Transcript
REFERATMIOKARDITIS
Ferdy Ferdian, drErwinanto, dr., SpJP.
Definisi
• Myocarditis is defined as inflammation of the heart muscle.
• Inflammation of the heart muscle as a result of exposure to either discrete external antigens (such as viruses, bacteria, parasites, toxins, or drugs) or internal triggers, such as autoimmune activation against self antigens
Liu P., et al. 2012
Etiologi
Schultheiss HP., et al. 2011. The management of myocarditis
Patofisiologi
Liu P., et al. 2012
Patofisiologi
Gejala klinis
Cooper LT, et al. 2013
AsimptomatikNyeri dada
PalpitasiCepat lelah
Sesak napasOrtopneu
Bengkak tungkaiSyok
Sudden death
Pemeriksaan fisik• Tanpa kelainan• Unstable hemodinamik• Aritmia (Extrabeat, AF)• JVP meningkat• Kardiomegali• S3 / S4• Murmur • Rhonki basah halus• Edema tungkai
Penunjang…
ElektrokardiogramNormal, abnormal, nonspesifik
Enzim jantungPeningkatan enzim jantung dapat ditemukan
Rontgen dadaNormal, Kardiomegali, Edema paruEfusi pleura
EchocardiografiDisfungsi ventrikel dll
MRIMRI dengan gandolinium
SkintigrafiAntimiosin skintigrafi
Endomyocardial biopsyGold standart
Cooper LT, et al. 2013
Diagnosis..
• Dallas criteria– myocarditis active require the presence of
inflammatory cells simultaneous with evidence of myocyte necrosis on the same microscopic section on examination of a myocardial biopsy
– Borderline myocarditis is characterized by inflammatory cell infiltrate without myocardial necrosis
Liu P., et al. 2012
Diagnosis..
Category I: Clinical Symptoms • Clinical heart failure
– Fever– Viral prodrome– Fatigue– Dyspnea on exertion– Chest pain– Palpitations– Presyncope or syncope
Liu P., et al. 2012
Diagnosis..
Category II Evidence of Cardiac Structural or Functional Perturbation in the absence of Regional Coronary Ischemia • Echocardiography
– Regional wall motion abnormalities– Cardiac dilation– Regional cardiac hypertrophy
• Troponine – High sensitivity (>0.1 ng/mL)
• Positive indium In 111 antimyosin scintigraphy and Normal coronary angiography or Absence of reversible ischemia by coronary distribution on perfusion scan
Liu P., et al. 2012
Diagnosis..
Category III: Cardiac Magnetic Resonance Imaging – Increased myocardial T2 signal on inversion recovery
sequence– Delayed contrast enhancement after gadolinium-DTPA
infusion
Liu P., et al. 2012
Diagnosis..
Category IV: Myocardial biopsy (Pathologic or Molecular Analysis) – Pathology findings compatible with Dallas criteria– Presence of viral genome by polymerase chain reaction or
in situ hybridization
Liu P., et al. 2012
Diagnosis..
• Any matching feature in category = positive for category • Suggestive of myocarditis
– 2 positive categories
• Compatible with myocarditis– 3 positive categories
• High probability of being myocarditis– all 4 categories positive
Liu P., et al. 2012
Tatalaksana
Liu P., et al. 2012
Sekian
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