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Myocarditis

By Tiarlin yuniar
Pengertian

Peradangan pada miokard atau otot


jantung yang dapat menyerang pada
semua umur
INTRODUCTION
As early as 1806 , a persistent
inflammatory process following such an
infection (eg, diphtheria) of the
myocardium led to progressive cardiac
damage and dysfunction
In 1837, the term myocarditis was first
introduced as inflammation or
degeneration of the heart by postmortem
INTRODUCTION
Endomyocardial biopsy in 1980 allows the
sampling of human myocardial tissue
during life and antemortem diagnosis of
myocarditis.

Dari penelitian diduga 20 % penyebab


sudden death adalah myocarditis ,
kematian tak terduga pada umur kurang
dari 40 thn.
PENYEBAB

Penyakit reumatik akut dan


Infeksi virus seperti cocksakie virus,
difteri , campak, influenza ,
poliomielitis, dan
Berbagai macam bakteri, rikettsia,
jamur, dan parasit.
Pathophysiology
 Several mechanisms of myocardial damage

(1) Direct injury of myocytes by the


infectious agent
(2) Myocyte injury caused by a toxin such as that
from Corynebacterium diphtheriae
(3) Myocyte injury as a result of infection-
induced immune reaction or autoimmunity.
Pathophysiology
Triphasic disease process

Phase I: Viral Infection and Replication(


7-10 days )

Phase 2: Autoimmunity and injury

Phase 3: Dilated Cardiomyopathy


http://content.nejm.org/content/vol343/issue19/images/large/08f2.jpeg
Clinical Findings
 Symptoms and Signs
- Patients(59%) frequently present days to weeks after
an acute febrile illness, particularly a flu-like syndrome
- Myocarditis is most commonly asymptomatic, with no
evidence of left ventricular dysfunction
- fever, malaise, fatigue, arthralgias, myalgias, and skin
rash.
-Cardiac symptoms may result from systolic or diastolic
left ventricular dysfunction or from tachyarrhythmias or
bradyarrhythmias (dyspnea, fatigue, decreased exercise
tolerance, palpitations )
Clinical Findings
 Symptoms and Signs
- Chest discomfort(35%) is a common symptom
and is typically pericardial in nature
- Myocarditis may present as sudden death, as a
result of malignant ventricular arrhythmias or
complete heart block
-Systemic and pulmonary thromboemboli have
also been noted.
Clinical Findings
 Physical Examination
-Tachycardia, hypotension, fever and tachycardia

-Bradycardia is seen rarely, and a narrow pulse


pressure is occasionally detected
-Murmurs of mitral or tricuspid regurgitation are
common , S3 and S4 gallops may also be heard.
-Distended neck veins, wheezes,
gallops, and peripheral edema may be detected
Diagnostic Studies
Electrocardiography
-The most common abnormality is sinus
tachycardia.
- may show ventricular arrhythmias or
heart block,
Diagnostic Studies
 Chest radiograph
-Mild to moderate cardiomegaly from
dilatation of the LV or RV cavity
-The cardiac silhouette may also be globular
when a pericardial effusion is present
- Venous congestion and pulmonary edema may
be seen in more severe cases
Diagnostic Studies
 Echocardiography

-Left ventricular systolic dysfunction, regional


wall motion abnormalities , global hypokinesis
- LV may be normal in size or minimally
enlarged
-Mitral or tricuspid regurgitation
-Mural thrombi in 15% of cases
Diagnostic Studies
 Cardiac catheterization
-elevated left ventricular end-diastolic
pressure, a depressed cardiac output, and
increased ventricular volumes
-Coronary angiogram typically
demonstrates normal coronary arteries.
Diagnostic
Endomyocardial biopsy
- gold standard for the diagnosis of
myocarditis
MRI
Normal Myocardium
Borderline Myocarditis
Active Myocarditis
Other tests
 elevated erythrocyte sedimentation rate
(ESR) , mild to moderate leukocytosis
CPK-MB , Cardiac troponin-I
 Other laboratory analyses that may be
useful include a Mono-spot test, Epstein-
Barr virus titers, hepatitis serology, and
urine and serum for cytomegalovirus
(CMV).
Triphasic disease process.
References
Advances in the understanding of
myocarditis. Circulation 2001;104:1076.
Feldman AM, McNamara D: Myocarditis. N
Engl J Med 2000;19:1388.
Diagnosis and presentation of fatal
myocarditis Human Pathology (2005) 36,
1003– 1007