MyMedR

Fulltext Transient severe myocarditis and intraventricular thrombus associated with SARS-CoV-2 vaccination

Loch A, Siew KSW, Tan KL, Azman Bin Raja Aman RRAB

Singapore Med J, 2023 Jun;64(6):366-372.

PMID: 35509213 DOI: 10.11622/smedj.2022042

Matched MeSH terms: Myocarditis*

Fulltext Can COVID-19 vaccines improve cardiovascular outcomes?

Kow CS, Ramachandram DS, Hasan SS

Travel Med Infect Dis, 2022;48:102350.

PMID: 35500844 DOI: 10.1016/j.tmaid.2022.102350

Thus far, the investigations on the efficacy of the COVID-19 vaccines in randomized trials [8,9] have been centered around reducing the risk of severe infection and mortality. We opine investigations on the efficacy of the COVID-19 vaccines to reduce the risk of cardiovascular outcomes should be performed to understand if COVID-19 vaccination has cardiovascular benefits. Such investigations could also develop more confidence toward the acceptance of COVID-19 vaccines by the public, especially when some of the COVID-19 vaccines (particularly the mRNA vaccines such as BNT162b2 and mRNA-1273 vaccines) have been associated with the rare occurrence of cardiovascular complications, including myocarditis and pericarditis [10,11]. While the infrequency and the mild nature of the myocarditis and pericarditis cases after vaccination greatly exceed the small increased risk, specious reports on social media are still fueling the COVID-19 vaccine hesitancy. Therefore, we urge the performance of prospective investigations to establish the relationship between COVID-19 vaccines and cardiovascular outcomes.

Matched MeSH terms: Myocarditis*

Fulltext Acute viral myocarditis, four cases in three weeks

Sufarlan AW, Khalid BA

Med J Malaysia, 1989 Dec;44(4):334-40.

PMID: 2520044

Four cases of acute viral myocarditis were diagnosed within three weeks. The clinical features, electrocardiography, cardiac enzymes and other laboratory investigations are described.

Matched MeSH terms: Myocarditis/diagnosis; Myocarditis/enzymology; Myocarditis/etiology*

[Myocarditis caused by enteroviruses in Greece--and in Germany?]

Braun R, Hassler D, Kimmig P

Dtsch. Med. Wochenschr., 2002 Jun 21;127(25-26):1364.

PMID: 12136792

Matched MeSH terms: Myocarditis/diagnosis; Myocarditis/epidemiology*; Myocarditis/therapy; Myocarditis/virology

Fulltext Glucocorticoid versus immunoglobulin in the treatment of COVID-19-associated fulminant myocarditis

Kow CS, Hasan SS

Infection, 2020 10;48(5):805-806.

PMID: 32388676 DOI: 10.1007/s15010-020-01441-4

Matched MeSH terms: Myocarditis*

Acute nonspecific carditis with advanced heart block in Malaysians

Chin K, Singham KT, Anuar M

Aust N Z J Med, 1983 Aug;13(4):374-5.

PMID: 6580862

Acute nonspecific carditis with advanced heart block is rare. We observed nine cases with complete heart block and one with Mobitz type II block over an eight and a half year period. Temporary cardiac pacing was instituted in all while permanent pacing was required in six patients. No death was recorded.

Matched MeSH terms: Myocarditis/complications*

Fulltext Chest discomfort in a patient with dengue – is it an acute myocardial infarction?

Koh, K.C., Hong, H.C.

Malaysian Family Physician, 2018;13(2):29-31.

MyJurnal

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic
dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a
56-year-old woman.

Matched MeSH terms: Myocarditis

Fulltext Chest discomfort in a patient with dengue - is it an acute myocardial infarction?

Koh KC, Hong HC

Malays Fam Physician, 2018;13(2):29-31.

PMID: 30302181

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a 56-year-old woman.

