Myocarditis Health Dictionary

If deaths from accidents are excluded, this term means the unexpected death of an apparently healthy person. CARDIAC ARREST is the most common cause of sudden death. Older people (35 years or above) who suffer cardiac arrest commonly have coronary artery disease (see HEART, DISEASES OF) with restriction or stoppage of blood supply to part of the heart which causes INFARCTION (heart attack). Irregularity of the heartbeat (cardiac ARRHYTHMIA) is another cause. MYOCARDITIS, PNEUMONIA and STROKE can also result in sudden death, as can ASTHMA, anaphylactic shock (see ANAPHYLAXIS), ruptured aortic ANEURYSM and SUICIDE, the incidence of which is rising, especially among young people, and is over 4,000 a year in the UK.

Sudden death sometimes occurs in infants, usually in the ?rst year of life: this is called SUDDEN INFANT DEATH SYNDROME (SIDS) or, colloquially, cot death, the possible causes of which are an ongoing subject for research and debate.

When a person dies unexpectedly the event must be reported to a CORONER, who has the power to decide whether an AUTOPSY is necessary.... death, sudden

A common disorder of the heartbeat caused by an interruption to the passage of impulses through the heart’s conducting system.

There are several grades of heart block, from a slight delay between the contractions of the atria (see atrium) and ventricles (called a prolonged P-R interval) to complete heart block, in which the atria and ventricles beat independently. Heart block may be due to coronary artery disease, myocarditis, overdose of a digitalis drug, or rheumatic fever. A prolonged P-R interval causes no symptoms. In more severe heart block, the rate of ventricular contraction does not increase in response to exercise. This may cause breathlessness as a result of heart failure, or chest pains or fainting due to angina pectoris. If the ventricular beat becomes very slow, or if it stops altogether for a few seconds, loss of consciousness and seizure may occur due to insufficient blood reaching the brain. If the delay is prolonged, a stroke may result.Symptomless heart block may not need treatment. Heart block that is causing symptoms is usually treated by the fitting of an artificial pacemaker. Drugs, such as isoprenaline, that increase the heart-rate and the strength of the heart’s contractions, may be given as a temporary measure.... heart block

A group of viruses so-called because they were ?rst isolated from two patients with a disease resembling paralytic POLIOMYELITIS, in the village of Coxsackie in New York State. Thirty distinct types have now been identi?ed. They constitute one of the three groups of viruses included in the family of ENTEROVIRUSES, and are divided into two groups: A and B. Despite the large number of types of group A virus (24) in existence, evidence of their role in causing human disease is limited. Some, however, cause aseptic MENINGITIS, non-specicifc upper respiratory infection and MYOCARDITIS, and others cause a condition known as HERPANGINA. HAND, FOOT AND MOUTH DISEASE is another disease caused by the A group. All six types of group B virus have been associated with outbreaks of aseptic meningitis, and they are also the cause of BORNHOLM DISEASE. Epidemics of type B2 infections tend to occur in alternate years. (See VIRUS.)... coxsackie viruses

Enteric fever is caused by bacterial infection with either Salmonella typhi or Salmonella paratyphi A, B or C. These infections are called typhoid fever, or paratyphoid fever respectively. Transmission usually occurs by ingestion of water or food that has been contaminated with human faeces – for example, by drinking water contaminated with sewage, or eating foods prepared by a cook infected with or carrying the organisms. Enteric fever is ENDEMIC in many areas of the world, including Africa, Central and South America, the Indian subcontinent and south-east Asia. Infection occasionally occurs in southern and eastern Europe, particularly with S. paratyphi B. However, in northern and western Europe and North America, most cases are imported.

Clinical course The incubation period of enteric fever is 7–21 days. Early symptoms include headache, malaise, dry cough, constipation and a slowly rising fever. Despite the fever, the patient’s pulse rate is often slow and he or she may have an enlarged SPLEEN. In the second week of illness, organisms invade the bloodstream again and symptoms progress. In general, symptoms of typhoid fever are more severe than those of paratyphoid fever: increasing mental slowness and confusion are common, and a more sustained high fever is present. In some individuals, discrete red spots appear on the upper trunk (rose spots). By the third week of illness the patient may become severely toxic, with marked confusion and delirium, abdominal distension, MYOCARDITIS, and occasionally intestinal haemorrage and/or perforation. Such complications may be fatal, although they are unusual if prompt treatment is given. Symptoms improve slowly into the fourth and ?fth weeks, although relapse may occur.

