• MYOCARDITIS: inflammation of the heart muscle; most common in young adults
  • Patho: myocellular damage leads to myocardial necrosis and dysfunction, ultimately leading to heart failure; typically infectious (viral most common, especially Coxsackie) but can also be bacterial; Auto-immune is a possibility as well
  • Clinical Manifestations: viral prodrome of fever, myalgias, malaise for several days followed by symptoms of systolic dysfunction (i.e. dilated cardiomyopathy); Also have heart failure symptoms (dyspnea, fatigue, exercise intolerance, S3 gallop)
  • Diagnostic Studies: cardiomegaly on chest x-ray, EKG= non-specific (may show sinus tach, normal); Echocardiogram= ventricular systolic dysfunction; Endomyocardial biopsy= gold standard (usually reserved for severe/refractory cases)
  • Management: supportive= mainstay of treatment (standard systolic heart failure treatment= ACE inhibitors, diuretics, beta blockers)

 

 

• PERICARDITIS: inflammation of the pericardial sac surrounding the heart 

 

• • Patho: acute inflammatory response producing either serous or purulent fluid; most commonly idiopathic or viral (Coxsackie)
  • Clinical Manifestations: pleuritic chest pain that is sharp and worse with inspiration, radiating to the back that is worse when lying back, and improved when leaning forward;The pain can radiate to the shoulder, back, neck, arm or even epigastric area;  tachycardia and pericardial friction rub (scratchy/squeaky sound over left sternal border)  are seen on physical exam
  • Diagnostic Studies: EKG shows diffuse ST elevations in V1-V6 with associated PR depression, and the opposite in aVR: PR elevations, ST depressions; Echo= could be useful to see if there is evidence of pericardial effusion or signs of cardiac tamponade but often time its normal in pericarditis patient
  • Management: NSAIDs, Colchicine + restrict from strenuous activity 

 

• • **OCCURRENCE IN COVID-19: 

 

• https://jamanetwork.com/journals/jamacardiology/fullarticle/2763843

 

• • • Case Report to determine what are the cardiac complications associated with COVID-19
    • 53 year old female who developed acute myopericarditis with systolic dysfunction a week after onset of fever + dry cough due to COVID

 

• https://www-uptodate-com.york.ezproxy.cuny.edu/contents/coronavirus-disease-2019-covid-19-critical-care-issues?search=pericarditis%20covid&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

 

• • • Pericarditis listed as one of the commonly seen complications of COVID-19 (along with AKI, elevated liver enzymes, and other cardiac injury)

 

• https://www-uptodate-com.york.ezproxy.cuny.edu/contents/coronavirus-disease-2019-covid-19-myocardial-injury?search=pericarditis%20covid&topicRef=127419&source=see_link

 

• • “Although some COVID-19 case reports have described findings consistent with a diagnosis of “clinically suspected myocarditis” [3] or possible stress cardiomyopathy [6-11], no case of biopsy- or autopsy-proven viral myocarditis caused by SARS-CoV-2 has been reported thus far”
  • Further investigation is needed to accurately describe this correlation between COVID-19 & myocardial injury (ex: autopsy to see if COVID in fact was a new cause of a patient’s viral myocarditis)

 

• BNP: brain natriuretic peptide; initially identified in the brain (hence name) but in actuality it’s released primarily from the heart, specifically the ventricles. Pro-BNP: the prohormone that is increased in heart failure in response to higher ventricular filling pressures. Plasma concentration of pro-BNP is increased in patients who are asymptomatic as well as symptomatic left ventricular dysfunction. Normally a patient will have a plasma concentration of about 10 picomoles per liter, but in a patient with left ventricular function there will be a significant rise (our patient had pro-BNP of 748). Measurement of N-Terminal Pro BNP has diagnostic and prognostic value for both heart failure and other cardiovascular diseases. It is primarily used in patients with systolic heart failure, but there is some preliminary data that suggests it could be useful in those with heart failure due to diastolic dysfunction. For a patient presenting with dyspnea, it has been proven useful to order pro-BNP, using cutoffs for diagnosing heart failure as well as eliminating the diagnosis of heart failure. Pro-BNP is also useful in its correlation with prognosis of patients with acute and chronic heart failure: the higher the pro-BNP concentration above the calculated median, the higher risk of mortality. In addition to its main role in heart failure, pro-BNP has also had a role in cardiomyopathy by predicting cardiac involvement as well as prognosis in patients with amyloidosis. Quick line on comparing plasma BNP and Pro-BNP: not much data comparing the two in terms of diagnostic and prognostic values, and there is no current universal conversion factor to compare the two.  

SOURCE: https://www-uptodate-com.york.ezproxy.cuny.edu/contents/natriuretic-peptide-measurement-in-heart-failure?search=pro%20BNP&source=search_result&selectedTitle=1~142&usage_type=default&display_rank=1#H35