Diagnostic approach to acute myocarditis case follow-up: an experience report

Authors

DOI:

https://doi.org/10.33448/rsd-v11i1.25010

Keywords:

Myocarditis; Cardiomyopathy; Multidisciplinary team.

Abstract

Myocarditis is an inflammatory heart disease that can occur as a consequence of infections (predominantly by viruses, but also by other infectious agents, including bacteria, protozoa and fungi), exposure to toxic substances (alcohol and drugs) and activation of the immune system. included among secondary cardiomyopathies in the 1996 classification of the World Health Organization. The present study aims to report the experience of health professionals in monitoring a patient with acute myocarditis, from the first day of admission to discharge. This is an experience report of a critical-reflective approach with a descriptive and comprehensive approach on a case experienced in the city of Niteroí - RJ, in a private hospital, about a patient with an initial suspicion of Coronary Artery Disease (CAD), the diagnosis of Acute Myocarditis (AM) was later confirmed in August 2019. The presentation of acute myocarditis is extremely variable and often subclinical, which can lead to acute complications or progress relatively asymptomatically to chronic heart failure. The gold standard for the diagnosis of myocarditis is still positive endomyocardial biopsy, an invasive procedure that requires a high pre-test clinical probability and a low risk/benefit ratio to be performed. However, the combination of measuring troponin levels and cardiac magnetic resonance imaging has made the diagnosis of MA possible with sufficient accuracy for uncomplicated forms. There are still gaps in understanding the pathogenesis and diagnostic and therapeutic options for myocarditis.

References

Ammirati, E., Veronese, G., Bottiroli, M., Wang, D. W., Cipriani, M., Garascia, A., Pedrotti, P., Adler, E. D., & Frigerio, M. (2021). Update on acute myocarditis. Trends in cardiovascular medicine, 31(6), 370–379.

Ammirati, E., Frigerio, M., Adler, E. D., Basso, C., Birnie, D. H., Brambatti, M., Friedrich, M. G., Klingel, K., Lehtonen, J., Moslehi, J. J., Pedrotti, P., Rimoldi, O. E., Schultheiss, H. P., Tschöpe, C., Cooper, L. T., Jr, & Camici, P. G. (2020). Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circulation. 13(11), e007405.

Ammirati, E., Cipriani, M., Moro, C., Raineri, C., Pini, D., Sormani, P., Mantovani, R., Varrenti, M., Pedrotti, P., Conca, C., Mafrici, A., Grosu, A., Briguglia, D., Guglielmetto, S., Perego, G. B., Colombo, S., Caico, S. I., Giannattasio, C., Maestroni, A., Carubelli, V., Metra, M., Lombardi, C., Campodonico, J., Agostoni, P., Peretto, G., Scelsi, L., Turco, A., Di Tano, G., Campana, C., Belloni, A., Morandi, F., Mortara, A., Cirò, A., Senni, M., Gavazzi, A., Frigerio, M,. Oliva, F. & Camici, P. G. (2018). Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry. Circulation. 11;138(11):1088-1099.

Ammirati, E., Veronese, G., Cipriani, M., Moroni, F., Garascia, A., Brambatti, M., Adler, E. D. & Frigerio, M. (2018). Acute and Fulminant Myocarditis: a Pragmatic Clinical Approach to Diagnosis and Treatment. Curr Cardiol Rep. 26;20(11):114.

Bracamonte-Baran, W., & Čiháková, D. (2017). Cardiac Autoimmunity: Myocarditis. Advances in experimental medicine and biology, 1003, 187–221.

Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., Levine, G. N., Narula, J., Starling, R. C., Towbin, J. & Virmani, R. (2007). American Heart Association; American College of Cardiology; European Society of Cardiology; Heart Failure Society of America; Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol. 6;50(19):1914-31.

Chopra, H., Arangalage, D., Bouleti, C., Zarka, S.., Fayard, F., Chillon, S., Laissy, J. P., Henry-Feugeas, M. C., Steg, P. G. & Vahanian, A. (2016). Prognostic value of the infarct- and non-infarct like patterns and cardiovascular magnetic resonance parameters on long-term outcome of patients after acute myocarditis. Int J Cardiol. 1;212:63-9.

Eichhorn, C., Bière, L., Schnell, F., Schmied, C., Wilhelm, M., Kwong, R. Y. & Gräni, C. (2020). Myocarditis in Athletes Is a Challenge: Diagnosis, Risk Stratification, and Uncertainties. JACC Cardiovasc Imaging. 13(2 Pt 1):494-507.

Ganatra, S. & Neilan, T. G. (2018). Immune Checkpoint Inhibitor-Associated Myocarditis. Oncologist. 23(8):879-886.

