Abstract
Myocarditis is an inflammatory disease of the myocardium, with heterogeneous etiology. Although rare, myocarditis can be a complication of the influenza infection. In the majority of cases, viral myocarditis is a self-limiting infection passing without permanent changes in the myocardium. We present a clinical case of a 30-year-old woman with acute heart failure in the course of respiratory infection accompanied by severe systolic dysfunction (left ventricular (LV) ejection fraction (EF) 16%). The patient was treated according to the current guideline recommendations for the treatment of acute and chronic heart failure with the conjunction of immunomodulating and metabolic therapy. During hospitalization from microbial and viral testing, acute-phase antibodies to parainfluenza virus were identified. Following the treatment, a complete resolution of heart failure symptoms and restoration of LVEF to baseline (40%) was observed. Timely initiation of treatment in myocarditis, followed by good clinical course and regression of LV systolic dysfunction, in some cases may cancel invasive procedures such as endomyocardial biopsy.
Highlights
Myocarditis is a challenging diagnosis, given the heterogeneous clinical presentation and numerous etiologic causes
It is difficult to determine the exact incidence of myocarditis, given that endomyocardial biopsy (EMB), which is the gold standard for diagnosis [1,2,3], is rarely used [23]
Patients presenting with mild symptoms and minimal left ventricular (LV) dysfunction usually proceed to spontaneous resolution without specific treatment [4]
Summary
Остър миокардит при пациент с парагрипна инфекция, седем години след костномозъчна трансплaнтация. В повечето от случаите вирусният миокардит е самоограничаваща се инфекция, преминаваща без да оставя трайни изменения в миокарда. Представяме клиничен случай на 30-годишна жена, развиваща остра сърдечна недостатъчност в хода на респираторна инфекция съпроводена от тежка систолна дисфункция [левокамерна (ЛК) фракция на изтласкване (ФИ) 19%]. При пациентката се проведе лечение, съобразено с настоящите препоръки за лечение на остра и хронична сърдечна недостатъчност в комбинация с имуностимулираща и метаболитна терапия. В резултат на проведеното лечението се отчете пълно обратно развитие на симптомите на сърдечна недостатъчност и възстановяване на изходната ФИ (40%). Навременното започване на лечение при миокардит, съпроводено с добър клиничен ход и обратно развитие на ЛК систолна дисфункция, в някой случай може да отмени провеждането на инвазивни процедури като ендомиокардна биопсия
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