Miokarditis

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