BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complicat...BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.展开更多
Eosinophilic myocarditis(EM)is a rare inflammatory condition of the heart,often associated with eosinophilic infiltration.While its causes range from allergies to autoimmune and infectious diseases,parasitic infection...Eosinophilic myocarditis(EM)is a rare inflammatory condition of the heart,often associated with eosinophilic infiltration.While its causes range from allergies to autoimmune and infectious diseases,parasitic infections are an uncommon but critical etiology.This mini-review focuses on a case of EM in a 47-year-old male from Vietnam,linked to Schistosoma spp.,Strongyloides stercoralis,and Toxocara spp.infections.The patient presented with severe chest pain and recovered fully after treatment with corticosteroids and albendazole.Drawing insights from this case and existing literature,we discuss the pathophysiology,diagnostic approaches,and therapeutic strategies for parasite-induced EM.Early diagnosis and tailored treatment are essential to improve clinical outcomes,especially in endemic para-sitic areas.展开更多
BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with cl...BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.展开更多
Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent ...Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent studies have increasingly highlighted the association between the gut microbiota and myocarditis.Here,we report a case of acute severe ulcerative colitis complicated by cytomegalovirus and Epstein-Barr virus co-infections that led to viral myocarditis.The patient experienced rapid remission of both intestinal and cardiac symptoms following washed microbiota transplantation,suggesting this intervention may serve as a potential alternative treatment for these life-threatening conditions.展开更多
BACKGROUND Esophageal cancer is a serious global health concern with poor prognosis in advanced stages.Immune checkpoint inhibitors(ICIs)have shown promise in enhancing survival,but they are associated with immune-rel...BACKGROUND Esophageal cancer is a serious global health concern with poor prognosis in advanced stages.Immune checkpoint inhibitors(ICIs)have shown promise in enhancing survival,but they are associated with immune-related adverse events,including potentially life-threatening myocarditis.Moreover,ICI-induced myocarditis can be asymptomatic,necessitating early diagnosis.Specific risk factors and biomarkers for esophageal cancer remain poorly characterized.AIM To investigate the determinants of ICI-associated asymptomatic myocarditis in patients with esophageal cancer and explore potential early biomarkers.METHODS A retrospective analysis was conducted on 202 cancer patients who received treatment at Shanxi Province Cancer Hospital from July 2019 to July 2024.RESULTS Older age,male gender,and elevated creatine kinase isoenzymes(CK-MB)and CK levels were found to be significant risk factors for asymptomatic myocarditis.The myocarditis occurrence group had higher CK-MB(3.05 ng/mL vs 5.02 ng/mL;P<0.001)and CK levels(187.29 U/L vs 212.25 U/L;P=0.005),and the predictive value of age,gender,CK,and CK-MB was low[are under the receiver operating characteristic curve(AUC)=0.579-0.608].However,their combination in a predictive model showed improved diagnostic capability,with an AUC of 0.808.CONCLUSION Age,gender,and cardiac biomarker levels considerably contribute to the risk of ICI-related myocarditis in patients with esophageal cancer.The integration of these factors into a predictive model enhances early diagnosis,facilitating personalized risk management.展开更多
BACKGROUND Autoimmune myocarditis(AM)associated with autoimmune diseases can cause complete atrioventricular block(CAVB),but the related autoantigens and the underlying mechanisms are unclear.Anti-SSA/Ro antibodies ma...BACKGROUND Autoimmune myocarditis(AM)associated with autoimmune diseases can cause complete atrioventricular block(CAVB),but the related autoantigens and the underlying mechanisms are unclear.Anti-SSA/Ro antibodies may play an important role in this process,but cases of AM with positive anti-SSA/Ro antibodies are rare.In addition,arrhythmias,such as atrioventricular block,are very common in patients with autoimmune diseases,but severe atrioventricular block requiring permanent pacemaker implantation is extremely rare.CASE SUMMARY The patient in this case had AM with anti-SSA/Ro antibody positivity,which was associated with connective tissue disease,and the patient subsequently developed CAVB.After intensive immunosuppressive therapy,the antibody test results became negative,and pulmonary hypertension significantly improved.However,the outcome of permanent pacemaker implantation did not change.CONCLUSION In clinical practice,the awareness of adult AM associated with autoimmune diseases combined with CAVB should be strengthened in clinicians,and anti-SSA/Ro antibodies may play a role in this process.Therefore,improving the detection of antibodies and early intervention,such as active immunosuppression therapy,may be very important for improving disease prognosis.For patients who do not respond to immunosuppressive therapy,implantation of a permanent pacemaker may become an essential treatment option.展开更多
BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemothe...BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.展开更多
Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional seve...Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.展开更多
