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Miocardite aguda : uma revisão : a propósito de um caso clínico
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A miocardite é uma doença de origem não familiar (1), definida histologicamente pela infiltração do miocárdio por células inflamatórias. A infeção viral é a etiologia mais comumente identificada. As primeiras descrições remontam ao ano de 1749 num livro do médico francês Jean Baptise Senac, intitulado de “Traité des Maladies du Coeur”. Contudo, só nos anos 80 do século passado é que houve segregação do termo miocardite de outras cardiomiopatias (2). Clinicamente pode assumir uma apresentação muito heterogénea, desde sintomas sistémicos não específicos, a alterações eletrocardiográficas assintomáticas, precordialgia, insuficiência cardíaca aguda (ICA), arritmias, choque cardiogénico (CC) ou até mesmo morte súbita (3). Apesar de a curto prazo a maioria dos episódios acarretar um bom prognóstico, pensa-se que esta identidade seja o principal percursor não diagnosticado de cardiomiopatia dilatada (CMD), que é por sua vez a principal causa de transplante cardíaco (4). O diagnóstico requer um grande grau de suspeição, que idealmente deverá ser confirmado pela biopsia endomiocárdica (BEM), o gold-standard. Contudo existem ainda algumas interrogações quanto a este procedimento, perante os claros avanços no campo da ressonância magnética cardíaca (RMC). Além do diagnóstico, um outro ponto deficitário é o tratamento dirigido à maioria das etiologias e a ausência de terapêutica que influencie a progressão das alterações a longo prazo. No presente artigo, é feita uma revisão sobre todos os aspetos de miocardite aguda, partindo de um caso clínico cuja apresentação clínica era idêntica à de um síndrome coronário agudo (SCA).
Myocarditis is a disease of non-familial origin, defined histologically by infiltration of the myocardium by inflammatory cells. Viral infection is the most commonly identified etiology. As early descriptions go back to the year of 1749, in a book of the French doctor Jean Baptise Senac, entitled "Traité des Maladies du Coeur". However, it was only in the 1980s that there was a segregation of the term myocarditis from other cardiomyopathies. Clinically it may take a very heterogeneous presentation, from nonspecific systemic subjects, to asymptomatic electrocardiographic alterations, chest pain, acute heart failure, ventricular arrhythmias, cardiogenic shock or even sudden death. Although most episodes have a good prognosis in the short term, it is thought that this identity is the main undiagnosed precursor of dilated cardiomyopathy, which is in turn the main cause of cardiac transplantation. Its diagnosis requires a high degree of suspicion, which is ideally required for confirmation by endomyocardial biopsy, the gold standard. However, many are questions about a BEM, given the clear advances in cardiac magnetic resonance imaging. In addition to the diagnosis, another deficit point is the treatment directed to most etiologies and the absence of treatment that influence the progression of long-term changes. In this article, a review is made on all aspects of acute myocarditis, starting from a clinical case whose clinical presentation was identical to that of an acute coronary syndrome.
Myocarditis is a disease of non-familial origin, defined histologically by infiltration of the myocardium by inflammatory cells. Viral infection is the most commonly identified etiology. As early descriptions go back to the year of 1749, in a book of the French doctor Jean Baptise Senac, entitled "Traité des Maladies du Coeur". However, it was only in the 1980s that there was a segregation of the term myocarditis from other cardiomyopathies. Clinically it may take a very heterogeneous presentation, from nonspecific systemic subjects, to asymptomatic electrocardiographic alterations, chest pain, acute heart failure, ventricular arrhythmias, cardiogenic shock or even sudden death. Although most episodes have a good prognosis in the short term, it is thought that this identity is the main undiagnosed precursor of dilated cardiomyopathy, which is in turn the main cause of cardiac transplantation. Its diagnosis requires a high degree of suspicion, which is ideally required for confirmation by endomyocardial biopsy, the gold standard. However, many are questions about a BEM, given the clear advances in cardiac magnetic resonance imaging. In addition to the diagnosis, another deficit point is the treatment directed to most etiologies and the absence of treatment that influence the progression of long-term changes. In this article, a review is made on all aspects of acute myocarditis, starting from a clinical case whose clinical presentation was identical to that of an acute coronary syndrome.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Miocardite Biópsia do endomiocárdio Ressonância magnética cardíaca Cardiologia