Fulminant Myocarditis

Description

This book provides readers recent advances on basic research and clinical management of fulminant myocarditis. First chapters introduce aetiology, pathology, and pathophysiology of fulminant myocarditis, in which excessive immune activation and subsequent cytokine storm are proposed to be the core pathogenesis. Following chapters present clinical management of fulminant myocarditis, including clinical manifestations, examinations, and diagnosis of fulminant myocarditis, as well as life support-based comprehensive treatment regimen in acute phase. Foreword Foreword Foreword Preface Contents Contributors 1: Introduction: Accumulating More Knowledge and Ability in Treating Fulminant Myocarditis to Save More Lives References 2: The Epidemiology of Fulminant Myocarditis 2.1 Introduction 2.2 The Incidence of Fulminant Myocarditis 2.3 The Prognosis of Patients with Fulminant Myocarditis References 3: Pattern Recognition Receptors and Fulminant Myocarditis 3.1 Brief Introduction 3.2 Pattern Recognition Receptors (PRRs) 3.2.1 Membrane-Bound TLRs 3.2.2 TLR1–2 and TLR6 3.2.3 TLR4 3.2.4 TLR5 3.2.5 TLR3 and TLR7-9 3.2.6 TLR10 3.2.7 NLRs 3.2.8 NLRP3 Inflammasome 3.2.9 RLRs 3.2.10 Cytoplasmic DNA Sensors 3.2.11 CLRs 3.2.12 Non-pattern Recognition Receptors 3.2.13 RAGE 3.2.14 PRMs 3.2.15 Myeloid Cells’s Triggering Receptors 3.2.16 G-Protein-Coupled Receptors 3.2.17 Actions of PRRs 3.2.18 Phagocytosis and TLRs 3.2.19 TLR Signaling Pathways 3.3 Pyroptosis and its Pathway 3.3.1 Expression of PRRs and Responses to Ligands in Heart References 4: Etiology and Pathogenesis of Fulminant Myocarditis 4.1 Etiology of Fulminant Myocarditis 4.1.1 Infectious Factors 4.1.1.1 Enterovirus 4.1.1.2 Adenovirus 4.1.1.3 Parvovirus 4.1.1.4 Human Herpes Virus 4.1.2 Non-infectious Factors 4.2 Pathogenesis of FM 4.3 Laboratory Test 4.3.1 Enterovirus 4.3.2 Adenovirus 4.3.3 Parvovirus 4.3.4 Human Herpes Virus 4.3.4.1 Enzyme-Linked Immunosorbent Assay 4.3.4.2 Flow Cytometry 4.3.4.3 Liquid Cytokine Chip 4.4 COVID-19 Pandemic-Related Etiology References 5: Pathophysiology and Mechanisms of Fulminant Myocarditis 5.1 Animal Models of Fulminant Myocarditis 5.1.1 Mouse Selection 5.1.2 Virus Selection 5.1.2.1 Modeling Method 5.1.3 Establishment and Evaluation of Common Animal Models of Fulminant Myocarditis 5.2 Cytokine Storm in Fulminant Myocarditis 5.2.1 Interferons 5.2.1.1 Type I Interferon (IFN I) 5.2.1.2 Type II Interferon (IFN II) 5.2.2 Interleukins 5.2.2.1 IL-1 Family 5.2.2.2 IL-2 5.2.2.3 IL-6 Family 5.2.2.4 IL-10 5.2.3 Chemokines 5.2.4 Tumor Necrosis Factor 5.3 Pathogenesis of Cytokine Storm in Fulminant Myocarditis 5.4 Possible Mechanisms of Cytokine Storm-Induced Cardiac Dysfunction 5.5 In the Future References 6: Pathology of Fulminant Myocarditis 6.1 Overview of the Pathology of Myocarditis and Fulminant Myocarditis 6.1.1 Infectious Myocarditis 6.1.2 Non-infectious Myocarditis 6.2 Pathological Characteristics of Myocarditis