Diagnosis Enteric fever should be considered in any traveller or resident in an ENDEMIC area presenting with a febrile illness. The most common di?erential diagnosis is MALARIA. Diagnosis is usually made by isolation of the organism from cultures of blood in the ?rst two weeks of illness. Later the organisms are found in the stools and urine. Serological tests for ANTIBODIES against Salmonella typhi antigens (see ANTIGEN) (the Widal test) are less useful due to cross-reactions with antigens on other bacteria, and diffculties with interpretation in individuals immunised with typhoid vaccines.

Treatment Where facilities are available, hospital admission is required. Antibiotic therapy with chloramphenicol or amoxyacillin is e?ective. However, the potential toxicity of the former and the widespread resistance that has developed to both these antibiotics has led to the use of QUINOLONES such as CIPROFLOXACIN as the initial therapy for enteric fever in the UK and in areas where resistant organisms are common. A few individuals become chronic carriers of the organisms after they have recovered from the symptoms. These people are a potential source of spread to others and should be excluded from occupations that involve handling food or drinking-water.

Prolonged courses of antibiotic therapy may be required to eradicate carriage.

Prevention Worldwide, the most important preventive measure is improvement of sanitation and maintenance of clean water supplies. Vaccination is available for travellers to endemic areas.... enteric fever

The result of myocardial infarction. Reduction in contractility and output of the heart.

Symptoms: low blood pressure, reduced urinary output, water in the lungs, etc. See: MYOCARDITIS. ... cardiogenic shock

A general term for inflammation of any part of the heart or its linings.

There are 3 types of carditis: myocarditis (inflammation of the heart muscle), which is usually caused by a viral infection; endocarditis (inflammation of the internal lining of the heart), which is usually due to a bacterial infection; and pericarditis (inflammation of the outer covering of the heart), which is usually due to a viral or bacterial infection but may be associated with a myocardial infarction or an autoimmune disorder, such as systemic lupus erythematosus.... carditis

An acute febrile illness, usually seen in children, which may include ARTHRALGIA, ARTHRITIS, CHOREA, carditis (see below) and rash (see ERUPTION). The illness has been shown to follow a beta-haemolytic streptococcal infection (see STREPTOCOCCUS).

Rheumatic fever is now extremely uncommon in developed countries, but remains common in developing areas. Diagnosis is based on the presence of two or more major manifestations – endocarditis (see under HEART, DISEASES OF), POLYARTHRITIS, chorea, ERYTHEMA marginatum, subcutaneous nodules – or one major and two or more minor ones – fever, arthralgia, previous attacks, raised ESR, raised white blood cell count, and ELECTROCARDIOGRAM (ECG) changes. Evidence of previous infection with streptococcus is also a criterion.

Clinical features Fever is high, with attacks of shivering or rigor. Joint pain and swelling (arthralgia) may affect the knee, ankle, wrist or shoulder and may migrate from one joint to another. TACHYCARDIA may indicate cardiac involvement. Subcutaneous nodules may occur, particularly over the back of the wrist or over the elbow or knee. Erythema marginatum is a red rash, looking like the outline of a map, characteristic of the condition.

Cardiac involvement includes PERICARDITIS, ENDOCARDITIS, and MYOCARDITIS. The main long-term complication is damage to the mitral and aortic valves (see HEART).

The chief neurological problem is chorea (St Vitus’s dance) which may develop after the acute symptoms have subsided.

Chronic rheumatic heart disease occurs subsequently in at least half of those who have had rheumatic fever with carditis. The heart valve usually involved is the mitral; less commonly the aortic, tricuspid and pulmonary. The lesions may take 10–20 years to develop in developed countries but sooner elsewhere. The heart valves progressively ?brose and ?brosis may also develop in the myocardium and pericardium. The outcome is either mitral stenosis or mitral regurgitation and the subsequent malfunction of this or other heart valves affected is chronic failure in the functioning of the heart. (see HEART, DISEASES OF).