This paper summarizes the nursing experience of a 65-year-old elderly patient with fulminant myocarditis complicated by cardiogenic shock who received veno-arterial extracorporeal membrane oxygenation(V-A ECMO)combine...This paper summarizes the nursing experience of a 65-year-old elderly patient with fulminant myocarditis complicated by cardiogenic shock who received veno-arterial extracorporeal membrane oxygenation(V-A ECMO)combined with intra-aortic balloon pump(IABP)support therapy.The core nursing measures included:establishing a multidisciplinary collaboration team to implement daily goal management;standardized anticoagulation monitoring;refined hemodynamic management;stepped respiratory support;and early rehabilitation intervention.After 9 days of ECMO support combined with 5 days of IABP support,the patient’s cardiac and respiratory functions recovered.The patient was discharged on the 42nd day and was fully recovered during the follow-up on the 60th day.This case suggests that refined nursing care for ECMO combined with IABP is the key to the treatment of fulminant myocarditis.展开更多
Background:Viral myocarditis(VMC)is an inflammatory myocardial disease induced by viral infections,and currently,there are no effective targeted treatments available.Cyclovirobuxine D(CVB-D),a major alkaloid extracted...Background:Viral myocarditis(VMC)is an inflammatory myocardial disease induced by viral infections,and currently,there are no effective targeted treatments available.Cyclovirobuxine D(CVB-D),a major alkaloid extracted from the traditional eastern medicinal plant Cephalotaxus,has been clinically used in the treatment of arrhythmias and coronary heart disease.However,its therapeutic effects and underlying mechanisms in VMC remain unclear.This study aims to investigate the cardioprotective effects of CVB-D in a murine model of viral myocarditis induced by Coxsackievirus B3(CVB3)and to elucidate the molecular mechanisms involved in its effects.Method:A murine model of VMC was established by infecting C57BL/6J mice with CVB3.The mice were randomly assigned to three groups:the sham-operated group,the model group,and the CVB-D treatment group.After 14 days of intervention,the general health status of the mice was evaluated.Histopathological changes in myocardial tissue and myocardial cell cross-sectional areas were examined using Hematoxylin and Eosin(H&E)staining.Cardiac function was assessed via echocardiography.Additionally,network pharmacology was employed to identify VMC-related targets and signaling pathways,which were further analyzed to hypothesize the potential therapeutic mechanisms of CVB-D in VMC.Result:CVB-D exerts significant protective effects against CVB3-induced VMC.The underlying mechanisms may be associated with mitochondrial energy metabolism,the electron transport chain,and oxidative phosphorylation processes.This study provides experimental evidence supporting the potential of CVB-D as a therapeutic agent for VMC.展开更多
Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]S...Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious process.Fever,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be present.In fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac output.Here,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of myocarditis.With the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.展开更多
Fulminant myocarditis(FM)is a severe inflammatory cardiac disease,typically triggered by viral pathogens or autoimmune disorders.[1,2]Early symptoms of the disease can be mild and nonspecific,but in certain cases,pati...Fulminant myocarditis(FM)is a severe inflammatory cardiac disease,typically triggered by viral pathogens or autoimmune disorders.[1,2]Early symptoms of the disease can be mild and nonspecific,but in certain cases,patients may experience sudden and severe heart failure,arrhythmias,refractory cardiogenic shock,or even death.展开更多
Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection often leads to pulmonary complications.Cardiovascular sequelae,including myocarditis and heart failure,have also been reported.Here,the study presen...Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection often leads to pulmonary complications.Cardiovascular sequelae,including myocarditis and heart failure,have also been reported.Here,the study presents two fulminant myocarditis cases infected by SARS-CoV-2 exhibiting remarkable elevation of cardiac biomarkers without significant pulmonary injury,as determined by imaging examinations.Immunohistochemical staining reveals the viral antigen within cardiomyocytes,indicating that SARSCoV-2 could directly infect the myocardium.The full viral genomes from respiratory,anal,and myocardial specimens are obtained via next-generation sequencing.Phylogenetic analyses of the whole genome and spike gene indicate that viruses in the myocardium/pericardial effusion and anal swabs are closely related and cluster together yet diverge from those in the respiratory samples.In addition,unique mutations are found in the anal/myocardial strains compared to the respiratory strains,suggesting tissue-specific virus mutation and adaptation.These findings indicate genetically distinct SARS-CoV-2 variants have infiltrated and disseminated within myocardial tissues,independent of pulmonary injury,and point to different infection routes between the myocardium and respiratory tract,with myocardial infections potentially arising from intestinal infection.These findings highlight the potential for systemic SARS-CoV-2 infection and the importance of a thorough multi-organ assessment in patients for a comprehensive understanding of thepathogenesisof COVID-19.展开更多