of Different Etiologies 6.2.1 Viral Myocarditis 6.2.2 Bacterial Myocarditis 6.2.3 Fungal Myocarditis 6.2.4 Systemic Disease-Associated Myocarditis 6.2.5 Granulomatous Myocarditis 6.2.6 Allergic Myocarditis 6.2.7 Toxic Myocarditis from Snake Venom 6.3 Typical Cases 6.3.1 Case 1 6.3.2 Case 2 6.3.3 Case 3 6.3.4 Case 4 6.3.5 Case 5 References 7: Clinical Manifestations of and Laboratory Tests for Myocarditis and Fulminant Myocarditis 7.1 Clinical Manifestations 7.1.1 Predisposing Factors 7.1.2 Early Symptoms 7.1.2.1 Respiratory Symptoms 7.1.2.2 Gastrointestinal Symptoms 7.1.2.3 Systemic Symptoms 7.1.2.4 Symptoms of Myocardial Damage 7.1.3 Progressive Symptoms 7.1.3.1 Symptoms of Myocardial Damage Chest Pain and Tightness Painless Myocarditis Arrhythmia 7.1.3.2 Hemodynamic Disorder Acute Heart Failure Cardiogenic Shock Adams–Stokes Syndrome 7.1.3.3 Manifestations of Multiple Organ Involvement 7.2 Physical Signs 7.2.1 Vital Signs 7.2.1.1 Fever 7.2.1.2 Hypotension 7.2.1.3 Breathing Changes 7.2.1.4 Heart Rate and Heart Rhythm Changes 7.2.2 Heart-Related Signs 7.2.2.1 Cardiac Size 7.2.2.2 Heart Sounds and Murmurs 7.2.2.3 Cardiac Insufficiency 7.2.3 Lung Signs 7.3 Laboratory Examination 7.3.1 Myocardial Injury Marker Cardiac Troponin I or T (cTnI or cTnT) Assessment 7.3.2 Brain Natriuretic Peptide (BNP) Assessment 7.3.3 Blood Routine Examination 7.3.4 General Biochemical Tests 7.3.5 Coagulation Function Tests 7.3.6 Inflammatory Indicator Assessment 7.3.7 Pathogen Detection 7.3.8 ECG 7.4 Case Reports References 8: Diagnostic Values and Clinical Application of Endomyocardial Biopsy in Fulmiant Myocarditis 8.1 EMB 8.1.1 Preoperative Preparation 8.1.2 Approach Selection and Equipment Preparation 8.1.3 Several Common EMB Operation Processes 8.1.3.1 Transradial Left Ventricular EMB 8.1.3.2 Transfemoral Left Ventricular EMB 8.1.3.3 Transfemoral Right Ventricular EMB 8.2 Management and Analysis of Myocardial Intimal Tissue 8.2.1 Light Microscopic Examination and Staining of Myocardial Intimal Tissues 8.2.2 Molecular Study of Myocardial Intimal Tissue 8.2.3 Molecular Biological Detection of the Virus Genome in Myocardium Tissue 8.2.4 Immunohistochemistry of the Myocardium 8.3 Clinical Application of EMB in Fulminant Myocarditis References 9: Association between Histological Changes and Clinical Manifestations of Fulminant Myocarditis 9.1 Lymphocytic Myocarditis 9.1.1 Stage 0 (Pre-Infection Stage) 9.1.2 Stage 1 (Acute Stage) 9.1.2.1 Entry of Virus into Cardiomyocytes 9.1.2.2 Replication of Virus 9.1.2.3 Direct Viral Damage to Cardiomyocytes 9.1.2.4 Host Defense—Innate Immune Response Interferons TLRs RNA Helicases 9.1.2.5 Host Defense–Acquired Immune Response 9.1.2.6 Damage to Host Cells by Host Immune Response 9.1.3 Stage 2 (Subacute Stage) 9.1.4 Stage 3 (Chronic Stage) 9.2 Giant Cell Myocarditis 9.3 Eosinophilic Myocarditis 9.4 Sarcoidosis Myocarditis 9.5 Connective Tissue Disease-Induced Autoimmune Myocarditis 9.6 Immune Checkpoint