Treatment Eradication of streptococcal infection is essential. Other features are treated symptomatically. PARACETAMOL may be preferred to ASPIRIN as an antipyretic in young children. One of the NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) may bene?t the joint symptoms. CORTICOSTEROIDS may be indicated for more serious complications.

Patients who have developed cardiac-valve abnormalities require antibiotic prophylaxis during dental treatment and other procedures where bacteria may enter the bloodstream. Secondary cardiac problems may occur several decades later and require replacement of affected heart valves.... rheumatic fever

Arrhythmia. Heart flutter. Disorderly uncoordinated contraction of atrial muscle wall, the ventricles responding irregularly.

Causes: thyrotoxicosis, valvular or coronary disease. Present in mitral stenosis and myocarditis. Precursor of heart failure. Carrying a bucket of coal upstairs may be sufficient to precipitate an attack. Symptoms. Pulse irregular in time and force, breathlessness, visible pulse in neck, excessive heart beats of sudden onset or permanent, with breathlessness often from emotional excitement.

Treatment. Patient should avoid excessive physical exercise or give way to anxiety and depression. Alternatives:– Tea. Equal parts: Hawthorn (berries or blossoms), Broom, Valerian. 1-2 teaspoons in each cup boiling water; infuse 5-15 minutes; dose – half-1 cup thrice daily.

Tablets/capsules. Hawthorn, Valerian, Motherwort.

Formula. Hawthorn 2; Passion flower 2; Broom 3. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or honey thrice daily. Practitioner. Tincture Gelsemium (BPC 1973): 2-5 drops. Tincture Lily of the Valley: 0.5-1ml.

Undue violence. Tincture Gelsemium 1; Tincture Cactus 2. Mix. Dose: 5-10 drops. Where heart muscle is damaged, add 1 part Liquid Extract Black Cohosh.

Broom. Spartiol Drops, 20 drops thrice daily. (Klein)

Diet. See: DIET – HEART AND CIRCULATION. ... atrial fibrillation

White thorn. Crataegus oxyacanthoides Thuill. Or C. monogyna Jacq. French: Aube?pine. German: Hagedorn. Spanish: Espina blanca. Italian: Marruca bianca. Parts used: Dried flowers, leaves, fruits. Keynote: heart.

Constituents. Flavonoids, phenolic acids, tannins, amines.

Action. Positive heart restorative. Coronary vasodilator BHP (1983), antispasmodic, antihypertensive, adaptogen, diuretic, sedative to nervous system, cholesterol and mineral solvent. Action lacks the toxic effects of digitalis. Useful where digitalis is not tolerated.

Uses: To increase blood flow through the heart. Strengthens heart muscle without increasing the beat or raising blood pressure. Enhances exercise duration. Myocarditis with failing compensation. Improves circulation in coronary arteries. Arteriosclerosis, atheroma, thrombosis, rapid heart beat, paroxysmal tachycardia BHP (1983), fatty degeneration; angina, enlargement of the heart from over-work, over- exercise or mental tension, alcoholic heart, Buerger’s disease, intermittent claudication, risk of infarction, dizziness (long term), mild to moderate hypertension, insomnia. Used by sportsmen to sustain the heart under maximum effort.

Preparations: Thrice daily.

Tea. Leaves and flowers. 1-2 teaspoons to each cup boiling water; infuse 5-10 minutes. Dose: 1 cup. Traditional for insomnia or for the heart under stress.

Decoction. Fruits. 1-2 heaped teaspoons haws to each cup water; simmer gently 2 minutes. Dose: half-1 cup.

Tablets/capsules. Two 200-250mg.

Liquid extract. 8-15 drops in water.

Tincture. 1:5 in 45 per cent alcohol, dose: 15-30 drops (1-2ml).

Popular combinations:–

With Mistletoe and Valerian (equal parts) as a sedative for nervous heart.

With Lily of the Valley 1; Hawthorn berries 2; for cardiac oedema.

With Lime flowers, Mistletoe and Valerian (equal parts) for high blood pressure.

With Horseradish or Cayenne, as a safe circulatory stimulant.