Objective:To explore the mechanism by which icariin alleviates viral myocarditis.Methods:CVB3-induced cardiomyocytes were used as an in vitro model of viral myocarditis to assess the effects of icariin treatment on ce...Objective:To explore the mechanism by which icariin alleviates viral myocarditis.Methods:CVB3-induced cardiomyocytes were used as an in vitro model of viral myocarditis to assess the effects of icariin treatment on cell viability,inflammation,and apoptosis.Moreover,the effects of icariin on ferroptosis and TLR4 signaling were assessed.After AC16 cells were transfected with TLR4 overexpression plasmids,the role of TLR4 in mediating the regulatory effect of icariin in viral myocarditis was investigated.Results:Icariin significantly elevated cell viability and reduced inflammatory factors TNF-α,IL-1β,IL-6,and IL-18.Flow cytometry revealed that icariin decreased apoptosis rate,and the protein expression of Bax and cleaved caspase 3 and 9 in CVB3-induced cardiomyocytes.Additionally,it suppressed ferroptosis including lipid peroxidation and ferrous ion,as well as the TLR4 signaling.However,TLR4 overexpression abrogated the modulatory effects of icariin.Conclusions:Icariin mitigates CVB3-induced myocardial injury by inhibiting TLR4-mediated ferroptosis.Further animal study is needed to verify its efficacy.展开更多
Coronavirus is an important pathogen causing disease in humans and animals.At the end of 2019,an investigation into an increase in pneumonia cases in Wuhan,Hubei Province,China,found that the cause was a new coronavir...Coronavirus is an important pathogen causing disease in humans and animals.At the end of 2019,an investigation into an increase in pneumonia cases in Wuhan,Hubei Province,China,found that the cause was a new coronavirus.This disease,which spread rapidly across China and caused an outbreak worldwide,resulted in a pandemic.Although this virus has previously been referred to as 2019-nCoV,which causes coronavirus disease 2019(COVID-19),later it was named severe acute respiratory syndrome coronavirus 2.Children were usually asymptomatic and rarely severely affected.In April 2020,reports from the United Kingdom indicated that children may have Kawasaki disease or a clinical condition similar to toxic shock syndrome.This clinical picture was later defined as multisystem inflammatory syndrome in children.Since then,similarly affected children as well as cases with other cardiac complications have been reported in other parts of the world.In this review,we aimed to evaluate COVID-19 in terms of cardiac involvement by reviewing the literature.展开更多
Background Adult Fulminant myocarditis(FM)is the more serious form of acute myocarditis,and extracorporeal membrane oxygenation(ECMO)is an effective adjunction that helps to maintain circulation while providing adequa...Background Adult Fulminant myocarditis(FM)is the more serious form of acute myocarditis,and extracorporeal membrane oxygenation(ECMO)is an effective adjunction that helps to maintain circulation while providing adequate treatment.The blood supply of vital organs is guaranteed,which helps patients to survive the acute attack and improves the survival rate of FM.Methods In this study,50 clinical data of adult FM patients received in our hospital from July 2018 to July 2023 were collected for retrospective analysis.According to different treatment methods,they were divided into ECMO group(n=25)and non-ECMO group(n=25).After 14 days of treatment,the level of left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),creatine kinase isoenzymes(CK-MB),cardiac troponinⅠ(cTnⅠ)and brain natriuretic peptide(BNP),and the incidence of complications were compared between the two groups.Results Before treatment,there was no significant difference in cardiac function between the two groups(P>0.05).After 14 days of treatment,ECMO group showed greater decline than non-ECMO group in LVESD and LVEDD,and LVEF was higher than that in the non-ECMO group(P<0.05).The level of CK-MB,cTnⅠ and BNP in ECMO group were lower than those in non-ECMO(P<0.05).The overall incidence of complications was 8% in the ECMO group,which was lower than 32% in the non-ECMO group(P<0.05).Conclusions The early efficacy of ECMO treatment in adult patients with FM is considerable,which is conducive to improving the cardiac function of patients and preventing complications.展开更多
Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. I...Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. In recent years, the incidence of acute myocarditis has gradually increased, especially in young people and athletes, which can cause serious cardiac complications and even lead to heart failure, cardiac arrest or major adverse cardiovascular events(MACEs). Methods A total of 90 patients with acute myocarditis(acute myocarditis group) and 30 healthy subjects(control group) admitted to our hospital from November 2021 to November 2023 were selected. Cardiac magnetic resonance(CMR) T1 and T2 mapping sequence scanning and cardiac function parameter measurement was performed on all subjects. The acute myocarditis group was followed up for 12 months and divided into the MACEs group and the non-MACEs group according to whether MACEs occurred. The differences in CMR parameters were analyzed, and receiver operating characteristic(ROC) curve was applied to analyze the predictive value of cardiac CMR T1 and T2 techniques for the occurrence of MACEs in patients with acute myocarditis. Results Compared with the control group, the level of left ventricular ejection fraction(LVEF) in the acute myocarditis group was significantly decreased, while left ventricular end-diastole volume(LVEDV), left ventricular endsystolic volume(LVESV), lactate dehydrogenase(LDH) and creatine kinase MB isoenzyme(CK-MB) increased significantly(P<0.05);T1 and T2 values, late gadolinium enhancement(LGE) percentage of left ventricle, left ventricular entropy and extracellular volume(ECV) in acute myocarditis group were significantly higher than those in the control group(P<0.05). Pearson correlation analysis showed that T1 and T2 values were negatively correlated with LVEF, while T1 and T2 values were positively correlated with LVESV, CK-MB, left ventricular entropy and ECV in patients with acute myocarditis(P<0.05). Among patients with acute myocarditis, the values of T1 and T2, left ventricular entropy and ECV in MACEs group were higher than those in non-MACEs group(P<0.05). Further multivariate analysis also showed that T1 and T2 values had independent predictive capacity for MACEs in patients with acute myocarditis(P<0.05). The maximum area under ROC curve was 0.894 and 0.912, and the sensitivity was 89.35% and 90.40% in patients with acute myocarditis predicted by T1 and T2 mapping. The specificity was 80.34% and 84.25%. Conclusions CMR T1 and T2 mapping techniques can effectively evaluate the cardiac function status of patients with acute myocarditis, and provide an important reference for the prognosis assessment of acute myocarditis.展开更多
