Myocarditis caused by Cytomegalovirus (CMV)


18 Sep 2020, 20:43 Harry Ridwan Dibaca : 320


Myocarditis caused by Cytomegalovirus (CMV)

Asep Sopandiana,MD.Christiani Muljono,MD.Syarief Hidayat,MD.FIHA, Toni M Aprami,MD.FIHA

Departement of Cardiology and Vascular Medicine,PadjajaranUniversitySchoolof Medicine,Bandung

 


Abstract

Introduction: Acute and chronic myocarditis can be induced by a number of agents, including viruses. Although enterovirus infections are recognized as a leading cause of myocarditis, evidence is accumulating that cytomegalovirus (CMV) is also of importance in inducing myocarditis in humans.

Case presentation: A 31-year-old woman was admitted with shortness of breath which had developed since the day before, while she was at rest, preceded by a chest pain episode 1 week before, felt as heaviness and stabbing sensation to back in 5-minutes duration and subsided spontaneously without any specific medication. The ECG (figure 1) showed low voltage, sinus tachycardia, normal axis, QS wave at III, aVF, V1 and V2 leads. Chest X-Ray (Figure 2) showed cardiomegaly without pulmonary congestion.  Laboratory results were leucocytosis (13,500/mm3), cardiac troponin T 1.8, D-dimer 3.4, fibrinogen 156, SGOT 6576, SGPT 4620, BGA normal, IgM CMV (-), IgG CMV (+). TTE was performed (figure 3-5), and revealed normal dimension of heart chambers, global hypokinetic, with impaired LV systolic function, and showed a movable thrombi in both ventricular apex (± 16x35mm in RV and ± 2,76 cm2 in LV) near to interventricular wall.

Discussion: The most common causes of viral myocarditis are enteroviruses such as coxsackievirus B and achovirus. Some other causes are adenovirus, CMV, HIV, influenza, measles, mumps and etc. The CMV infection is usually manifested as pneumonitis, hepatitis, chorioretinitis, and enteritis or as a disease resembling mononucleosis. Carditis and gastric ulcers are known but unusual manifestations.  Patients with myocarditis are predisposed to ventricular and atrial thrombi due to endocardial injury, procoagulant effects of cytokines and blood flow stasis. And congestive heart failure is partly considered to be releated with the formation of thrombus. The risk of systemic thromboembolims caused byLV thrombus is about 5ÔöÇ6%, but if the thrombus is movable and pedunculated, the risk is icreased up to 60%. When giving anticoagulants in acute myocarditis, the prevalence ofLV thrombus was not reduced, and anticoagulant therapy ofLV thrombosis caused by acute myocarditis may not be effective and may even cause a major thromboembolism.


Keywords: myocarditis, cytomegalovirus,  thrombus, echocardiography

 

Pengirim : Asep Sopandiana,MD


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