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DETECTION AND EARLY DIAGNOSIS OF CARDIOVASCULAR DISEASES
¹Shukurullayev Adhamjon
²Rashidova Maftuna
³Shermatov Bektosh
¹'²'³Samarkand State Medical University, DKTF, Department of Internal Medicine, Cardiology
and Functional Diagnostics, 2nd year clinical residents
https://doi.org/10.5281/zenodo.14866265
Introduction
: Myocarditis is inflammation of the myocardium with necrosis of
cardiomyocytes. Myocarditis can be caused by a variety of factors (e.g., infectious diseases,
cardiotoxins, drugs, systemic diseases such as sarcoidosis), but is most often idiopathic. Symptoms
can be varied and include fatigue, shortness of breath, edema, tachycardia, and sudden death.
Diagnosis is based on symptoms and clinical findings, including abnormal
electrocardiogram, cardiac biomarkers, and cardiac imaging in the absence of cardiovascular risk
factors. Endomyocardial biopsy confirms the clinical diagnosis of myocarditis. Treatment depends
on the cause, but common measures include medications and devices to treat heart failure and
arrhythmias, and rarely, surgery (e.g., intra-aortic balloon pump, left ventricular assist device,
transplantation). Immunosuppression is used in some types of myocarditis (e.g., hypersensitivity
myocarditis, giant cell myocarditis, and myocarditis caused by sarcoidosis).
Methods and Materials:
Infectious myocarditis in the United States and other developed
countries is most commonly of viral etiology ( 1 ). The most common viral causes in the United
States are parvovirus B19 and human herpesvirus 6. In low-income countries, infectious
myocarditis is most commonly associated with rheumatic carditis, Chagas disease, or HIV
infection ( 2 ). Direct myocardial injury due to SARS-CoV-2 infection is rare in patients with
COVID-19, with symptoms ranging from mild chest discomfort to fulminant myocarditis, but the
risk of myocarditis is 16-fold higher in infected patients than in uninfected patients ( 3 ).
Research objective.
Noninfectious causes include cardiotoxins, certain drugs, and certain
systemic diseases. Drug-induced myocarditis is called hypersensitivity myocarditis. Myocarditis
following COVID-19 vaccination with mRNA-based vaccines is rare and less common than
COVID-associated myocarditis ( 4 ). It occurs primarily in adolescent and young adult males,
usually within a week of vaccination, and is usually mild. Giant cell myocarditis is a rare form of
myocarditis with a fulminant course. The etiology is unclear, but it may involve an autoimmune
mechanism. Biopsy reveals characteristic multinucleated giant cells. Patients with giant cell
myocarditis are in cardiogenic shock and often suffer from persistent ventricular arrhythmias or
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complete atrioventricular block. Giant cell myocarditis has a poor prognosis, but it should be
excluded in a healthy patient with heart failure or persistent arrhythmias, as immunosuppressive
therapy may improve survival.
Results
: The clinical manifestations of myocarditis are diverse. Patients may have minimal
clinical manifestations or fulminant heart failure and fatal arrhythmias. Symptoms depend on both
the etiology of myocarditis and the severity of myocardial damage.
Symptoms of heart failure may include fatigue, shortness of breath, and edema. Patients
may have signs of fluid overload, such as wheezing, increased jugular venous pressure, and edema.
A third (S3) or fourth (S4) heart sound may be heard on cardiac examination. Patients with
ventricular dilatation may have systolic murmurs of mitral regurgitation, as well as tricuspid
regurgitation. Patients with pericarditis may present with chest pain typical of pericarditis. Dull or
sharp precordial or retrosternal pain may radiate to the neck, trapezius muscles (especially on the
left), or shoulders. The pain varies from mild to severe. The pain may be relieved by sitting or
leaning forward. Unlike ischemic pain, pericarditis pain is usually aggravated by chest movement,
coughing, breathing, or swallowing. A pericardial friction rub may be heard in patients with
pericardial effusion.
Conclusion
: The clinical presentation of myocarditis ranges from subclinical symptoms to
fulminant heart failure, persistent arrhythmias, and sudden cardiac death.
Diagnosis is often based on clinical signs and noninvasive tests, including cardiac MRI;
endomyocardial biopsy is performed if patients have fulminant heart failure or persistent
arrhythmias, or if the results change treatment.
Patients with heart failure and arrhythmias should be treated; immunosuppression is added
for sarcoidosis or drug-induced myocarditis and giant cell myocarditis.
Pericarditis is an inflammation of the pericardium, often with fluid accumulation in the
pericardial cavity. Pericarditis can occur for a variety of reasons (e.g., infectious diseases,
myocardial infarction, trauma, tumors, metabolic disorders), but is most often idiopathic.
Symptoms of pericarditis include chest pain or tightness, often worsened by deep breathing. If
cardiac tamponade or constrictive pericarditis develops, cardiac output may be significantly
reduced. Diagnosis is based on symptoms, auscultatory findings (pericardial friction rub),
electrocardiographic changes, and the presence of fluid accumulation in the pericardial cavity on
radiographs or echocardiography. Further investigation is required to determine the cause.
Treatment depends on the cause, but usually includes analgesics, anti-inflammatory drugs,
colchicine, and occasionally surgery.
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