Myocarditis is a serious cardiovascular ailment that can lead to severe consequences if not promptly treated.It is triggered by viral infections and presents symptoms such as chest pain and heart dysfunction.Early det...Myocarditis is a serious cardiovascular ailment that can lead to severe consequences if not promptly treated.It is triggered by viral infections and presents symptoms such as chest pain and heart dysfunction.Early detection is crucial for successful treatment,and cardiac magnetic resonance imaging(CMR)is a valuable tool for identifying this condition.However,the detection of myocarditis using CMR images can be challenging due to low contrast,variable noise,and the presence of multiple high CMR slices per patient.To overcome these challenges,the approach proposed incorporates advanced techniques such as convolutional neural networks(CNNs),an improved differential evolution(DE)algorithm for pre-training,and a reinforcement learning(RL)-based model for training.Developing this method presented a significant challenge due to the imbalanced classification of the Z-Alizadeh Sani myocarditis dataset from Omid Hospital in Tehran.To address this,the training process is framed as a sequential decision-making process,where the agent receives higher rewards/penalties for correctly/incorrectly classifying the minority/majority class.Additionally,the authors suggest an enhanced DE algorithm to initiate the backpropagation(BP)process,overcoming the initialisation sensitivity issue of gradient-based methods like back-propagation during the training phase.The effectiveness of the proposed model in diagnosing myocarditis is demonstrated through experimental results based on standard performance metrics.Overall,this method shows promise in expediting the triage of CMR images for automatic screening,facilitating early detection and successful treatment of myocarditis.展开更多
Paediatric cardiac disease is an established cause of ischemic stroke in the neonatal and infantile groups. These diseases may be congenital or acquired. However, clinical myocarditis is in itself, relatively uncommon...Paediatric cardiac disease is an established cause of ischemic stroke in the neonatal and infantile groups. These diseases may be congenital or acquired. However, clinical myocarditis is in itself, relatively uncommon in older children. The most common pathogen is Coxsackie virus B. The offending agent instigates an immune response, which causes myocardial oedema with eventual systolic and diastolic dysfunction. Cardioembolic stroke can occur secondary to an intra-mural thrombus in a dysfunctional atrium or ventricle. We describe the case of an adolescent male with acute myocarditis complicated by a thromboembolic stroke. After initial management of acute pulmonary oedema and heart failure with restricted ejection fraction (HFrEF), the child developed seizure-like symptoms on the 10th day of hospitalization, prompting urgent neuro-radio diagnosis, which revealed acute infarcts in the cerebellum and frontal lobe of the cerebrum. We believe this case to be of clinical relevance because;1) The diagnosis of an acute stroke in children is often delayed due to the atypical clinical presentation and often the absence of traditional stroke-like symptoms, and 2) There is a lack of sufficient high-quality evidence regarding the predictors and the immediate management of stroke in paediatric heart disease, as well as inadequate data on prevalence and incidence in paediatric cardioembolic strokes.展开更多
Background:Fulminant myocarditis(FM)is associated with high mortality and an unfavorable long-term prognosis.However,noninvasive,rapid diagnostic and monitoring methods for FM are lacking.Case summary:This report deta...Background:Fulminant myocarditis(FM)is associated with high mortality and an unfavorable long-term prognosis.However,noninvasive,rapid diagnostic and monitoring methods for FM are lacking.Case summary:This report details the case of a patient diagnosed with FM through a comprehensive assessment involving typical clinical symptoms,laboratory analyses,echocardiographic evidence,and cardiac magnetic resonance(CMR)findings.Before the patient underwent CMR,optical pumped magnetometer magnetocardiography(OPM-MCG)revealed abnormalities characteristic of substantial myocardial injury.After invasive coronary angiography,the patient’s coronary arteries were determined not to exhibit significant stenosis.Additionally,a myocardial bridge was observed in the middle segment of the anterior descending branch of the left coronary artery.Over a 7-month follow-up,the patient’s symptoms showed marked improvement,and the OPM-MCG eventually normalized,aligning with the findings indicated by the CMR.Conclusion:OPM-MCG is a valuable tool for therapy monitoring in FMs,offering a safe,non-invasive,and highly effective test for ancillary diagnostics and long-term prognostic follow-up.Additionally,MCG may potentially assist in clinical decision-making regarding the need for further interventions in patients with myocardial bridge.展开更多
文摘BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.