Gradual onset of action. Low incidence of side-effects. No absolute contra-indications.

Note: Dr D. Greene, Ennis, County Clare, Eire, attained an international reputation for treatment of heart disease keeping the remedy a secret. Upon his death his daughter revealed it as a tincture of red-ripe Hawthorn berries. Pharmacy only ... hawthorn

See: ANEURISM, ANGINA, AORTIC STENOSIS, ARTERITIS, ATHEROSCLEROSIS, ATHLETE’S HEART, ATRIAL FIBRILLATION, BRADYCARDIA, CARDIAC ARREST, CORONARY HEART DISEASE, ENDOCARDITIS, MITRAL STENOSIS, MYOCARDITIS, PALPITATION, PERICARDITIS, SMOKER’S HEART, TACHYCARDIA, THROMBOSIS.

For all heart disorders. Weight reduction, stop smoking. Reduction of excessive physical exertion. Correction of aggravating factors such as anaemia and dietetic tendency to eat too much animal fat. Specific herbal treatment may be taken with profit before surgery (coronary bypass grafts). Cardiac herbs reduce oxygen consumption by the heart muscle (myocardium) by having a beta-blocker-like effect, lowering the heart rate particularly during exercise and reducing systolic blood pressure, thus decreasing the demand for oxygen. ... heart

Astragalus membranaceus. Chinese anti-viral, anti-bacterial. Immune system enhancer. 2,000-year old herb drunk as tea in China.

Action. Anti-infective against Coxsackie virus. Immune stimulant. Antiviral.

Uses: Myalgic encephalomyelitis (ME). Upper respiratory infection. For increased white blood cell count, improved sleep habits and to stimulate appetite in patients receiving chemotherapy and radiation. (American Health 1989 8th Oct. –100) To increase production of interferon. Gastric ulcer therapy. Influenza. The common cold. To combat Coxsackie B myocarditis. Of value for incontinence and frequency of urine. Inhibits HIV-1 replication in cells acutely or chronically infected.

Preparation. Decoction. Dried root: 2 teaspoons to each cup of water simmered gently 20 minutes. Half- 1 cup thrice daily. ... huang qi

Viscum album L. German: Mistel. French: Gui blanc. Spanish: Liga. Russian: Olma. Indian: Banda. Italian: Visco quercino. Arabian: Kishmish-j-kawaliyan. Chinese: San-shang-chi-she?ng. Leaves and terminal twigs. Practitioner use only.

Constituents: alkaloids, glycoproteins, polypeptides, flavonoids.

Action: tranquilliser, vasodilator – reducing blood pressure after an initial rise. Cardiac depressant. Used as an alternative to beta-blocking drugs when they produce sore eyes and skin rash. Stimulates the vagus nerve which slows the pulse. Contains acetylcholine. Diuretic. Immune enhancer. Anti-inflammatory. Uses. Arterial hypertension, insomnia, temporal arteritis, nervous excitability, hyperactivity, limb- twitching, epilepsy, (petit mal), chorea, tinnitus, rabies (Dr Laville). Benzodiazepine addiction – to assist withdrawal. Arteriosclerosis (with Horsetail). Headache, dizziness, fatigue.

Cancer: some success reported in isolated cases. Juice of the berries has been applied to external cancers since the time of the Druids. Present-day pharmacy: Iscador (Weleda), Viscotoxin. Pliny the Elder (AD 23-79) and Hippocrates record its use in epilepsy and for tumours. The berries may be prescribed by a medical practitioner only (UK). As an immune enhancer it is used as an adjunct to surgery and radiotherapy for patients for whom cytotoxic drugs are inappropriate because of adverse side-effects. Lymphocytes divide more readily by production of interferon.

Combinations: (1) with Skullcap and Valerian for nervous disorders (2) with Motherwort and Hawthorn for myocarditis (3) with Blue Cohosh for menstrual irregularity (4) with Hawthorn and Lime flowers for benign hypertension. Never combine with Gotu Kola. (Dr John Heinerman)

Preparations: Average dose: 2-6g, or equivalent. Thrice daily.

Tea: 1 heaped teaspoon to each cup cold water steeped 2 hours. Dose: half-1 cup.

