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| ===Right ventricle=== | | ===Right ventricle=== |
| *Make cut throught the apex (transverse/biventicular section). | | *Make cut through the apex (transverse/biventicular section). |
| *Open along lateral edge (from RA cut). | | *Open along lateral edge (from RA cut). |
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| ==Standard sections== | | ==Standard sections== |
| Minimalist approach (Cybulsky): | | Minimalist approach (Dr. C.): |
| #LV and PPM (left ventricle and posterior papillary muscle). | | #LV and PPM (left ventricle and posterior papillary muscle). |
| #LV and APM (left ventricle and anterior papillary muscle). | | #LV and APM (left ventricle and anterior papillary muscle). |
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| #RV. | | #RV. |
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| Make the lab work hard approach (Butany): | | Make the lab work hard approach (Dr. B.): |
| #PRV (post. RV) with tricuspid valve. | | #PRV (post. RV) with tricuspid valve. |
| #ARV (ant. RV) with pulm. valve. | | #ARV (ant. RV) with pulm. valve. |
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| The pathologist (like radiologists) can say... | | The pathologist (like radiologists) can say... |
| *Pericardial [[effusion]]. | | *[[Pericardial]] [[effusion]]. |
| **Hemopericardium. | | **Hemopericardium. |
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| *[[Myocardial infarction]] (MI). | | *[[Myocardial infarction]] (MI). |
| **Classically occurs at 2-3 days following a MI.<ref name=Ref_PCPBoD8_293>{{Ref PCPBoD8|293}}</ref> | | **Classically occurs at 2-3 days following a MI.<ref name=Ref_PCPBoD8_293>{{Ref PCPBoD8|293}}</ref> |
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| | Note: |
| | *Roberts suggests that ''pericardial heart disease'' may be a better term for this, as this isn't really an inflammatory process.<ref name=pmid16200146>{{Cite journal | last1 = Roberts | first1 = WC. | title = Pericardial heart disease: its morphologic features and its causes. | journal = Proc (Bayl Univ Med Cent) | volume = 18 | issue = 1 | pages = 38-55 | month = Jan | year = 2005 | doi = | PMID = 16200146 }}</ref> |
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| ===Gross=== | | ===Gross=== |
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| *Fibrin - pink amorphous material. | | *Fibrin - pink amorphous material. |
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| | Note: |
| | *Inflammation is not a strict requirement for the diagnosis.<ref name=pmid16200146>{{Cite journal | last1 = Roberts | first1 = WC. | title = Pericardial heart disease: its morphologic features and its causes. | journal = Proc (Bayl Univ Med Cent) | volume = 18 | issue = 1 | pages = 38-55 | month = Jan | year = 2005 | doi = | PMID = 16200146 }}</ref> |
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| Images: | | Images: |
| *[http://autopsy.stanford.edu/images/FibrinousPericarditis.jpg Fibrinous pericarditis (stanford.edu)].<ref>URL: [http://autopsy.stanford.edu/fellowships.html http://autopsy.stanford.edu/fellowships.html]. Accessed on: 21 January 2012.</ref> | | *[http://autopsy.stanford.edu/images/FibrinousPericarditis.jpg Fibrinous pericarditis (stanford.edu)].<ref>URL: [http://autopsy.stanford.edu/fellowships.html http://autopsy.stanford.edu/fellowships.html]. Accessed on: 21 January 2012.</ref> |
| *[http://commons.wikimedia.org/wiki/File:Pericarditis_fibrinosa.jpg Fibrinous pericarditis (WC)].
| | <gallery> |
| | Image:Pericarditis_fibrinosa.jpg | Fibrinous pericarditis. (WC) |
| | </gallery> |
| | |
| | ===Sign out=== |
| | <pre> |
| | Pericardium, Excision: |
| | - Fibrinous pericardial heart disease. |
| | </pre> |
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| ==Myocardial infarction== | | ==Myocardial infarction== |
| *Abbreviated ''MI''. | | *Abbreviated ''MI''. |
| *[[AKA]] ''myocardial infarct''. | | *[[AKA]] ''myocardial infarct''. |
| ===Clinical===
| | {{Main|Myocardial infarction}} |
| *Usually diagnosed clinically - with blood work (troponin, CK-MB) or EKG.
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| *MI may be precipitated by cocaine use... and further exacerbated by treatment with a beta-blocker.<ref name=pmid19127137>{{cite journal |author=Mohamad T, Kondur A, Vaitkevicius P, Bachour K, Thatai D, Afonso L |title=Cocaine-induced chest pain and beta-blockade: an inner city experience |journal=Am J Ther |volume=15 |issue=6 |pages=531-5 |year=2008 |pmid=19127137 |doi=10.1097/MJT.0b013e3181758cfc |url=}}</ref>
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| *Acute myocardial infarction (abbreviated AMI) = MI < 6 hours old.<ref name=pmid19258462>{{Cite journal | last1 = Senter | first1 = S. | last2 = Francis | first2 = GS. | title = A new, precise definition of acute myocardial infarction. | journal = Cleve Clin J Med | volume = 76 | issue = 3 | pages = 159-66 | month = Mar | year = 2009 | doi = 10.3949/ccjm.75a.08092 | PMID = 19258462 | URL = http://www.ccjm.org/content/76/3/159.full }}</ref>
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| **Usually no [[PMN]] infiltrate.