Matched MeSH terms: Myocarditis

Pacemaker infection secondary to burkholderia pseudomallei

Zainal Abidin I, Syed Tamin S, Huat Tan L, Chong WP, Azman W

Pacing Clin Electrophysiol, 2007 Nov;30(11):1420-2.

PMID: 17976112

Infection is a relatively rare but devastating complication of intracardiac device implantation. Burkholderia pseudomallei is the organism which causes melioidosis, an endemic and lethal infection in the tropics. We describe a case of pacemaker infection secondary to Burkholderia pseudomallei, which was treated by explantation of the device and appropriate antimicrobial therapy.

Matched MeSH terms: Myocarditis/diagnosis*; Myocarditis/etiology*

Rheumatic fever is a major cause of acquired heart disease in children and young adults throughout the developing world

Chadha S, Inechen B

Singapore Med J, 1997 Mar;38(3):138.

PMID: 9269387

Matched MeSH terms: Myocarditis/etiology*; Myocarditis/epidemiology

Fulltext Deaths in children during an outbreak of hand, foot and mouth disease in Peninsular Malaysia--clinical and pathological characteristics

Shekhar K, Lye MS, Norlijah O, Ong F, Looi LM, Khuzaiah R, et al.

Med J Malaysia, 2005 Aug;60(3):297-304.

PMID: 16379183

From July through December 1997, 11 previously healthy children in Peninsular Malaysia succumbed to an illness clinically characterised by an acute severe refractory left-ventricular failure, following a brief prodromal illness, in the midst of an outbreak of hand, foot and mouth disease (HFMD), similar to the reported experience in Sarawak and Taiwan. Retrospective reviews of the clinical features and results of laboratory, pathological and virological investigations of cases were conducted. The median age of the 11 case-patients was 31 months (range, 13 to 49 months); 6 were males. A brief prodromal illness of 3 days (range, 2 to 5 days) was characterised by fever (axillary temperature > 38 degrees C) (100%), oral ulcers (72%), extremity rashes (45%) and significant vomiting (55%). Upon hospitalisation, 7 of 11 case-patients had features suggestive of cardiogenic shock, while 4 of 11 case-patients developed shock during hospitalisation as evidenced by marked sustained tachycardia (heart rate > or = 180 beats per minute), poor peripheral pulses and peripheral perfusion, mottled extremities, pulmonary oedema (haemorrhagic pulmonary secretions in 8 of 11 cases during tracheal intubation, often precipitated by conservative crystalloid boluses, and radiographic evidence of acute pulmonary oedema in 5 of 7 cases) and markedly impaired left ventricular function on echocardiographic examination (7 of 7 cases). Three of 4 case-patients had aseptic meningitis while one case-patient also had an acute flaccid paraparesis. Despite supportive therapy, death occurred within a median of 13.4 hours following hospitalization. Post-mortem findings (all 8 specimens examined) consistently demonstrated brain-stem encephalitis with foci of neuronal necrosis and micro-abscesses. None of the 11 specimens examined revealed histological evidence of myocarditis. Enterovirus 71 (EV71) was detected in 10 of 11 case-patients, many (7) from various sterile tissue sites (5 from central nervous tissues). No other viruses were isolated or identified. Clinical features and pathological studies closely paralleled the reported experience in Sarawak and Taiwan. The uniform necropsy findings of necrotizing brain-stem encephalitis coupled with essentially normal myocardial histology, in concert with the concurrent and consistent detection of EV71 points to a primary EV71 encephalitis; as yet unclear neurogenic mechanisms may account for the cardiovascular manifestations.

Matched MeSH terms: Myocarditis/mortality; Myocarditis/pathology

Fulltext Targeted Therapy for Acute Autoimmune Myocarditis with Nano-Sized Liposomal FK506 in Rats

Okuda K, Fu HY, Matsuzaki T, Araki R, Tsuchida S, Thanikachalam PV, et al.

PLoS One, 2016;11(8):e0160944.

