Serial Electrocardiographic Findings in Acute Myocarditis.

Nakashima, Hiroshi; Honda, Yukiharu; Katayama, Tomoyuki

doi:10.2169/internalmedicine.33.659

Cited by 56 publications

(55 citation statements)

References 16 publications

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“…The electrocardiographic findings are often variable [3,4] . It can frequently mimic AMI [3,5,6] and most of these cases were reported to have normal coronary arteries [5,6] and long-term prognosis is generally good [3] .…”

Section: Discussionmentioning

confidence: 99%

Fulminant myocarditis complicated with cardiac arrest and subsequent acute respiratory distress syndrome formation rescued by Extracorporeal Membrane Oxygenation – A rare case report

Hsieh

et al. 2014

CRIM

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Acute fulminant myocarditis (AFM) is a relatively rare diagnosis characterized by heart failure preceded by symptoms of viral infection. Sometimes circulatory mechanical support is required for this catastrophic condition and mortality rate was still high. Adult respiratory distress syndrome (ARDS) was a rare complication of myocarditis in the literature. However, there was limited literature discussing AFM complicated with cardiac arrest and subsequent ARDS formation and the prognosis of extracorporeal membrane oxygenation (ECMO) treatment is unknown. Here we report a case of AFM suffering from cardiac arrest and ARDS formation and successfully treated by ECMO. This rare case reminds physicians that ARDS is still a possible but extremely rare complication of fulminant myocarditis, and ECMO is a lifesaving treatment not only for AFM with profound shock but also for possible ARDS formation.

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Section: Discussionmentioning

confidence: 99%

Fulminant myocarditis complicated with cardiac arrest and subsequent acute respiratory distress syndrome formation rescued by Extracorporeal Membrane Oxygenation – A rare case report

Hsieh

et al. 2014

CRIM

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“…4 Myocarditis can cause a spectrum of EKG changes that include ST segment elevation, ST depression, any degree of heart block, T wave inversion, abnormal Q waves, bundle branch blocks, atrial and ventricular arrhythmias. 3,5 Numerous cases of myocarditis mimicking myocardial infarction have been reported. [6][7][8][9][10] However, in myocarditis the ST elevation does not correspond to any coronary artery distribution and ST depressions while present are usually not reciprocal.…”

Section: Discussionmentioning

confidence: 99%

“…These can serve as distinguishing features between myocarditis and an infarct. 5 But, unfortunately, EKG changes are non-specific and in cases with focal myocarditis, they can closely resemble an acute myocardial infarction. 7 Consequently, recognizing acute myocarditis remains a serious challenge and inappropriate management of the disease can lead to fatal consequences.…”

Section: Discussionmentioning

confidence: 99%

A 40-year-old Woman with Chest Pain, ST Elevation, Elevated Troponin and Normal Coronary Arteries: A Case Report

Chokkalingam-Mani¹,

Chandra²

2010

TMF

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Electrocardiographic changes resembling myocardial ischemia or infarction can be caused by a variety of causes other than ischemia. One of them is acute myocarditis which further confounds clinical judgment by causing elevation in troponins as well. We report a case of myocarditis which underscores the importance of identifying the clinical presentation of acute myocarditis and the electrocardiographic changes that can be associated with it. Case ReportA 40-year-old mother of two children with no significant past medical history presented to an outside hospital (OSH) complaining of intermittent chest pain for a week. She described it as "pressure-like" pain in the retrosternal and epigastric regions, with no radiation and reported it had been particularly worsening in the past two days. She notes that her youngest child aged three was sick with an upper respiratory infection in the past week. On arrival at the OSH, patient's electrocardiogram (EKG) showed significant ST elevations in V1 and V2, ST depression and T wave inversion in the inferior and other precordial leads. (Figure 1) Her initial troponin was 28.6 ng/ml (normal rangeless than 0.5 ng/ml). Anticoagulation was initiated with heparin and an emergent cardiac catheterization was performed at the OSH, which revealed normal coronary arteries.During the procedure, she developed hemodynamic instability, requiring an infusion of norepinephrine and phenylephrine and a placement of an intra-aortic balloon pump (IABP). Patient was then transferred to our institution for further management. Subsequently, she started experiencing repeated episodes of sustained ventricular tachycardia, requiring multiple boluses and continuous infusions of amiodarone. She also developed an irregular tachyarrhythmia with right bundle branch block (Figure 2 and 3). Laboratory work and other cardiovascular studies from OSH were reviewed. Echocardiogram revealed an ejection fraction of 15-20% with severe global LV dysfunction. A presumptive diagnosis of acute myocarditis was made. On the second day of admission, extra-corporeal membrane oxygenation (ECMO) was initiated due to further hemodynamic deterioration.Viral titers for adenovirus, cocksackie, Cytomegalovirus (CMV), herpes, echovirus, Epstein-Barr virus, hepatitis, parainfluenza and varicella were sent. Antibody titers for Lyme, mycoplasma and toxoplasma were also sent. The titers were positive only Figure 1. EKG 1 at the time of initial presentation to the OSH. EKG shows sinus tachycardia with ST elevation in V1 and V2, ST depression in V3 to V6, I, II, III, aVF.

