Myocarditis

Young Soldier With A Failing Heart Manju Goyal, M.D. Walter Reed Army Medical Center April 2008

Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case ,[object Object],[object Object],Young patient in SHOCK with concerning cardiac exam and EKG

Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],New onset of Dilated Cardiomyopathy (DCM)

Dilated Cardiomyopathy www.uptodate.com

Review of 1230 Patients with DCM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEJM 2000

Importance of Etiology NEJM 2000

Additional Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],What’s the differential? Any further tests?

Review of 1230 Patients with DCM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEJM 2000 Endomyocardial Biopsy

Biopsy Results Dr. Brendan Graham Dept. of Pathology

Case of Viral Myocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Objectives: Myocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Myocarditis ,[object Object],[object Object]

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Circulation 1976 2. Ann Intern Med 2004

Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathophysiology of Viral Myocarditis Braunwald 2007

Viral Phase ,[object Object],[object Object],[object Object],[object Object],Braunwald 2007

Immune Response Braunwald 2007 Autoimmune response : auto-antibodies to myosin and other cardiac proteins Overexpression of cytokines (IL-2, INF- γ , TNF- α )

Clinical Presentation Acute Fulminant Chronic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnosis: Cardiac MRI ,[object Object],[object Object],[object Object],[object Object],WITH Contrast WITHOUT Contrast Eur Heart J 1994 LV RV RV LV

Diagnosis: Coronary Angiography ,[object Object],[object Object],[object Object]

Diagnosis: Endomyocardial Biopsy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

When to consider biopsy? Mayo Clin Proc 2001

Treatment Dr. Barnett Gibbs Dept. of Cardiology

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]

Intra-aortic balloon pump ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Intra-aortic balloon pump ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ventricular-assist device ,[object Object],[object Object],[object Object]

* *Centrifugal pump vs. corkscrew

Ventricular-assist device ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ventricular-assist device ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CID. 2005;40:1108.

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medical therapy ,[object Object],[object Object],[object Object],[object Object]

Medical therapy ,[object Object],[object Object],[object Object],[object Object],Am Heart J. 1990;120:1377.

Medical therapy ,[object Object],Circulation. 1991;83:2021..

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Immunosuppressive Therapies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Int Heart J. 2005;46:113.

Immunosuppressive Therapies Int Heart J. 2005;46:113.

Immunosuppressive Therapies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Int Heart J. 2005;46:113. NEJM. 2000;343:1388.

Prognosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEJM. 2000;342:1077.

Prognosis ,[object Object],[object Object],NEJM. 2000;342:1077.

Prognosis NEJM. 2000;342:1077.

Prognosis ,[object Object],[object Object],[object Object],[object Object]

SUMMARY ,[object Object],[object Object],[object Object],[object Object]

Back to the case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Biopsy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Myocarditis

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (7)

Ähnlich wie Myocarditis

Ähnlich wie Myocarditis (20)

Mehr von jcm MD

Mehr von jcm MD (18)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Myocarditis