PMID: 27501378 DOI: 10.1371/journal.pone.0160944

Immunosuppressive agents are used for the treatment of immune-mediated myocarditis; however, the need to develop a more effective therapeutic approach remains. Nano-sized liposomes may accumulate in and selectively deliver drugs to an inflammatory lesion with enhanced vascular permeability. The aims of this study were to investigate the distribution of liposomal FK506, an immunosuppressive drug encapsulated within liposomes, and the drug's effects on cardiac function in a rat experimental autoimmune myocarditis (EAM) model. We prepared polyethylene glycol-modified liposomal FK506 (mean diameter: 109.5 ± 4.4 nm). We induced EAM by immunization with porcine myosin and assessed the tissue distribution of the nano-sized beads and liposomal FK506 in this model. After liposomal or free FK506 was administered on days 14 and 17 after immunization, the cytokine expression in the rat hearts along with the histological findings and hemodynamic parameters were determined on day 21. Ex vivo fluorescent imaging revealed that intravenously administered fluorescent-labeled nano-sized beads had accumulated in myocarditic but not normal hearts on day 14 after immunization and thereafter. Compared to the administration of free FK506, FK506 levels were increased in both the plasma and hearts of EAM rats when liposomal FK506 was administered. The administration of liposomal FK506 markedly suppressed the expression of cytokines, such as interferon-γ and tumor necrosis factor-α, and reduced inflammation and fibrosis in the myocardium on day 21 compared to free FK506. The administration of liposomal FK506 also markedly ameliorated cardiac dysfunction on day 21 compared to free FK506. Nano-sized liposomes may be a promising drug delivery system for targeting myocarditic hearts with cardioprotective agents.

Matched MeSH terms: Myocarditis/drug therapy*; Myocarditis/metabolism

Fulltext Risk of serious adverse events after the BNT162b2, CoronaVac, and ChAdOx1 vaccines in Malaysia: A self-controlled case series study

Ab Rahman N, Lim MT, Lee FY, Lee SC, Ramli A, Saharudin SN, et al.

Vaccine, 2022 Jul 30;40(32):4394-4402.

PMID: 35667917 DOI: 10.1016/j.vaccine.2022.05.075

BACKGROUND: Rapid deployment of COVID-19 vaccines is challenging for safety surveillance, especially on adverse events of special interest (AESIs) that were not identified during the pre-licensure studies. This study evaluated the risk of hospitalisations for predefined diagnoses among the vaccinated population in Malaysia.

METHODS: Hospital admissions for selected diagnoses between 1 February 2021 and 30 September 2021 were linked to the national COVID-19 immunisation register. We conducted self-controlled case-series study by identifying individuals who received COVID-19 vaccine and diagnosis of thrombocytopenia, venous thromboembolism, myocardial infarction, myocarditis/pericarditis, arrhythmia, stroke, Bell's Palsy, and convulsion/seizure. The incidence of events was assessed in risk period of 21 days postvaccination relative to the control period. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI) with adjustment for calendar period.

RESULTS: There was no increase in the risk for myocarditis/pericarditis, Bell's Palsy, stroke, and myocardial infarction in the 21 days following either dose of BNT162b2, CoronaVac, and ChAdOx1 vaccines. A small increased risk of venous thromboembolism (IRR 1.24; 95% CI 1.02, 1.49), arrhythmia (IRR 1.16, 95% CI 1.07, 1.26), and convulsion/seizure (IRR 1.26; 95% CI 1.07, 1.48) was observed among BNT162b2 recipients. No association between CoronaVac vaccine was found with all events except arrhythmia (IRR 1.15; 95% CI 1.01, 1.30). ChAdOx1 vaccine was associated with an increased risk of thrombocytopenia (IRR 2.67; 95% CI 1.21, 5.89) and venous thromboembolism (IRR 2.22; 95% CI 1.17, 4.21).