文摘Eosinophilic myocarditis(EM)is a rare inflammatory condition of the heart,often associated with eosinophilic infiltration.While its causes range from allergies to autoimmune and infectious diseases,parasitic infections are an uncommon but critical etiology.This mini-review focuses on a case of EM in a 47-year-old male from Vietnam,linked to Schistosoma spp.,Strongyloides stercoralis,and Toxocara spp.infections.The patient presented with severe chest pain and recovered fully after treatment with corticosteroids and albendazole.Drawing insights from this case and existing literature,we discuss the pathophysiology,diagnostic approaches,and therapeutic strategies for parasite-induced EM.Early diagnosis and tailored treatment are essential to improve clinical outcomes,especially in endemic para-sitic areas.
文摘BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.
文摘Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent studies have increasingly highlighted the association between the gut microbiota and myocarditis.Here,we report a case of acute severe ulcerative colitis complicated by cytomegalovirus and Epstein-Barr virus co-infections that led to viral myocarditis.The patient experienced rapid remission of both intestinal and cardiac symptoms following washed microbiota transplantation,suggesting this intervention may serve as a potential alternative treatment for these life-threatening conditions.
文摘BACKGROUND Esophageal cancer is a serious global health concern with poor prognosis in advanced stages.Immune checkpoint inhibitors(ICIs)have shown promise in enhancing survival,but they are associated with immune-related adverse events,including potentially life-threatening myocarditis.Moreover,ICI-induced myocarditis can be asymptomatic,necessitating early diagnosis.Specific risk factors and biomarkers for esophageal cancer remain poorly characterized.AIM To investigate the determinants of ICI-associated asymptomatic myocarditis in patients with esophageal cancer and explore potential early biomarkers.METHODS A retrospective analysis was conducted on 202 cancer patients who received treatment at Shanxi Province Cancer Hospital from July 2019 to July 2024.RESULTS Older age,male gender,and elevated creatine kinase isoenzymes(CK-MB)and CK levels were found to be significant risk factors for asymptomatic myocarditis.The myocarditis occurrence group had higher CK-MB(3.05 ng/mL vs 5.02 ng/mL;P<0.001)and CK levels(187.29 U/L vs 212.25 U/L;P=0.005),and the predictive value of age,gender,CK,and CK-MB was low[are under the receiver operating characteristic curve(AUC)=0.579-0.608].However,their combination in a predictive model showed improved diagnostic capability,with an AUC of 0.808.CONCLUSION Age,gender,and cardiac biomarker levels considerably contribute to the risk of ICI-related myocarditis in patients with esophageal cancer.The integration of these factors into a predictive model enhances early diagnosis,facilitating personalized risk management.
文摘BACKGROUND Autoimmune myocarditis(AM)associated with autoimmune diseases can cause complete atrioventricular block(CAVB),but the related autoantigens and the underlying mechanisms are unclear.Anti-SSA/Ro antibodies may play an important role in this process,but cases of AM with positive anti-SSA/Ro antibodies are rare.In addition,arrhythmias,such as atrioventricular block,are very common in patients with autoimmune diseases,but severe atrioventricular block requiring permanent pacemaker implantation is extremely rare.CASE SUMMARY The patient in this case had AM with anti-SSA/Ro antibody positivity,which was associated with connective tissue disease,and the patient subsequently developed CAVB.After intensive immunosuppressive therapy,the antibody test results became negative,and pulmonary hypertension significantly improved.However,the outcome of permanent pacemaker implantation did not change.CONCLUSION In clinical practice,the awareness of adult AM associated with autoimmune diseases combined with CAVB should be strengthened in clinicians,and anti-SSA/Ro antibodies may play a role in this process.Therefore,improving the detection of antibodies and early intervention,such as active immunosuppression therapy,may be very important for improving disease prognosis.For patients who do not respond to immunosuppressive therapy,implantation of a permanent pacemaker may become an essential treatment option.
文摘BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.
文摘Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.
