MYOCARDITIS

dr. Muchamad Abusari (resident of cardiology and vascular

Medicine
dr. Sumakto, SpA (K) supervisor of Pediatri, Infection
Division
MYOCARDITIS
 Myocarditis is inflamation of heart muscle
 Most often due to infection by common viruses
 Myocarditis is an infection of the heart with an
inflamatory infiltrate and damage to to the heart
muscle without blockage of coronary arteries that
differs it from myocardial infarction
 Myocarditis is often an autoimmune reaction
SIGNS AND SYMPTOMS
 Chest pain
 Congestive heart failure (edema, breathlessness and
hepatic congestion)
 Palpitation due to arrhytmias
 Sudden death (in young adults, it causes up to
20%)
 Fever
 Symptoms in infants and toddler tend to be more
nonspesific
CAUSES
 Viral (adenovirus, parvovirus B19, coxsackie,HIV,
enterovirus, rubella, polio, cytomegalovirus, human
herpesvirus 6)
 Protozoa (trypanosoma cruzi, toxoplasma gondii)
 Bacterial (brucella, corynebacterium diphteriae,
gonococcus, haemophillus influenzae,
leptospirosis)
 Fungal (aspergillus)
 Parasitic (ascaris, echinococcus granulosus,
schistosoma, taenia solium)
 Toxin: ethanol, chemotheraphy, antipsychotic)
 Immunology: allergic, rejection after heart
transplatation, autoantigens, toxin, heavy metals
 Physical agent: electric shock, hyperpyrexia and
radiation
DIAGNOSIS
 ECG (diffuse ST segment elevation)
 Laboratory: elevated CRP, ESR, Increased IgM
against virus, increased troponin and CK/CKMB
 Echocardiography: global hypokinetic
TREATMENT
 In acute phase: bed rest
 For symptomatic patients: inotropic agent and
diuretic, ACE inhibitor)
 People who do not respond to conventional therapy
are candidate to left ventricular assist device
 Systemic corticosteroid still remains controversial
COXSACKIE B VIRUS
 Serotype of enterovirus
 It can trigger illness ranging

From mild gastrointestinal

Distress to pericarditis and
myocarditis
GEOGRAPHIC DISTRIBUTION
 It can be discovered almost entirely US, Phillipines
 The virus is most frequently distributed via fecal
oral route and infection commonly occurs after
eating contaminated food
 Infection in infants are mostly asymptomatic but
sometimes results in the death of the infants due to
myocarditis
PATOPHYSIOLOGY
 The coxsackie virus B initially replicates in the gut
and spleen and eventually spread to the target organ
(the heart)
 In the heart replication of the virus causes damage to
the heart cells and induce migration of white blood
cells into heart tissue.
 The white blood cells activate an autoimmune
process in which they will kill infected heart cell and
normal cell. The autoimmune process persist long
after viral particles are no longer detected.
SIGNS AND SYMPTOMS
 Symptoms: fever, headache, sore throat,
gastrointestinal distress, muscle pain
 In some cases it can cause progression to
myocarditis or pericarditis
 The incubation period is 2-6 days and illness may
last for up to weeks but may resolve as quickly as
two days
DIAGNOSIS
 ELISA test
 Cell culture
TREATMENT
 Symptomatic and supportive therapy
 antiinflamatory
THANK YOU