1. KHALID ALSUHAIBANI MYOCARDITIS My supervisor: Dr. Ghous

2. OPJECTIVES: Define myocarditis. Classify myocarditis. Mention etiological factors of myocarditis. Outline preventive measures and management of myocarditis.

3. DEFINITION: It is diverse group of pathologic entities in which infectious microorganisms' and\or an inflammatory process cause myocardial injury.

4. CONT.. Persistent inflammation, myocardial destruction, and adverse remodeling can lead to persistent ventricular dysfunction and dilated cardiomyopathy. Asymptomatic. Age groups: Any age group. Most common in Children 1 -10 years.

6. PROBLEMS WITH MYOCARDITIS: Difficult to diagnose many cases missed and so its previously underappreciated role in sudden dysrhythmia death. Morbidity and mortality data are difficult to construct.

7. CONT. Most cases are viral but PCR needed for confirmation. If these patients survive the first 3-4 weeks of illness they have near 100% recovery and far fewer long- term complications compared with those patients with more indolent courses.

8. CLASSIFICATION OF MYOCARDITIS: Primary: Inflammation and myocyte damage without a clear etiologic agent. Secondary: Myocarditis caused by HIV directly or by an opportunistic pathogen.

10. ETIOLOGICAL FACTORS: A- Infection: 1- Viruses (E.g. Coxsackievirus, ECHO, Influenza, HIV, Cytomegalovirus) 2- Bacteria Chlamydiae (e.g. C.psittaci), rickettsiae(e.g. R.typhi, typhus fever), Corynebacterium diphtheriae, Neisseria meningococcus, Borrelia (Lyme disease)

11. CONT. 3- Fungi (e.g. candida) 4- Parasite  Protozoa (E.g. trypanosoma cruzi "Chagas disease“(GIT), toxoplamosis)  Helmimths (E.g. trichinosis)

12. CONT. 2- Immune-Mediated Reactions: Postviral Poststreptococcal (Rheumatic Fever) Systemic Lupus Erythromatosus Drug Hypersensitivity (E.g. methyldopa, sulfonamides) Transplant Rejection

13. CONT. 3- Unknown: Sacoidosis Giant cell myocarditis

14. PREVENTION: The condition does not have specific preventive measures, but almost all efforts are to preventing the occurrence of threatening infections: 1- Practicing good hygiene. 2- Vaccinations for diphtheria and polio should be kept current.

15. CONT. 3- Avoid taking non prescribed drugs or even higher dosage of prescribed drugs by yourself. 4- Prompt treatment of diseases that can lead to myocarditis may reduce the risk of developing this condition.

16. MANAGEMENT: Treatment of myocarditis depends on the cause and severity of condition. 1- Bed rest is essential, and avoids activates that increase cardiac workload. 2- Administration of supplemental oxygen. 3- Antipyretics, other than NSAIDs for fever and analgesics for pain.

17. CONT. 4- Patient with congestive heart failure treated by administration of sodium and fluids and diuretics, ACE inhibitors, β-blockers and spironolactone. 5- Anticoagulants e.g. warfarin to prevent blood clots. 6- Immunosuppressive therapy may be used if myocarditis is due to an autoimmune disorder such as lupus.

18. CONT. 7- If the cause is a bacterial infection, antibiotics are prescribed 8- If it is viral, antiviral agents will be prescribed. 9- For patients who have suffered severe damage to the heart, a heart transplant might be the only choice left.

19. SUMMARY Define myocarditis Classify myocarditis

20. REFERENCES Dr. nassima lect. Robbins basis pathology

21. ANY QUESTIONs

22. THANK YOU