (2010). "HFSA 2010 Comprehensive Heart Failure Practice Guideline". J Card Fail. 16 (6): e1–194. doi:10.1016/j.cardfail.2010.04.004. PMID 20610207.
- ↑ Magnani JW, Danik HJ, Dec GW, DiSalvo TG (2006). "Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors". Am Heart J. 151 (2): 463–70. doi:10.1016/j.ahj.2005.03.037. PMID 16442915.
- ↑ Tominaga M, Matsumori A, Okada I, Yamada T, Kawai C (1991). "Beta-blocker treatment of dilated cardiomyopathy. Beneficial effect of carteolol in mice". Circulation. 83 (6): 2021–8. PMID 1674900.
- ↑ Matsumori A, Igata H, Ono K, Iwasaki A, Miyamoto T, Nishio R; et al. (1999). "High doses of digitalis increase the myocardial production of proinflammatory cytokines and worsen myocardial injury in viral myocarditis: a possible mechanism of digitalis toxicity". Jpn Circ J. 63 (12): 934–40. PMID 10614837.
- ↑ Wang JF, Meissner A, Malek S, Chen Y, Ke Q, Zhang J; et al. (2005). "Propranolol ameliorates and epinephrine exacerbates progression of acute and chronic viral myocarditis". Am J Physiol Heart Circ Physiol. 289 (4): H1577–83. doi:10.1152/ajpheart.00258.2005. PMID 15923319.
- ↑ Rockman HA, Adamson RM, Dembitsky WP, Bonar JW, Jaski BE (1991). "Acute fulminant myocarditis: long-term follow-up after circulatory support with left ventricular assist device". Am Heart J. 121 (3 Pt 1): 922–6. PMID 2000764.
- ↑ Chen JM, Spanier TB, Gonzalez JJ, Marelli D, Flannery MA, Tector KA; et al. (1999). "Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance". J Heart Lung Transplant. 18 (4): 351–7. PMID 10226900.