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Abbreviations
ENGLISH TRANSLATION UNDER CONSTRUCTION
18-F FDG izotop fluoru – fluorodeoxyglukóza
2CH 2 komorový
3D IT T1 název sekvence pro průkaz LGE
4CH 4 komorový
ACE-I …
Discussion
The examined group consisted mostly of young males up to the age of 40. Majority of patients (77 %) had increased troponin I level and generally, the examined group showed a strong heterogeneity in the question of symptoms and examinations´ findings….
Results
Clinical characteristics
Clinical characteristics of the examined group are presented in Table 6. Patients were of the average age of 35 ± 14 years with considerable predominance of males (24 males and 6 females). The only statistically sig…
Methods
Examined group
The examined group comprised of patients hospitalized on the Department of Cardiology of Na Homolce Hospital between the 1st January 2002 and the 31st December 2016 with the diagnosis of myocarditis or p…
Aims
Aim 1
To evaluate subjective symptoms, objective findings and results of examinations of patients hospitalized in Na Homolce Hospital in the acute phase of myocarditis or perimyocarditis. The aim is to evaluate the results of the …
References
- RICHARDSON P., MCKENNA W., BRISTOW M., MAISCH B., MAUTNER B., O´CONNELL J., OLSEN E., THIENE G., GOODWIN J., GYARFAS I., MARTIN I., NORDER P. Report of the 1995 World Health Organization/International Society and Federation of Cardiol…
Prognosis
It is difficult to determine the prognosis of myocarditis and ICMP because it depends on a number of different factors including age and disease type. The highest mortality and heart transplant necessity are in GCM with 48 to 89 % [49, 55, 56]. In HI…
Mechanical support of inner organs and heart transplant
This kind of therapy is indicated in the fulminant course of myocarditis and patients with cardiogenic shock with haemodynamic instability despite the optimal therapy [43, 127]. It serves as “bridge to recovery or bridge to transplant” [96]. From mec…
Immunoadsorption and interferons
Immunoadsorption
The use of this therapy is considered in ICMP with induced autoimmune reaction and with the production of anti-myocardial autoantibodies [24, 98, 99]. The principle of the therapy lies in the removal of circulating autoanti…
Immunosuppressive therapy
This therapeutic option is indicated in cases of GCM, eosinophilic myocarditis, cardiac sarcoidosis and in myocarditis connected with autoimmune diseases [55, 62, 76, 77]. It consists mostly of a combination of prednisone, cyclosporine and/or azathio…
Immunoglobulines
Intravenously administered immunoglobulins (IVIG) in high doses are indicated in patients with different immune system disorders. Their effect lies in the modulation of the immune system including inactivation of autoantibodies [99]. The favorable ef…
Immunological therapy generally
This part of therapy is currently still a subject of researches which are aimed at both acute and chronic myocarditis treatment. Their conclusions are however often different or the specific kinds of therapy are suitable just for specific groups of p…
Treatment with ATB and antivirotics
In the Czech Republic, Borrelia burgdorferi dominates over other bacterial agents of myocarditis. It is treated with 3-weeks´ therapy with cephalosporines of the 3rd generation administering intravenously [99]. Even in ICMP, this treatment…
Treatmenf of arrhythmias and thromboembolism
In the treatment of arrhythmias, there are not recommended any specific procedures yet. Their treatment with instrument techniques is problematic because arrhythmias may disappear themselves after the acute disease phase [43] and thus in references, …
Heart failure therapy
Heart failure therapy in myocarditis and ICMP should, according to references, follow the recommendations of cardiological societies. However, some studies proved the positive or negative impact of some medicaments on prognosis and inflammatory chang…
Regime measures
Strict physical and sports activity restriction is always indicated in patients with myocarditis [26, 43, 96, 98, 99, 100]. In both sportsmen and non-professional sportsmen, the minimal time of this restriction is six months provided that the heart f…
Treatment generally
Treatment of myocarditis and ICMP is relatively complicated what is caused by a number of factors. Further, it is still a subject for research.
