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      MRSA-Associated Bacterial Myocarditis Causing Ruptured Ventricle and Tamponade

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          Abstract

          We report a case of an 81-year-old man with bacterial myocarditis presenting with elevated troponins and sepsis, who succumbed due to a ruptured ventricle. The infecting organism was found to be methicillin-resistant Staphylococcus aureus. Bacterial myocarditis is a rare occurrence when independent of infective endocarditis. Generally, this is a complication of bacteremia that is discovered post-mortem. Rarely, as in our patient, it causes significant necrosis of the myocardium leading to rupture of a ventricle. As with viral myocarditis, this disease can present with signs and symptoms of acute myocardial infarction, complicating the diagnosis. Much of the available data on bacterial myocarditis was collected before the development of many modern diagnostic tests and before antibiotics. Accordingly, the appropriate workup, diagnosis and treatment remain unclear. Our patient represents the first reported case of ventricular rupture due to methicillin-resistant S. aureus-associated bacterial myocarditis.

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          Most cited references 6

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          MRI changes in myocarditis--evaluation with spin echo, cine MR angiography and contrast enhanced spin echo imaging.

          Myocarditis is probably under-diagnosed with clinical criteria generally used for diagnosis. Magnetic resonance imaging (MRI) has shown promise in detecting heart muscle disorders and we set out to assess the role of cine magnetic resonance angiography (MRA) and contrast enhancement in myocarditis, as there is a need for a non-invasive tool that can aid prognosis and follow-up. Twenty patients were evaluated with T1 SE pre- and post-gadolinium enhancement and cine MRA. Four patients were histologically proven to have myocarditis, eight others were diagnosed as having myocarditis by clinical criteria and eight did not have myocarditis. Images were evaluated in a blinded fashion for regional wall motion abnormality and contrast enhancement pattern. Analysis of contrast enhancement by signal intensity measurement was also performed. Focal myocardial enhancement with associated regional wall motion abnormality correlated with myocarditis in 10 out of 12 patients, two patients with abnormal focal enhancement alone also clinically had myocarditis. None of the non-myocarditis patients showed abnormal focal enhancement. Enhancement analysis suggests that focal corrected myocardial enhancement of > 40% is abnormal. In the correct clinical context, focal myocardial enhancement on spin echo MRI strongly supports a diagnosis of myocarditis, especially when associated with regional wall motion abnormality.Roditi, G. H. (2000). Clinical Radiology55, 752-758. Copyright 2000 The Royal College of Radiologists.
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            Primary bacterial infection of the myocardium.

            Primary bacterial infection of myocardial tissue without associated endocarditis occurs only rarely. It is generally seen in the setting of overwhelming bacteremia. The most common bacterial cause of myocarditis is Staphylococcus aureus, although infections with a broad range of bacterial pathogens have been described. Pathologically, the disease process is characterized by multifocal studding of the myocardium with tiny abscesses, and the left ventricle is most commonly involved. Complications include cardiac dysfunction, rhythm disturbances, and myocardial rupture with secondary purulent pericarditis. Since virtually all information regarding primary bacterial myocarditis originates from autopsy studies conducted in the pre-antibiotic era, little is known about the modern approach to diagnosis and management of this clinical entity.
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              ABSCESS OF THE MYOCARDIUM

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2008
                September 2008
                25 April 2008
                : 111
                : 3
                : 188-190
                Affiliations
                Departments of aMedicine, and bPathology, Emory University School of Medicine, Atlanta, Ga., cAtlanta Veterans Affairs Medical Center, Decatur, Ga., and dEmory University School of Medicine, Atlanta, Ga., USA
                Article
                121602 Cardiology 2008;111:188–190
                10.1159/000121602
                18434723
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, References: 12, Pages: 3
                Categories
                Novel Insights from Clinical Experience

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