CONCLUSION: This study shows acceptable safety profiles of COVID-19 vaccines among recipients of BNT162b2, CoronaVac, and ChAdOx1 vaccines. This information can be used together with effectiveness data for risk-benefit analysis of the vaccination program. Further surveillance with more data is required to assess AESIs following COVID-19 vaccination in short- and long-term.

Matched MeSH terms: Myocarditis/chemically induced; Myocarditis/epidemiology

Massive pericardial effusion - An uncommon initial presentation of systemic lupus erythematosus (SLE)

Cheo SW, Low QJ

Med J Malaysia, 2019 Oct;74(5):439-440.

PMID: 31649224

Systemic lupus erythematosus (SLE) is a common autoimmune disease that we see in our daily clinical practice. It can involve almost every organs in the body. Cardiac manifestations of SLE include pericarditis, myocarditis, heart block, coronary artery disease and others. Here, we report a case of SLE with an uncommon presentation of massive pericardial effusion as initial presentation. Here we also highlight that massive pericardial effusion can also be associated with other complications of SLE such as heart failure and lupus nephritis.

Matched MeSH terms: Myocarditis

Potential forensic implications of kerokan therapy - a traditional Indonesian therapy associated with neck bruising

Samberkar PN, Samberkar SP, Byard RW

Med Sci Law, 2020 Oct;60(4):315-318.

PMID: 32501165 DOI: 10.1177/0025802420926867

Kerokan is a traditional Indonesian treatment involving abrading the skin over various parts of the body with a blunt object such as a coin or a piece of ginger which may create suspicious injuries. Here, the case of a 30-year-old woman who had undergone kerokan therapy is reported. She was complaining of retro-sternal pain and epigastric discomfort and subsequently became markedly short of breath and died. The observation of injuries predominantly located around the neck initiated a police investigation and forensic autopsy. Scattered abrasions, blisters and bruises were present on the forehead, the bridge of the nose extending to the ala, the upper and anterior aspect of the chin and the sternal notch, with discrete fresh and scabbed abrasions around the neck, over the sternum and on the backs of both hands. There were, however, no facial or conjunctival petechiae and no bruising of the underlying strap muscles, or fractures of the hyoid bone or thyroid cartilage. Histology revealed that myocarditis was the cause of death. Traditional practices may cause unusual bruises, abrasions, blisters and burns that may raise suspicion of inflicted injury from an assault. Knowledge of the manifestations of socio-ethnic practices such as kerokan is important in the evaluation of trauma in specific cultural groups.

Matched MeSH terms: Myocarditis/diagnosis*

Electroimmunodetection of cardiac C-reactive protein for determining myocardial Injury

Gan X, Gong T, Zheng Y, Gopinath SCB, Zhao K

Biotechnol Appl Biochem, 2021 Apr;68(2):272-278.

PMID: 32275089 DOI: 10.1002/bab.1921

C-reactive protein (CRP) is an acute phase reactant to be a marker of inflammation and has been correlated with the cardiac injury. An immunoassay was performed using anti-human CRP antibody on an InterDigitated electrode (IDE) sensor to determine and specify CRP concentration for diagnosing the condition of myocardial inflammation. To promote the detection, gold nanoparticle (GNP) was seeded on the aminated-IDE surface. Anti-CRP was hitched on the GNP-seeded surface and identified the abundance of CRP. The limit of quantification was found as 100 fM, and the higher current response was noticed by increasing CRP concentrations with the sensitivity at 1 pM. Furthermore, CRP-spiked human serum did not interfere the determination of CRP and increased the current response, indicating suitability for a real-life sample. Similarly, the control experiments with nonimmune antibody Troponin I are not showing the definite current responses, proving the selective identification of CRP. This method of diagnosing is needful to determine the cardiovascular injury at the right time.

Matched MeSH terms: Myocarditis/blood*

Acute myocarditis mimicking ST-elevation myocardial infarction: A diagnostic challenge for frontline clinicians

Ang KP, Quek ZQ, Lee CY, Lu HT

Med J Malaysia, 2019 12;74(6):561-563.

