Myocarditis

Case report:

A 52 year old patient came to the practice and complained of mild cough, malaise, weakness and Herzpalpitationen; Moreover, she had vomited spontaneously twice in the last three days. Questions about chest pain, shortness of breath, or night sweats are negated. Past medical history is important that the patient was 22 days previously vaccinated as part of their professional activities as a nurse against smallpox.

Diagnosis:

On physical examination immediately falls on a tachycardia at 120 beats per minute with arrhythmia and low peripheral pulse deficit. Increased body temperature is not, the blood pressure 130/85 mmHg is that further examination findings are unremarkable. In ECG atrial fibrillation and nonspecific changes of the ST segment and the T wave were registered. Routine blood tests including TSH were normal as the CK and troponin concentrations; However, CK-MB concentration was increased moderately in three-time determination. Before subsequent echocardiographic examination, there is a spontaneous conversion to sinus rhythm; the ejection fraction is determined with 60% in the echocardiographic examination, the heart valves are normal and abnormal wall motion abnormalities are not seen.

Pathogenesis:

Enteroviruses, such as Coxsackie viruses and Echo viruses are the predominant causative agents of idiopathic myocarditis. However, bacterial pathogens such as streptococcus, mycobacteria but also Gram-negative pathogens must be considered, the latter, however, are dominant in the pericarditis. Experimental data suggest that myocardial damage is primarily immunologically mediated by monoclonal antibodies against specific viral or bacterial proteins that react with the human cardiac myosin. A similar mechanism is also discussed in the very rare myocarditis after smallpox vaccination. This myocarditis is in the United States in a frequency of 1: 1,700 vaccinees observed at the time.

Therapy:

A causal therapy does not exist. Up to stabilize physical protection should be respected. Are not recommended corticosteroids, beta-blockers, anticoagulants, anti-inflammatory non-steroidal substances or antibiotics. Symptomatic therapy with digitalis glycosides, diuretics and anti-arrhythmic drugs in appropriate clinical findings should be done.