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.

Downloads

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://www.rsdjournal.org/index.php/rsd/article/view/25010. Acesso em: 19 apr. 2024.

Issue

Vol. 11 No. 1

Section

Health Sciences

License

Copyright (c) 2022 Barbara Beatriz Lira da Silva; Ana Klara Rodrigues Alves; Gabriel Brito da Silva; Flávia Dias Nogueira ; Lizandra Azevedo Brito; José Vieira Amorim Filho ; Pedro Henrique Fréres Holanda; Ana Carla Souza Menezes; Myrcia Ferreira Lopes Nogueira; Julyana de Souza Araujo; Elisa Costa Leitão ; Vinicius Enrico de Azevedo; Jairo da Costa Souza; Victor Rocha Santos; Verbena Krieger Rocha Santos

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.