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“…Наиболее часто при острых миокардитах на ЭКГ выявляются неспецифические изменения сегмента ST и зубца Т (подъем ST, инверсия зубца Т), замед-ление внутрижелудочковой проводимости, частая экстрасистолия, блокады ножек пучка Гиса [4][5][6]. Более серьезными осложнениями являются арест синусового узла, суправентрикулярная и желудоч-ковая тахикардии, фибрилляция предсердий, атрио-вентрикулярные блокады (АВБ) и фибрилляция желудочков [7].…”

Section: The Specifics and Way Of Atrioventricular Block Course In Inunclassified

The Specifics and Way of Atrioventricular Block Course in Infants Myocarditis

Васичкина¹,

Люскина²,

Первунина³

et al. 2016

Russ J Cardiol

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В статье представлены данные о 6 детях младшей возрастной группы с атрио-вентрикулярными блокадами сердца (АВБ), развившимися на фоне острого или подострого миокардита. Цель. проанализировать особенности течения и исходы АВБ высокой сте-пени, развившихся на фоне воспалительных изменений миокарда у детей младшей возрастной группы в течение трех лет наблюдения. Материал и методы. Для изучения особенностей течения АВБ на фоне теку-щего миокардита были обобщены данные обследования 6 пациентов в возра-сте до 1,5 лет; средний возраст 10,0±4,5 месяцев (от 3 до 16 месяцев). Во всех клинических случаях был проведен анализ медицинской документации с выко-пировкой данных о течении беременности, проанализированы результаты кардиотокографии (кТГ) и ультразвукового исследования (УЗИ) плода (для исключение врожденного генеза АВБ), этапах роста и развития ребенка, пере-несенных заболеваниях. проведено комплексное лабораторно-инструмен-тальное обследование, включающее определение биохимических маркеров воспаления и сывороточных маркеров повреждения миокарда, электрокардио-графическое ЭкГ) и эхокардиографическое (ЭхокГ) обследование. Результаты. Длительность наблюдения составила 23,3±10,4 месяцев (от 9 до 35 месяцев). На фоне терапии у всех пациентов отмечена тенденция к сни-жению уровня кардиоспецифических ферментов, выявлено уменьшение функ-ционального класса сердечной недостаточности и положительная динамика ЭхокГ-показателей к концу первого года наблюдения. Однако нарушения АВ-проводимости сердца у всех пациентов носили необратимый характер. посто-янный электрокардиостимулятор (пЭкС) был имплантирован двум пациентам через 6 и 14 месяцев после установления диагноза. заключение. У детей младшего возраста нарушения АВ проведения, развив-шиеся на фоне миокардита, носят стойкий, необратимый характер. THE SPECIFICS AND WAY OF ATRIOVENTRICULAR BLOCK COURSE IN INFANTS MYOCARDITISVasichkina E. S. Aim. To study the specifics of clinical course and outcomes of higher degree AVB, developed due to inflammatory changes of myocardium in infants, during three years follow-up. Material and methods. For the assessment of AVB specifics in current myocarditis we have summarized the investigation data of 6 patients younger than 1,5 y. o.; mean age 10,0±4,5 months (3 to 16 months). In all clinical cases we performed the analysis of medical source documents with outcopying of pregnancy data, analysis of cardiotocography (CTG) data and ultrasound examination (uSE) of the fetus (to rule out inborn cause for AVB), stages of the growth and development of a child, diseases anamnesis. The complex laboratory and instrumental investigation was done, including evaluation of biochemical markers of inflammation and serum markers of myocardial damage, electrocardiographic (ECG) and echocardiographic (EchoCG) studies. Results. mean follow-up was 23,3±10,4 months (from 9 to 35 months). On treatment, all patients had tendency for the decrease of cardiac specific enzymes, the decrease of heart failure functional class and positive EchoCG dynamics by the end of t...

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Serial Electrocardiographic Findings in Acute Myocarditis.

Cited by 56 publications

References 16 publications

Fulminant myocarditis complicated with cardiac arrest and subsequent acute respiratory distress syndrome formation rescued by Extracorporeal Membrane Oxygenation – A rare case report

Fulminant myocarditis complicated with cardiac arrest and subsequent acute respiratory distress syndrome formation rescued by Extracorporeal Membrane Oxygenation – A rare case report

A 40-year-old Woman with Chest Pain, ST Elevation, Elevated Troponin and Normal Coronary Arteries: A Case Report

The Specifics and Way of Atrioventricular Block Course in Infants Myocarditis

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