Inhibitor-Induced Myocarditis References 10: Changes of Electrpcardiography in Patients with Fulminant Myocarditis 10.1 Mechanism of Arrhythmias in Viral Myocarditis 10.2 Common ECG Findings of Fulminant Myocarditis 10.2.1 Sinus Arrhythmia 10.2.2 Atrial Arrhythmia 10.2.3 Changes in the Cardiac Conduction System 10.3 Arrhythmias and Prognosis of Myocarditis References 11: Echocardiography in Fulminant Myocarditis 11.1 Introduction 11.2 Two-Dimensional Echocardiography 11.2.1 Left Ventricular (LV) Function 11.2.2 Left Ventricular Dimension and Wall Thickness 11.2.3 Right Ventricular (RV) Function 11.2.4 Pericardial Effusion and Intra-cardiac Thrombus 11.3 Speckle-Tracking Echocardiography (STE) 11.4 Proposed Echocardiographic Scan Protocols 11.5 Utility of Echocardiography in Treating FM with Extracorporeal Membrane Oxygenation (ECMO) 11.6 Prognostic Value of Echocardiographic Measurements in FM 11.7 Conclusions References 12: Cardiac Magnetic Resonance in Fulminant Myocarditis 12.1 Introduction 12.2 Utility of CMRI in Acute Myocarditis 12.3 Lake Louise Criteria (LCC) 12.4 Novel CMR Mapping Techniques 12.5 Functional Abnormalities 12.6 Pericardial Abnormalities 12.7 Update to the LCC 12.8 Utility of CMRI in FM 12.9 Prognostic Value of CMRI in Myocarditis 12.10 Limitations of CMRI in FM 12.11 Conclusion References 13: Diagnosis and Differential Diagnosis of Fulminant Myocarditis 13.1 Clinical Diagnosis of Fulminant Myocarditis 13.2 Pathological Classification of Fulminant Myocarditis 13.3 Differential Diagnosis of Fulminant Myocarditis References 14: Novel Conceptions in Treatments of Fulminant Myocarditis 14.1 New Understanding of Pathophysiology of Fulminant Myocarditis 14.2 Design of Treatment Regimen 14.3 Treatment Regimen 14.4 Life Support Treatment 14.4.1 ECMO 14.4.2 IABP 14.4.3 Percutaneous Left Ventricular Assist Device 14.5 Immunomodulatory Therapy 14.5.1 Intravenous Gamma Globulin 14.5.2 GCs 14.5.3 Cytotoxic Immunosuppressive Drugs 14.5.4 CRRT 14.6 Antiviral Treatment References 15: Treatments of Fulminant Myocarditis in Acute Phase 15.1 Treatment in Acute Phase: Core Treatments 15.2 Mechanical Circulation Support 15.3 Immunomodulation Therapy 15.4 Administration of Neuraminidase Inhibitors and Antiviral Drugs 15.5 Assessment of Treatment Effects 15.6 Auxiliary Care References 16: Prevention and Treatment of Arrhythmias Complicated by Fulminant Myocarditis 16.1 Prediction and Prevention of Lethal Arrhythmias 16.1.1 Hypotension 16.1.2 Usage of Catecholamines 16.1.3 Long-Term Usage of α-Receptor Agonists 16.1.4 Sustained Shock 16.1.5 Prolonged QRS Interval 16.1.6 Female Patients 16.1.7 Hypokalemia 16.1.8 Hypoxemia 16.2 Treatments to Bradyarrhythmia 16.2.1 Drug Treatment 16.2.2 Temporary Pacemaker 16.3 Tachycardia 16.3.1 Electrolytes Management 16.3.2 Monitor the QTc Interval 16.3.3 Anti-arrhythmia Drugs 16.3.4 Electrical Cardioversion 16.3.5 Electrical Storms 16.3.6 Traditional Chinese Medicine References 17: Prevention