Green Tincture. 4oz bruised freshly-gathered leaves in spring to 1 pint 45 per cent alcohol (Vodka, strong wine, etc). Macerate 8 days, shaking daily. Filter and bottle. Dose: 3-5 drops: (every 2 hours if an epileptic attack is suspected).

Powder, capsules: 300mg. 2 capsules thrice daily before meals. (Arkocaps)

Plenosol. (Madaus)

Liquid Extract (1:1): 8-10 drops.

Sale: pharmacy only. ... mistletoe

A wide range of disorders can disrupt the heart’s action.

In general, genetic factors do not play a large part in causing heart disorders, however they do contribute to the hyperlipidaemias that predispose a person to atherosclerosis and coronary artery disease. Structural abnormalities in the heart are among the most common birth defects (see heart disease, congenital).

Infections after birth may result in endocarditis or myocarditis. Tumours arising from the heart tissues are rare. They include noncancerous myxomas and cancerous sarcomas.

The heart muscle may become thin and flabby from lack of protein and calories. Thiamine (vitamin B1) deficiency, common in alcoholics, causes beriberi with congestive heart failure. Alcohol poisoning over many years may cause a type of cardiomyopathy. Obesity is an important factor in heart disease, probably through its effect on other risk factors, such as hypertension, diabetes, and cholesterol.

The coronary arteries may become narrowed due to atherosclerosis, depriving areas of heart muscle of oxygen. The result may be angina pectoris or, eventually, a myocardial infarction.

Some drugs, such as the anticancer drug doxorubicin, tricyclic antidepressants, and even drugs used to treat heart disease, may disturb the heartbeat or damage the heart muscle.

Many common and serious heart disorders may be a complication of an underlying condition, such as cardiomyopathy or a congenital defect. Such disorders include cardiac arrhythmia, some cases of heart block, and heart failure. Cor pulmonale is a failure of the right side of the heart as a consequence of lung disease.... heart, disorders of

An infestation by fly larvae, which is primarily restricted to tropical areas. In Africa, the tumbu fly lays eggs on wet clothing left outside; the larvae hatch and penetrate the skin to cause boil-like swellings. Other flies may lay eggs in open wounds, on the skin, or in the ears or nose. Sometimes, larvae penetrate deeply into the tissues. Intestinal infestation can occur after eating contaminated food. Preventative measures include keeping flies away from food, covering open wounds, and ironing clothes that have been dried outdoors.

Myiasis of the skin is treated by placing drops of oil over the swelling. The larva comes to the surface, where it can be removed with a needle. In deeper tissues, surgery may be needed. Intestinal myiasis is treated with a laxative. myo- A prefix denoting a relationship to muscle (as in myocarditis).... myiasis

(echovirus) one of a group of RNA-containing viruses that are able to multiply in the gastrointestinal tract (see enterovirus). About 30 different types exist. Type A Coxsackie viruses generally cause less severe and less well-defined diseases, such as *hand, foot, and mouth disease, although some cause meningitis and severe throat infections (see herpangina). Type B Coxsackie viruses cause inflammation or degeneration of heart tissue, resulting in pericarditis or myocarditis, or brain tissue, producing meningitis or encephalitis. They can also attack the muscles of the chest wall, the bronchi, pancreas, thyroid, or conjunctiva and recent evidence suggests they may be implicated in diabetes in children and in motor neuron disease. See also Bornholm disease.... coxsackie virus

(Kawasaki syndrome, mucocutaneous lymph node syndrome) a condition of unknown cause affecting young children, usually less than five years old and most commonly of Japanese or Korean descent, and characterized by fever, conjunctivitis, a sore throat, and a generalized rash and reddening of the palms and soles. This is followed by peeling of the fingers and toes. The fever usually persists for 1–2 weeks. In approximately one-fifth of children there is involvement of the coronary arteries and heart muscle (myocardium), resulting in *myocarditis and *aneurysms of the coronary arteries. About 2% of cases are fatal. The aneurysms will usually resolve spontaneously but slowly. Treatment involves aspirin therapy, and *gammaglobulin reduces the risk of coronary artery disease. [T. Kawasaki (20th century), Japanese physician]... kawasaki disease