文摘This paper summarizes the nursing experience of a 65-year-old elderly patient with fulminant myocarditis complicated by cardiogenic shock who received veno-arterial extracorporeal membrane oxygenation(V-A ECMO)combined with intra-aortic balloon pump(IABP)support therapy.The core nursing measures included:establishing a multidisciplinary collaboration team to implement daily goal management;standardized anticoagulation monitoring;refined hemodynamic management;stepped respiratory support;and early rehabilitation intervention.After 9 days of ECMO support combined with 5 days of IABP support,the patient’s cardiac and respiratory functions recovered.The patient was discharged on the 42nd day and was fully recovered during the follow-up on the 60th day.This case suggests that refined nursing care for ECMO combined with IABP is the key to the treatment of fulminant myocarditis.
基金supported by Zhejiang Provincial College Students’Science and Technology Innovation Program and Xinmiao Talent Plan(No:2024R413C093)。
文摘Background:Viral myocarditis(VMC)is an inflammatory myocardial disease induced by viral infections,and currently,there are no effective targeted treatments available.Cyclovirobuxine D(CVB-D),a major alkaloid extracted from the traditional eastern medicinal plant Cephalotaxus,has been clinically used in the treatment of arrhythmias and coronary heart disease.However,its therapeutic effects and underlying mechanisms in VMC remain unclear.This study aims to investigate the cardioprotective effects of CVB-D in a murine model of viral myocarditis induced by Coxsackievirus B3(CVB3)and to elucidate the molecular mechanisms involved in its effects.Method:A murine model of VMC was established by infecting C57BL/6J mice with CVB3.The mice were randomly assigned to three groups:the sham-operated group,the model group,and the CVB-D treatment group.After 14 days of intervention,the general health status of the mice was evaluated.Histopathological changes in myocardial tissue and myocardial cell cross-sectional areas were examined using Hematoxylin and Eosin(H&E)staining.Cardiac function was assessed via echocardiography.Additionally,network pharmacology was employed to identify VMC-related targets and signaling pathways,which were further analyzed to hypothesize the potential therapeutic mechanisms of CVB-D in VMC.Result:CVB-D exerts significant protective effects against CVB3-induced VMC.The underlying mechanisms may be associated with mitochondrial energy metabolism,the electron transport chain,and oxidative phosphorylation processes.This study provides experimental evidence supporting the potential of CVB-D as a therapeutic agent for VMC.
文摘Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious process.Fever,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be present.In fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac output.Here,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of myocarditis.With the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.
基金funded by CAMS Innovation Fund for Medical Sciences(CIFMS)(NO.2020-I2M-C&T-B-054).
文摘Fulminant myocarditis(FM)is a severe inflammatory cardiac disease,typically triggered by viral pathogens or autoimmune disorders.[1,2]Early symptoms of the disease can be mild and nonspecific,but in certain cases,patients may experience sudden and severe heart failure,arrhythmias,refractory cardiogenic shock,or even death.
基金supported by the National Key R&D Program of China(2023YFC2307500 and 2021YFC2701700)National Natural Science Foundation of China(82341115)+5 种基金Beijing Research Center for Respiratory Infectious Diseases(BJRID2024-003)Major Project of Guangzhou National Laboratory(GZNL2023A01001 and SRPG22-001)the National Science and Technology Infrastructure of China(National Pathogen Resource Center-NPRC-32)Y.B.is supported by the Youth Innovation Promotion Association of CAs(Y2021034)CAS Project for Young Scientists in Basic Research(YSBR-086)the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine(ZYYCXTD-D-202208).
文摘Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection often leads to pulmonary complications.Cardiovascular sequelae,including myocarditis and heart failure,have also been reported.Here,the study presents two fulminant myocarditis cases infected by SARS-CoV-2 exhibiting remarkable elevation of cardiac biomarkers without significant pulmonary injury,as determined by imaging examinations.Immunohistochemical staining reveals the viral antigen within cardiomyocytes,indicating that SARSCoV-2 could directly infect the myocardium.The full viral genomes from respiratory,anal,and myocardial specimens are obtained via next-generation sequencing.Phylogenetic analyses of the whole genome and spike gene indicate that viruses in the myocardium/pericardial effusion and anal swabs are closely related and cluster together yet diverge from those in the respiratory samples.In addition,unique mutations are found in the anal/myocardial strains compared to the respiratory strains,suggesting tissue-specific virus mutation and adaptation.These findings indicate genetically distinct SARS-CoV-2 variants have infiltrated and disseminated within myocardial tissues,independent of pulmonary injury,and point to different infection routes between the myocardium and respiratory tract,with myocardial infections potentially arising from intestinal infection.These findings highlight the potential for systemic SARS-CoV-2 infection and the importance of a thorough multi-organ assessment in patients for a comprehensive understanding of thepathogenesisof COVID-19.
基金supported by Affiliated Hospital of Youjiang Medical University for Nationalities(No.Y20212615).
