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Ventricular tachycardia (VT) is one of the difficult clinical problems for the physician. Its evaluation and treatment are complicated because of its life-threatening nature and urgent need of rapid management. Any process that creates myocardial scar tissue could be the substrate for ventricular tachycardia. The coronary artery disease is the most...
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... treatment is necessary. With some exceptions, VT is associated with increased risk of sudden death. Approach to it not only depends on the emergency management to revert it to normal sinus rhythm either by DC cardio version or by pharmacotherapy, but also on identification of the etiology and to cure it if possible. Though most common and most important clinical setting is ischemic or scar related VTs of coronary artery disease due to atherosclerosis, nonischemic causes are also not very uncommon, especially in young individuals. Etiological aspects of acute myocarditis may vary depending on the age, predisposing factors and geographical location of the patient. In tropical countries like Nepal and India where tuberculosis is endemic, it may be one of the rare but potential causes of myocarditis. Tuberculous involvement of the heart has been described in the form of pericardial effusion, constrictive or effusive-constrictive pericarditis and rarely coronary vasculitis leading to coronary artery obstruction. As effective therapeutic strategies are available for extra pulmonary tuberculosis, early diagnosis and prompt treatment effectively results in cure of the disease. A 33 year old Asian male, without any significant past medical history presented to the Emergency Room with complaints on palpitation, breathless- ness, sweating and abdominal discomfort of 4 days duration. He lost weight of 8 kilograms over past 3 months. He denied smoking, any drug abuse or high risk sexual behavior. No family history of heart disease or sudden cardiac death was present. He was dyspneic, tachypneic, with a pulse rate of 190 bpm; BP 100/60mm Hg. Examination revealed intermittent cannon waves in JVP, normally placed apex, right and left ventricular gallop sounds, basal rales of lungs. ECG showed VT that had northwest axis with right bundle branch block (RBBB) pattern (Figure 1). Taking hypoxemia (SaO2=80%) and hemodynamic deterioration into consideration he was DC cardioverted and was intubated. Even though he became hemodynamically stable with electrocardiography showing normal sinus rhythm after DC shock (Figure 2), VT was recurrent with a different morphology – right axis deviation with left bundle branch block (LBBB) pattern (Figure 3). Chest X-ray was normal and Echocardiogram showed normal sized chambers with trivial mitral regurgitation, mild tricuspid regurgitation (PA pressure 33 mmHg) and an ejection fraction of 30 –35 %. His BNP was within normal limits. His CPK-MB was 29 IU/L, Troponin T < 0.01 mg/ml. Ultrasound abdomen showed fatty liver. Other laboratory data are summarized in Table1. Upon conservative management he had improved with ejection fraction of 45-50% but continued to have frequent ventricular premature complexes (VPCs) and non-sustained ventricular tachycardia (NSVT) and occasional sinus rhythm. His serial ECGs showed persisting VT with northwest axis RBBB pattern or right axis deviation with LBBB pattern. Only rarely he had sinus rhythm (Figure 4). A working diagnosis of non ischemic VT was made and he was evaluated for ...
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... On the other hand, tuberculous myocarditis includes the nodular form with myocardial damage and central caseation, miliary forms, or diffuse giant cell forms. 15 The clinical manifestations are variable, ranging from no symptoms to sudden cardiac death, intractable ventricular arrhythmias, long QT syndrome, heart block, or congestive heart failure. 10,16 In this regard, clinical studies report that 80% of fatal cases occur in female patients with associated left ventricular systolic dysfunction. ...
Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.
... In these cases, involvement of the right mediastinal lymph nodes has been observed, with a greater chance of contiguous involvement of the right side of the heart [15]. Identified forms include nodular myocardial damage with central caseation, miliary forms, or diffuse, inflammatory, giant cell forms [44]. ...
Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.
... При этом аритмия не является характерным симптомом для изолированного туберкулезного перикардита [15,16], но при миокардите он встречается достаточно часто [17]. В литературе описано развитие блокады правой ножки пучка Гиса [18], полной атриовентрикулярной блокады [19], эктопического желудочкового ритма [20][21][22] при туберкулезном миокардите. ...
... Помимо того, что данная патология встречается редко, и клинический опыт по ведению таких пациентов пока отсутствует, нарушения сердечного ритма при этом часто бывают резистентными к проводимой терапии. Так, в случае, описанном Khurana и соавт., пациенту с рефрактерной к медикаментозному лечению нарушений ритма сердца был имплантирован кардиовертер-дефибриллятор [22], а пациенту, описанному M.P. Gautan, была проведена электрическая кардиоверсия [21]. ...
... An anatomical predilection for the right-sided mediastinal lymph nodes has been described in this condition, making the right side of the heart the most vulnerable area of the myocardium owing to the potential for contiguous spread [4]. Three distinct forms of myocardial involvement are recognized: nodular tubercles of the myocardium (characterized by central caseation); miliary tubercles of the myocardium (resulting from hematogenous spread); and an uncommon diffuse infiltrative type associated with tuberculous pericarditis (characterized microscopically by giant cells and lymphocytes) [5,6]. The myocardium may be involved by hematogenous spread, by retrograde lymphatic spread from mediastinal lymph nodes or by direct invasion from the pericardium [7,8]. ...
Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty one percent (81%) occur in the 'young' patients (below 45years). Antituberculosis drug therapy does not appear to offer mortality benefit against sudden cardiac deaths.
Infiltration of the myocardium with various cell types, cytokines and chemokines plays a crucial role in the pathogenesis of cardiomyopathies including inflammatory cardiomyopathies and myocarditis. A more comprehensive understanding of the precise immune mechanisms involved in acute and chronic myocarditis is essential to develop novel therapeutic approaches. This review offers a comprehensive overview of the current knowledge of the immune landscape in cardiomyopathies based on etiology. It identifies gaps in our knowledge about cardiac inflammation and emphasizes the need for new translational approaches to improve our understanding thus enabling development of novel early detection methods and more effective treatments.
A rare case of ventricular tachycardia caused by extrapulmonary tuberculosis has been followed up. Automatic implantable cardioverter defibrillator implantation was done at the time of presentation. Following this, the patient is clinically well without any episodes of ventricular tachycardia and is considered for an implantable cardioverter defibrillator explantation.
Tuberculat myocarditis is an extremely rare entity with few published reports. We report a 13 year old male who presented with ventriculat tachycardia. On evaluation he was observed to have MRI features and workup consistent with nodular variant of tubercular myocarditis. Child had fatal outcome on follow up.