and Treatment of Disseminated Intravascular Coagulation in Fulminant Myocarditis 17.1 Etiology of DIC Secondary to Fulminant Myocarditis 17.2 Pathogenesis of DIC Secondary to Fulminant Myocarditis 17.2.1 Activation of the Coagulation System 17.2.2 Fibrinolysis Dysfunction 17.3 Factors Affecting the Occurrence and Development of DIC 17.3.1 Impaired Function of the Monocyte-Macrophage System 17.3.2 Severe Liver Dysfunction 17.3.3 Hypercoagulative State of the Blood 17.3.4 Microcirculation Disturbance 17.4 Main Clinical Manifestations of DIC Secondary to Fulminant Myocarditis 17.5 Treatment of DIC Secondary to Fulminant Myocarditis References 18: Rehabilitation Treatment for Myocarditis 18.1 Overview 18.2 Cardiac Rehabilitation 18.2.1 Cardiac Assessment 18.3 Five Prescriptions for Cardiac Rehabilitation References 19: Follow-Up and Long-Term Prognosis of Myocarditis and Fulminant Myocarditis 19.1 Histopathological Type and Prognosis 19.2 Clinical Manifestations and Prognosis 19.3 Clinical Treatment and Prognosis 19.4 Follow-Up of Fulminant Myocarditis Patients References 20: Clinical Nursing for Patients with Fulminant Myocarditis 20.1 Basic Nursing 20.1.1 Pressure Ulcer Prevention 20.1.2 Keeping Warm 20.1.3 Continuous Monitoring 20.2 Nursing of Life-Support Devices 20.2.1 ECMO 20.2.1.1 Catheter Care 20.2.1.2 The Monitoring of ECMO Patients Speed and Flow Rate Oxygenation Monitor Gas Management Pressure Monitor Temperature Management Volume Management Anticoagulation Monitor Indicators for Weaning ECMO [11–13] 20.2.2 IABP 20.2.2.1 Effective Trigger 20.2.2.2 Continuous Observation 20.2.2.3 Catheter Care 20.2.2.4 Surveil Anticoagulant 20.2.2.5 Indicators for Weaning IABP [17, 18] 20.2.2.6 Care After Weaning IABP 20.2.3 Care for Temporary Pacemaker 20.2.4 Care for Invasive Ventilator 20.2.4.1 Respirator-Assisted Ventilation 20.2.4.2 Tracheal Cannula 20.2.4.3 Mechanical Ventilation 20.2.4.4 Respiratory Tract Nursing 20.2.5 CRRT Nursing 20.2.5.1 CRRT Mode [42] 20.2.5.2 Vascular Access 20.2.5.3 Parameters Setting 20.2.5.4 Anticoagulation for CRRT 20.2.5.5 Commencing Treatment 20.2.5.6 Volume Management 20.2.5.7 Disconnection 20.2.5.8 Supplement 20.3 Nursing of Drug Therapy 20.4 Nursing of Complications 20.5 Rest and Nutrition 20.6 Psychological Nursing References 21: Introduction of Clinical Courses of Typical Cases of Fulminant Myocarditis (Including Six Cases) 21.1 Typical Case 1 21.1.1 Clinical Features 21.1.1.1 Chief Complaint 21.1.1.2 Present Medical Information 21.1.1.3 Medical History 21.1.1.4 Physical Examination 21.1.2 Diagnosis 21.1.3 Physical Examination and Tests 21.1.3.1 Day 1 of Admission Bedside Echocardiography Laboratory Tests Treatments and Course After Admission 21.1.3.2 Day 2 of Admission Bedside Ultrasound Examination 21.1.3.3 Day 3 of Admission (Fig. 21.6) 21.1.3.4 Days 4–7 of Admission 21.1.4 Variation Trend of the Main Indicators During Admission 21.1.5 Case Review 21.2 Typical Case 2 21.2.1 The Clinical