文摘Objective:To explore the mechanism by which icariin alleviates viral myocarditis.Methods:CVB3-induced cardiomyocytes were used as an in vitro model of viral myocarditis to assess the effects of icariin treatment on cell viability,inflammation,and apoptosis.Moreover,the effects of icariin on ferroptosis and TLR4 signaling were assessed.After AC16 cells were transfected with TLR4 overexpression plasmids,the role of TLR4 in mediating the regulatory effect of icariin in viral myocarditis was investigated.Results:Icariin significantly elevated cell viability and reduced inflammatory factors TNF-α,IL-1β,IL-6,and IL-18.Flow cytometry revealed that icariin decreased apoptosis rate,and the protein expression of Bax and cleaved caspase 3 and 9 in CVB3-induced cardiomyocytes.Additionally,it suppressed ferroptosis including lipid peroxidation and ferrous ion,as well as the TLR4 signaling.However,TLR4 overexpression abrogated the modulatory effects of icariin.Conclusions:Icariin mitigates CVB3-induced myocardial injury by inhibiting TLR4-mediated ferroptosis.Further animal study is needed to verify its efficacy.
文摘Coronavirus is an important pathogen causing disease in humans and animals.At the end of 2019,an investigation into an increase in pneumonia cases in Wuhan,Hubei Province,China,found that the cause was a new coronavirus.This disease,which spread rapidly across China and caused an outbreak worldwide,resulted in a pandemic.Although this virus has previously been referred to as 2019-nCoV,which causes coronavirus disease 2019(COVID-19),later it was named severe acute respiratory syndrome coronavirus 2.Children were usually asymptomatic and rarely severely affected.In April 2020,reports from the United Kingdom indicated that children may have Kawasaki disease or a clinical condition similar to toxic shock syndrome.This clinical picture was later defined as multisystem inflammatory syndrome in children.Since then,similarly affected children as well as cases with other cardiac complications have been reported in other parts of the world.In this review,we aimed to evaluate COVID-19 in terms of cardiac involvement by reviewing the literature.
基金supported by the Natural Science Foundation of Hunan Province,China(No.2021JJ40505/No.2021JJ30619/No.2020JJ8002)the Scientific Research Project of Hunan Provincial Health Commission(No.202210004450)。
文摘Background Adult Fulminant myocarditis(FM)is the more serious form of acute myocarditis,and extracorporeal membrane oxygenation(ECMO)is an effective adjunction that helps to maintain circulation while providing adequate treatment.The blood supply of vital organs is guaranteed,which helps patients to survive the acute attack and improves the survival rate of FM.Methods In this study,50 clinical data of adult FM patients received in our hospital from July 2018 to July 2023 were collected for retrospective analysis.According to different treatment methods,they were divided into ECMO group(n=25)and non-ECMO group(n=25).After 14 days of treatment,the level of left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),creatine kinase isoenzymes(CK-MB),cardiac troponinⅠ(cTnⅠ)and brain natriuretic peptide(BNP),and the incidence of complications were compared between the two groups.Results Before treatment,there was no significant difference in cardiac function between the two groups(P>0.05).After 14 days of treatment,ECMO group showed greater decline than non-ECMO group in LVESD and LVEDD,and LVEF was higher than that in the non-ECMO group(P<0.05).The level of CK-MB,cTnⅠ and BNP in ECMO group were lower than those in non-ECMO(P<0.05).The overall incidence of complications was 8% in the ECMO group,which was lower than 32% in the non-ECMO group(P<0.05).Conclusions The early efficacy of ECMO treatment in adult patients with FM is considerable,which is conducive to improving the cardiac function of patients and preventing complications.
文摘Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. In recent years, the incidence of acute myocarditis has gradually increased, especially in young people and athletes, which can cause serious cardiac complications and even lead to heart failure, cardiac arrest or major adverse cardiovascular events(MACEs). Methods A total of 90 patients with acute myocarditis(acute myocarditis group) and 30 healthy subjects(control group) admitted to our hospital from November 2021 to November 2023 were selected. Cardiac magnetic resonance(CMR) T1 and T2 mapping sequence scanning and cardiac function parameter measurement was performed on all subjects. The acute myocarditis group was followed up for 12 months and divided into the MACEs group and the non-MACEs group according to whether MACEs occurred. The differences in CMR parameters were analyzed, and receiver operating characteristic(ROC) curve was applied to analyze the predictive value of cardiac CMR T1 and T2 techniques for the occurrence of MACEs in patients with acute myocarditis. Results Compared with the control group, the level of left ventricular ejection fraction(LVEF) in the acute myocarditis group was significantly decreased, while left ventricular end-diastole volume(LVEDV), left ventricular endsystolic volume(LVESV), lactate dehydrogenase(LDH) and creatine kinase MB isoenzyme(CK-MB) increased significantly(P<0.05);T1 and T2 values, late gadolinium enhancement(LGE) percentage of left ventricle, left ventricular entropy and extracellular volume(ECV) in acute myocarditis group were significantly higher than those in the control group(P<0.05). Pearson correlation analysis showed that T1 and T2 values were negatively correlated with LVEF, while T1 and T2 values were positively correlated with LVESV, CK-MB, left ventricular entropy and ECV in patients with acute myocarditis(P<0.05). Among patients with acute myocarditis, the values of T1 and T2, left ventricular entropy and ECV in MACEs group were higher than those in non-MACEs group(P<0.05). Further multivariate analysis also showed that T1 and T2 values had independent predictive capacity for MACEs in patients with acute myocarditis(P<0.05). The maximum area under ROC curve was 0.894 and 0.912, and the sensitivity was 89.35% and 90.40% in patients with acute myocarditis predicted by T1 and T2 mapping. The specificity was 80.34% and 84.25%. Conclusions CMR T1 and T2 mapping techniques can effectively evaluate the cardiac function status of patients with acute myocarditis, and provide an important reference for the prognosis assessment of acute myocarditis.
