De novo atrial fibrillation and acute myocarditis

Fibrilación auricular de novo y miocarditis aguda

Main Article Content

Nathalia Buitrago Gómez
Álvaro Herrera Escandón
Laura Patricia Uribe Posso
Steven Zambrano Castro

Abstract

Introduction:  myocarditis (MCT) is characterized by an inflammatory infiltration into the myocardium associated with degeneration and/or necrosis. Its etiologies include multiple bacteria, toxins, and autoimmune diseases among others. But most commonly it is induced by viruses. Diagnosis is challenging due to its variable presentation, imaging, and laboratory results. Objective: to describe two cases of myocarditis which debuted with atrial fibrillation as an unusual manifestation. Methodology: two cases were registered in Cali, Colombia, with myocarditis diagnosed by contrasted cardiovascular magnetic resonance imaging (cMRI). Cases: the first case corresponds to a 66-year-old female patient with a history of diabetes and hypothyroidism who was admitted for a syncope episode. The second case is a 43-year-old male with chest pain and a negative medical history. Atrial fibrillation (AF) and acute MCT were documented by cMRI. Patients received medical treatment and evolved satisfactorily presenting no cardiac failure at follow-up. Discussion and conclusions: these cases show the heterogeneity of acute MCT clinical manifestations and the importance of suspecting MCT in the presence of de novo AF. Diagnosis may be delayed in our setting due to the lack of access to cMRI, which has become a fundamental tool to distinguish MCT from other life-threatening conditions, such as myocardial ischemia, which also elevate markers such as ultrasensitive troponin.

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Article Details

Author Biographies

Nathalia Buitrago Gómez, Universidad Libre seccional Cali

Residente de Medicina Interna, Universidad Libre seccional Cali

Álvaro Herrera Escandón, DIME Clínica Neurocardiovascular

Médico internista. Cardiólogo. DIME Cínica Neurocardiovascular. Profesor Asistente Profesor asistente, Departamento de Medicina Interna. Universidad del Valle.

Laura Patricia Uribe Posso, DIME Clínica Neurocardiovascular

Médica Internista. Cardióloga DIME Clínica Neurocardiovascular. Cali, Colombia. Profesora Auxiliar. Universidad Libre Seccional Cali.

Ángela Ramírez Solarte, Universidad Libre Cali

Residente de Medicina Interna. Universidad Libre seccional Cali.

References

Rroku A, Kottwitz J, Heidecker B. Update on myocarditis – what we know so far and where we may be heading. Eur Hear J Acute Cardiovasc Care. 2020;204887262091010. doi: 10.1177/2048872620910109 DOI: https://doi.org/10.1177/2048872620910109

Ammirati E, Veronese G, Bottiroli M, Wang DW, Cipriani M, Garascia A, et al. Update on acute myocarditis. Trends Cardiovasc Med. 2020;31(6):370-379. https://doi.org/10.1016/j.tcm.2020.05.008 DOI: https://doi.org/10.1016/j.tcm.2020.05.008

Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ Res. 2016;118(3):496–514. doi: 10.1161/CIRCRESAHA.115.306573 DOI: https://doi.org/10.1161/CIRCRESAHA.115.306573

Vio R, Zorzi A, Corrado D. Arrhytmias in Myocarditis. In: Caforio A (eds) Myocarditis Springer, Cham. 2020. p. 329–41. DOI: https://doi.org/10.1007/978-3-030-35276-9_19

Heymans S, Eriksson U, Lehtonen J, Cooper LT. The Quest for New Approaches in Myocarditis and Inflammatory Cardiomyopathy. J Am Coll Cardiol. 2016;68(21):2348–64. doi: 10.1016/j.jacc.2016.09.937 DOI: https://doi.org/10.1016/j.jacc.2016.09.937

den Hoogen P van, den Akker F van, Deddens JC, Sluijter JPG. Heart Failure in Chronic Myocarditis: A Role for microRNAs? Curr Genomics. 2015;16(2):88–94. doi: 10.2174/1389202916999150120153344 DOI: https://doi.org/10.2174/1389202916999150120153344

Peretto G, Sala S, Rizzo S, De Luca G, Campochiaro C, Sartorelli S, et al. Arrhythmias in myocarditis: State of the art. Hear Rhythm. 2019;16(5):793–801. https://doi.org/10.1016/j.hrthm.2018.11.024 DOI: https://doi.org/10.1016/j.hrthm.2018.11.024

Bussani R, Silvestri F, Perkan A, Gentile P, Sinagra G. Endomyocardial Biopsy. In: Sinagra G, Merlo M, Pinamonti B (eds) Dilated cardiomyopathy Springer, Cham. 2019. p. 75–89. DOI: https://doi.org/10.1007/978-3-030-13864-6_9

Senior JM, Saldarriaga CI. Utilidad de la biopsia endomiocárdica en el síndrome de falla cardiaca. Acta Med Colomb. 2008;33(3):131–4.