Features 21.2.1.1 Chief Complaint 21.2.1.2 Present Medical History 21.2.1.3 Past Medical History 21.2.1.4 Physical Examination Laboratory Tests 21.2.2 Diagnosis 21.2.3 Treatment 21.2.3.1 Bedside Echocardiography 21.2.3.2 Day 2 After Admission 21.2.3.3 Physical Examination Laboratory Tests Bedside Echocardiography (10 a.m., Feb 7, 2019) 21.2.3.4 3–5 Days After Admission 21.2.3.5 Holter 1 Week After Admission 21.2.4 Variation Trend of Main Biomarkers and Cardiac Function During Treatments (Figs. 21.14, 21.15, and 21.16) 21.2.5 Comments 21.3 Typical Case 3 21.3.1 Clinical Features 21.3.1.1 Chief Complaint 21.3.1.2 Present Medical History 21.3.1.3 Past Medical History 21.3.1.4 Physical Examination 21.3.1.5 Examination and Laboratory Tests 21.3.2 Diagnosis 21.3.3 Treatment 21.3.3.1 Day 1 21.3.3.2 Bedside Echocardiography 21.3.3.3 2 Days After Admission 21.3.3.4 Days 3–5 21.3.3.5 6 Days After Admission: Before Discharge 21.3.4 Variation Trend of Primary Indicators During Admission 21.3.5 Comments 21.4 Typical Case 4 21.4.1 Comments 21.5 Typical Case 5 21.5.1 The Clinical Features 21.5.1.1 Chief Complaint 21.5.1.2 Present Medical History 21.5.1.3 Past Medical History 21.5.1.4 Physical Examination 21.5.1.5 Examination (Fig. 21.22) 21.5.2 Diagnosis 21.5.3 Treatment 21.5.3.1 Day 1 After Admission Bedside Echocardiography 21.5.3.2 On the Second Day of Hospital Ambulatory ECG 21.5.3.3 The Third Day of Admission 21.5.3.4 Day 4–7 of Admission 21.5.3.5 Day 8 of Admission 21.5.3.6 Echocardiography Diagnosis After 1 Week: Reduced Left Ventricular Systolic Function 21.5.3.7 The Ninth Day of Admission 21.5.3.8 On the Tenth Day of Admission 21.5.4 Variation Trend of Main Indicators During Admission 21.5.5 Comments 21.6 Typical Case 6 21.6.1 Comments Appendix A: Chinese Expert Consensus Statement on the Nursing Strategies of Adult Fulminant Myocarditis Consensus Formulation Application Scope Clinical Evaluation and Treatments Definition Etiology Symptoms Treatments Symptomatic and Supportive Treatment Anti-viral and Immunomodulating Therapy Mechanical Circulatory Support Contents of the Consensus Early Assessment and Dynamic Monitoring Intravenous Treatment and Medication Nursing Intravenous Treatment Medication Nursing Life Support Nursing Application Time Circulatory Support Nursing Respiratory Support Care Continuous Renal Replacement Therapy (CRRT) Care Catheter Management Anticoagulation Management Common Complications Prevention and Care Arrhythmia Hemorrhage and Thrombosis Care Infection Hemolysis Lower Extremity Arterial Ischemia Brain Injury Rehabilitation Strategy Exercise Rehabilitation Nutrition Rehabilitation Psychological Rehabilitation Health Instruction and Follow-Up Professional Team Management Appendix B: Actively Promote and Apply the China’s Regimen for Treatments of Fulminant Myocarditis to Save More Lives Diagnosis and Treatment Status at Home and Abroad Core Content of the Chinese Regimen Features of the Chinese Regimen