文摘Myocarditis is a serious cardiovascular ailment that can lead to severe consequences if not promptly treated.It is triggered by viral infections and presents symptoms such as chest pain and heart dysfunction.Early detection is crucial for successful treatment,and cardiac magnetic resonance imaging(CMR)is a valuable tool for identifying this condition.However,the detection of myocarditis using CMR images can be challenging due to low contrast,variable noise,and the presence of multiple high CMR slices per patient.To overcome these challenges,the approach proposed incorporates advanced techniques such as convolutional neural networks(CNNs),an improved differential evolution(DE)algorithm for pre-training,and a reinforcement learning(RL)-based model for training.Developing this method presented a significant challenge due to the imbalanced classification of the Z-Alizadeh Sani myocarditis dataset from Omid Hospital in Tehran.To address this,the training process is framed as a sequential decision-making process,where the agent receives higher rewards/penalties for correctly/incorrectly classifying the minority/majority class.Additionally,the authors suggest an enhanced DE algorithm to initiate the backpropagation(BP)process,overcoming the initialisation sensitivity issue of gradient-based methods like back-propagation during the training phase.The effectiveness of the proposed model in diagnosing myocarditis is demonstrated through experimental results based on standard performance metrics.Overall,this method shows promise in expediting the triage of CMR images for automatic screening,facilitating early detection and successful treatment of myocarditis.
文摘Paediatric cardiac disease is an established cause of ischemic stroke in the neonatal and infantile groups. These diseases may be congenital or acquired. However, clinical myocarditis is in itself, relatively uncommon in older children. The most common pathogen is Coxsackie virus B. The offending agent instigates an immune response, which causes myocardial oedema with eventual systolic and diastolic dysfunction. Cardioembolic stroke can occur secondary to an intra-mural thrombus in a dysfunctional atrium or ventricle. We describe the case of an adolescent male with acute myocarditis complicated by a thromboembolic stroke. After initial management of acute pulmonary oedema and heart failure with restricted ejection fraction (HFrEF), the child developed seizure-like symptoms on the 10th day of hospitalization, prompting urgent neuro-radio diagnosis, which revealed acute infarcts in the cerebellum and frontal lobe of the cerebrum. We believe this case to be of clinical relevance because;1) The diagnosis of an acute stroke in children is often delayed due to the atypical clinical presentation and often the absence of traditional stroke-like symptoms, and 2) There is a lack of sufficient high-quality evidence regarding the predictors and the immediate management of stroke in paediatric heart disease, as well as inadequate data on prevalence and incidence in paediatric cardioembolic strokes.
基金supported by Sponsored by Beijing Nova Program(20220484222)‘Deng Feng’Training Program(DFL20220603)Project of The Beijing Lab for Cardiovascular Precision Medicine(PXM2018_014226_000013).
文摘Background:Fulminant myocarditis(FM)is associated with high mortality and an unfavorable long-term prognosis.However,noninvasive,rapid diagnostic and monitoring methods for FM are lacking.Case summary:This report details the case of a patient diagnosed with FM through a comprehensive assessment involving typical clinical symptoms,laboratory analyses,echocardiographic evidence,and cardiac magnetic resonance(CMR)findings.Before the patient underwent CMR,optical pumped magnetometer magnetocardiography(OPM-MCG)revealed abnormalities characteristic of substantial myocardial injury.After invasive coronary angiography,the patient’s coronary arteries were determined not to exhibit significant stenosis.Additionally,a myocardial bridge was observed in the middle segment of the anterior descending branch of the left coronary artery.Over a 7-month follow-up,the patient’s symptoms showed marked improvement,and the OPM-MCG eventually normalized,aligning with the findings indicated by the CMR.Conclusion:OPM-MCG is a valuable tool for therapy monitoring in FMs,offering a safe,non-invasive,and highly effective test for ancillary diagnostics and long-term prognostic follow-up.Additionally,MCG may potentially assist in clinical decision-making regarding the need for further interventions in patients with myocardial bridge.