Gräni, C., Eichhorn, C., Bière, L., Murthy, V. L., Agarwal, V., Kaneko, K., Cuddy, S., Aghayev, A., Steigner, M., Blankstein, R., Jerosch-Herold, M., & Kwong, R. Y. (2017). Prognostic Value of Cardiac Magnetic Resonance Tissue Characterization in Risk Stratifying Patients With Suspected Myocarditis. Journal of the American College of Cardiology, 70(16), 1964–1976.

Gil, A. C. (2007) Como Elaborar Projetos de Pesquis., Atlas, 4(4): 41-57.

Gilotra, N. A., Minkove, N., Bennett, M. K., Tedford, R. J., Steenbergen, C., Judge, D. P., Halushka, M. K. & Russell, S. D. (2016). Lack of Relationship Between Serum Cardiac Troponin I Level and Giant Cell Myocarditis Diagnosis and Outcomes. J Card Fail. 22(7):583-5.

Hung, Y., Lin, W. H., Lin, C. S., Cheng, S. M., Tsai, T. N., Yang, S. P., & Lin, W. Y. (2016). The Prognostic Role of QTc Interval in Acute Myocarditis. Acta Cardiologica Sinica, 32(2), 223–230.

Kang, T. D., Ren, Y. L., Zhao, H., Ning, S. Q., & Liu, W. X. (2020). Risk factors for adverse cardiac events in adults with fulminant myocarditis during hospitalization. World journal of clinical cases, 8(2), 255–263.

Mahmood, S. S., Fradley, M. G., Cohen, J. V., Nohria, A., Reynolds, K. L., Heinzerling, L. M., Sullivan, R. J., Damrongwatanasuk, R., Chen, C. L., Gupta, D., Kirchberger, M. C., Awadalla, M., Hassan, M., Moslehi, J. J., Shah, S. P., Ganatra, S., Thavendiranathan, P., Lawrence, D. P., Groarke, J. D., & Neilan, T. G. (2018). Myocarditis in Patients Treated With Immune Checkpoint Inhibitors. Journal of the American College of Cardiology, 71(16), 1755–1764.

McKenna, W. J, Maron, B. J & Thiene, G. (2017). Classification, Epidemiology, and Global Burden of Cardiomyopathies. Circ Res. 15;121(7):722-730.

Lurz, P., Luecke, C., Eitel, I., Föhrenbach, F., Frank, C., Grothoff, M., Waha, S., Rommel, K. P., Lurz, J. A., Klingel, K., Kandolf, R., Schuler, G., Thiele, H. & Gutberlet, M. (2016). Comprehensive Cardiac Magnetic Resonance Imaging in Patients With Suspected Myocarditis: The MyoRacer-Trial. J Am Coll Cardiol. 67(15):1800-1811.

Palaskas, N., Lopez-Mattei, J., Durand, J. B., Iliescu, C., & Deswal, A. (2020). Immune Checkpoint Inibitor Myocarditis: Pathophysiological Characteristics, Diagnosis, and Treatment. Journal of the American Heart Association, 9(2), e013757.

Tschöpe, C., Ammirati, E., Bozkurt, B., Caforio, A., Cooper, L. T., Felix, S. B., Hare, J. M., Heidecker, B., Heymans, S., Hübner, N., Kelle, S., Klingel, K., Maatz, H., Parwani, A. S., Spillmann, F., Starling, R. C., Tsutsui, H., Seferovic, P., & Van Linthout, S. (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Cardiology, 18(3), 169–193.

Wang, Z., Wang, Y., Lin, H., Wang, S., Cai, X., & Gao, D. (2019). Early characteristics of fulminant myocarditis vs non-fulminant myocarditis: A meta-analysis. Medicine, 98(8), e14697.

Published

07/01/2022

How to Cite

SILVA, B. B. L. da; ALVES, A. K. R. .; SILVA, G. B. da .; NOGUEIRA , F. D. .; BRITO, L. A.; AMORIM FILHO , J. V. .; HOLANDA, P. H. F. .; MENEZES, A. C. S.; NOGUEIRA, M. F. L. .; ARAUJO, J. de S.; LEITÃO , E. C. .; AZEVEDO, V. E. de; SOUZA, J. da C.; SANTOS, V. R. .; SANTOS, V. K. R. . Diagnostic approach to acute myocarditis case follow-up: an experience report. Research, Society and Development, [S. l.], v. 11, n. 1, p. e30311125010, 2022. DOI: 10.33448/rsd-v11i1.25010. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/25010. Acesso em: 22 nov. 2024.

Issue

Section

Health Sciences