PMID: 31929492

The clinical presentation of acute myocarditis is highly variable ranging from no symptoms to cardiogenic shock. Despite considerable progress, it remains a challenge for frontline physicians to discriminate between acute myocarditis and myocardial infarction, especially in the early phase. Our case serves as a reminder that acute presentation of myocarditis could resemble ST elevation myocardial infarction potentially misdirecting the therapeutic decision. The clinical presentation, electrocardiographic and laboratory findings of the patient are not specific enough to distinguish acute myocarditis from myocardial infarction. The gold standard tests such coronary angiography and cardiovascular magnetic resonance (CMR) can reliably differentiate the two entities.

Matched MeSH terms: Myocarditis/diagnosis*

Giant cell myocarditis with cardiac tamponade: a rare combination

Murty OP

Am J Forensic Med Pathol, 2008 Sep;29(3):245-8.

PMID: 18725781 DOI: 10.1097/PAF.0b013e318183d55f

Giant cell myocarditis (GCM) is a rare but fatal disease of idiopathic origin. It results in focal necrosis of myocardium. This is a case report of middle aged Malaysian Indian female who died due to cardiac tamponade due to rupture myocardium and tear in the root of aorta. On naked eye examination, it simply resembled as recent as well as old fibrotic areas of myocardial infarction. She was clinically diagnosed as a case of obstructive cardiomyopathy with atrioventricular block, and was on pace maker. There was subendocardial fibrosis and left ventricular transmural infarction in the left ventricle. On histopathology, this was diagnosed as GCM, there were widespread areas of inflammatory cellular infiltration within the myocardium with multinucleated giant cells and granulomas interspersed with lymphocytes. Microscopic field showed up to 10 multinucleated giant cells. In this case, there were focal areas at multiple locations and caused uneven thickness in the left ventricle wall. Idiopathic GCM is very rare and causation of hemopericardium is the unique feature of this case. In this case the direct link of GCM with aortitis and rupture of left ventricle wall resulting in hemopericardium is shown. This case is documented through macroscopic as well as microscopic photographs in H&E, Ziel-Nelson, and GMS staining.

Matched MeSH terms: Myocarditis/complications; Myocarditis/pathology*

Fulltext Traditional Jones criteria: limitation in the diagnosis of rheumatic fever in patients with mitral valve repair

Putri Yubbu, Johan Aref Jamaluddin, Lydia Chang Mun Yin, Geetha Kandavello, Mazeni Alwi, Hasri Samion, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):316-319.

MyJurnal

The present study aims to determine the limitations of traditional Jones criteria during the first episode of acute rheu- matic fever (ARF) at the initial referral hospital, in a cohort of patients below 18 years old who had undergone mitral valve repair in National Heart Institute (IJN) from 2011 to 2016. Carditis followed by fever and joint involvement were the most frequent manifestations at first diagnosis. Of the 50 patients, only seven (14%) fulfilled the traditional Jones criteria for the diagnosis of the first episode of ARF. When compulsory evidence of a previous group A Beta he- molytic streptococcus (GABHS) was disregarded, this figure rose to 54%. Therefore, strict adherence to Jones criteria with absolute documentation of GABHS will lead to underdiagnoses of ARF. The application of echocardiographic diagnostic criteria of rheumatic heart disease (RHD) needs to be emphasized to allow early diagnosis and adminis- tration of secondary prophylaxis to prevent progression to severe valvular disease.

Matched MeSH terms: Myocarditis

Enterovirus 71 infection in Australian expatriate children following an outbreak in Malaysia

Craig ME, Vale T, Robertson P, Rawlinson WD, Gould B

J Paediatr Child Health, 1999 Feb;35(1):107-8.

PMID: 10234649

Matched MeSH terms: Myocarditis/virology

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