Janardhanan R. Myocarditis with very high troponins: Risk stratification by cardiac magnetic resonance. J Thorac Dis. 2016;8(10):E1333–6. doi: 10.21037/jtd.2016.10.60 DOI: https://doi.org/10.21037/jtd.2016.10.60

Yoo SM, Jang S, Kim JA, Chun EJ. Troponin-positive non-obstructive coronary arteries and myocardial infarction with non-obstructive coronary arteries: Definition, etiologies, and role of ct and mr imaging. Korean J Radiol. 2020;21(12):1305-1316. doi: 10.3348/kjr.2020.0064 DOI: https://doi.org/10.3348/kjr.2020.0064

Adler Y, Charron P. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36(42):2873–4. doi: 10.1093/eurheartj/ehv479 DOI: https://doi.org/10.1093/eurheartj/ehv479

Patriki D, Gresser E, Manka R, Emmert MY, Lüscher TF, Heidecker B. Approximation of the Incidence of Myocarditis by Systematic Screening With Cardiac Magnetic Resonance Imaging. JACC Hear Fail. 2018;6(7):573–579. doi: 10.1016/j.jchf.2018.03.002 DOI: https://doi.org/10.1016/j.jchf.2018.03.002

Subahi A, Akintoye E, Yassin AS, Abubakar H, Adegbala O, Mishra T, et al. Impact of atrial fibrillation on patients hospitalized for acute myocarditis: Insights from a nationally-representative United States cohort. Clin Cardiol. 2019;42(1):26–31. doi: 10.1002/clc.23088 DOI: https://doi.org/10.1002/clc.23088

Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997;96(4):1180–4. doi: 10.1161/01.cir.96.4.1180 DOI: https://doi.org/10.1161/01.CIR.96.4.1180

Schyltheiss HP, Kühl U, Cooper LT. The management of myocarditis. Eur Heart J. 2011;32(21):2616-25. doi: 10.1093/eurheartj/ehr165 DOI: https://doi.org/10.1093/eurheartj/ehr165

Guillén-Ortega F, Soto ME, Reyes PA. Miocarditis aguda primaria. Experiencia de diez años en el Instituto Nacional de Cardiología “Ignacio Chávez.” Arch Cardiol Mex. 2005;75(Supl.3):81–88.

Mahfoud F, Grtner B, Kindermann M, Ukena C, Gadomski K, Klingel K, et al. Virus serology in patients with suspected myocarditis: Utility or futility? Eur Heart J. 2011;32(7):897–903. doi: 10.1093/eurheartj/ehq493 DOI: https://doi.org/10.1093/eurheartj/ehq493

Van Linthout S, Tschöpe C. Viral myocarditis: A prime example for endomyocardial biopsy-guided diagnosis and therapy. Curr Opin Cardiol. 2018;33(3):325–333. doi: 10.1097/HCO.0000000000000515 DOI: https://doi.org/10.1097/HCO.0000000000000515

Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M, Yilmaz A, et al. Update on myocarditis. J Am Coll Cardiol. 2012;59(9):779–92. http://dx.doi.org/10.1016/j.jacc.2011.09.074 DOI: https://doi.org/10.1016/j.jacc.2011.09.074

Tschöpe C, Cooper LT, Torre-Amione G, Van Linthout S. Management of Myocarditis-Related Cardiomyopathy in Adults. Circ Res. 2019;124(11):1568–1583. doi: 10.1161/CIRCRESAHA.118.313578 DOI: https://doi.org/10.1161/CIRCRESAHA.118.313578

Morgenstern D, Lisko J, Boniface NC, Mikolich BM, Ronald Mikolich J. Myocarditis and colchicine: A new perspective from cardiac MRI. J Cardiovasc Magn Reson. 2016;18(Suppl 1):O100. DOI: https://doi.org/10.1186/1532-429X-18-S1-O100

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