From the point of view of causal therapy, an important obstacle is a vast number of different agents of…
Endomyocardial biopsy (EMB) and nuclear methods and cardiac catheterization
Endomyocardial biopsy
EMB is an invasive diagnostic method which is described in many references as a gold standard in the diagnosis of myocarditis and ICMP and which definitively confirms the diagnosis and has also an important role in the…
Laboratory examination
Laboratory examination consists of basic examinations and the detection of biomarkers of the myocardial damage, heart failure and inflammation. The testing of anti-myocardial autoantibodies is recommended by the European Society of Cardiology ([24], …
Cardiac magnetic resonance imaging (CMRI)
Cardiac magnetic resonance is in the present the leading non-invasive imaging method for patients with myocarditis [24, 97, 98, 99]. It is even described by some authors as one of the basic examinations and in stable patients, it is preferred to perf…
ECHO and Chest X-Ray
The echocardiographic examination has, similar to ECG, its role primarily in stratification and observation of patients´ state of health and it has a role even in the exclusion of other symptoms and cardiac dysfunction causes [24, 96, 98, 99, 100]. T…
ECG and Holter monitoring
ECG changes in patients with myocarditis are varied. In up to ¼ of patients, ECG findings are normal [97]. According to the references, ECG is important primarily for the exclusion of other pathological states which could explain the patients´ diffic…
Subjective symptoms and physical examination
Patients with myocarditis, alternatively with ICMP, have heterogenous inconveniences and symptoms. In up to 60 % of cases, the disease is most commonly preceded by a viral infection of the gastrointestinal or respiratory system. In children, previous…
Diagnosis generally
Diagnosis of myocarditis belongs to one of the most challenging in cardiology because of many reasons. One of them is, for example, an enormous variability of symptoms and manifestations of the disease including asymptomatic individuals, heart failur…
Chagas disease
Chagas disease is a parasitic disease caused by an infection with Trypanosoma cruzi. It is mostly found in the area of Central and South America [26]. According to WHO, 8 million people are infected worldwide, whereas 10 000 infected patients die yea…
Myocarditis connected with autoimmune diseases
Myocarditis in HIV positive patients
Cardiac impairment in HIV positive patients is a very frequent complication which is observed in 25 to 75 % of patients. In patients with AIDS, myocarditis was post-mortem identified in 40 to 52 % of cases [34]. Some resources warn about the increase…
Cardiac sarcoidosis
Sarcoidosis is a multiorgan granulomatous inflammatory disease whose prevalence in the Czech Republic is approximately 60 cases per 100 000 inhabitants [50]. It affects most frequently lungs and lymphatic nodes. Cardiac sarcoidosis manifests in about…
Giant-cell myocarditis
Giant-cell myocarditis (GCM) is a rare form of myocarditis mostly with a dramatic course and life-threatening complications.
GCM is characterized by the histopathological finding of giant multinuclear cells, infiltration with eosinophils and T lym…
Eosinophilic myocarditis
Eosinophilic myocarditis is a rare type of myocarditis usually caused by a hypersensitive or allergic reaction. Its prevalence in myocardial autopsy examinations was approximately 0,5 % [25]. It is more frequent in patients who are undergoing heart t…
Fulminant, acute and chronic myocarditis
Fulminant myocarditis
It is an uncommon form of myocarditis which is characterized by a fast progression of the disease. Usually in the term of just several days, often one or two, before the first manifestation of the disease, prodrome of …
Classification of myocarditis and ICMP
Classification of myocarditis and ICMP is not stabilized so far and develops with increasing knowledge about aetiology and pathogenesis of the disease. There are several classifications which may be combined.
It may be classified based on the aeti…
Histopathology
Macroscopic changes of the heart are observed in severe forms of myocarditis when the dilatation of the heart chambers and changes in the myocardial consistence may occur.
The histological finding may be very various. The most common one is lympho…
Pathogenesis
The knowledge about myocarditis and ICMP is still limited. It is determined by their varied aetiology and sometimes not quite cleared autoimmune processes which have been detected in myocarditis. Most of the information about the pathogenesis of thes…
Aetiology
Aetiology of myocarditis is highly varied (Tab. 1) and includes both infectious and non-infectious agents. The introduction of PCR and electron microscopy for the analysis of bioptically taken samples of the myocardium of patients with myocarditis ha…
Epidemiology
The determination of the epidemiology of myocarditis and ICMP is complicated as a result of a lot of factors including primarily challenging diagnosis lacking for now in a single test which would provide sufficient specificity and sensitivity for the…
Definition of myocarditis and inflammatory cardiomyopathy (ICMP)
Myocarditis is an inflammatory disease of the myocardium of the focal or diffuse characteristic caused primarily by a viral agent. It is a condition with a varied manifestation and course including asymptomatic cases, new-onset dilated cardiomyopathy…