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| Classic symptoms:
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| *Retrosternal chest pain +/- with radiation down the arms.
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| *Nausea & vomiting.
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| *Diaphoresis.
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| Enzymatic tests:<ref>URL: [http://pro2services.com/Lectures/Fall/CardEnz/a6mienz.gif http://pro2services.com/Lectures/Fall/CardEnz/a6mienz.gif]. Accessed on: 27 April 2012.</ref>
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| *CK: peaks at day 1, resolves after 2-3 days.
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| *AST: peaks close to day 2, resolves after 4-5 days.
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| *LDH: peaks day 2, resolves after ~6 days.
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| Complications of MI:<ref name=Ref_PCPBoD8_293>{{Ref PCPBoD8|293}}</ref>
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| *Contractile dysfunction.
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| *[[Cardiac arrhythmia]].
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| *Aneurysm formation, e.g. left ventricular aneurysm.
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| *Ventricular rupture:
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| **Ventricular free wall rupture.
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| **Ventricular septal rupture.
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| *[[Fibrinous pericarditis]].
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| **''Dressler's syndrome'' [[AKA]] ''postmyocardial infarction syndrome''<ref name=pmid5039567>{{cite journal |author=Hutchcroft BJ |title=Dressler's syndrome |journal=Br Med J |volume=3 |issue=5817 |pages=49 |year=1972 |month=July |pmid=5039567 |pmc=1788531 |doi= |url=}}</ref>; pericarditis post-myocardial infarction +/- pericardial effusion (clinically tamponade).
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| *Mural thrombosis.
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| *Extension of MI.
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| ===Pathologic===
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| ====Gross====
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| Sequence:<ref>[http://library.med.utah.edu/WebPath/TUTORIAL/MYOCARD/MYOCARD.html http://library.med.utah.edu/WebPath/TUTORIAL/MYOCARD/MYOCARD.html]</ref>
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| *18-24 hours - myocardial pallor.
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| *1-3 days - pallor, moderate hyperemia (redness due to congestion with blood).
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| *3-7 days - yellow lesion with hyperemic border.
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| *10-21 days - maximally yellow.
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| *6 weeks - white (fibrosis).
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| ====Microscopic====
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| Sequence:<ref>[http://library.med.utah.edu/WebPath/TUTORIAL/MYOCARD/MYOCARD.html http://library.med.utah.edu/WebPath/TUTORIAL/MYOCARD/MYOCARD.html]</ref>
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| *1-3 hours - Wavy (myocardial) fibers
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| *4-12 hours - Coagulative [[necrosis]] & loss of cross striations, [[contraction band necrosis|contraction bands]], edema, hemorrhage, PMN infiltrate.
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| *18-24 hours - Coagulative necrosis, pyknosis of nuclei, and marginal contraction bands.
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| *1-3 days - Loss of nuclei (karyolysis), loss of striations, abundant PMNs.
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| *3-7 days - Macrophage and mononuclear infiltration, fibrovascular response.
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| *10-21 days - Fibrovascular response, prominent granulation tissue.
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| *6 weeks - Fibrosis.
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| Images:
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| *[http://path.upmc.edu/cases/case158/micro.html MI (upmc.edu)].
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| =====Contraction band necrosis=====
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| General:
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| *Mediated by catecholamines.<ref>{{cite journal |author=Hopster DJ, Milroy CM, Burns J, Roberts NB |title=Necropsy study of the association between sudden cardiac death, cardiac isoenzymes and contraction band necrosis |journal=J. Clin. Pathol. |volume=49 |issue=5 |pages=403–6 |year=1996 |month=May |pmid=8707956 |pmc=500481 |doi= |url=}}</ref>
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| *Thought to arise in reperfusion from hypercontraction.
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| Microscopic:
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| *Thick intensely eosinophilic staining bands (on H&E) ~ typically 4-5 micrometres wide
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| **Span the short axis of myocyte.
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| **Can be thought of bunched-up striae.
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| Notes:
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| *Better seen with special stains (Masson or Gomori trichrome).<ref>{{cite journal |author=Hopster DJ, Milroy CM, Burns J, Roberts NB |title=Necropsy study of the association between sudden cardiac death, cardiac isoenzymes and contraction band necrosis |journal=J. Clin. Pathol. |volume=49 |issue=5 |pages=403–6 |year=1996 |month=May |pmid=8707956 |pmc=500481 |doi= |url=}}</ref>
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| ======Images======
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| <gallery>
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| Image:MI_with_contraction_bands_high_mag.jpg | CBN - high mag. (WC)
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| Image:MI_with_contraction_bands_very_high_mag.jpg | CBN - very high mag. (WC)
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| </gallery>
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| ==Coronary artery atherosclerosis== | | ==Coronary artery atherosclerosis== |
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| <math>percent\ stenosis = ( 1 - ( minimal\ diameter ) / ( poststenotic\ diameter ) ) x 100%.</math> | | <math>percent\ stenosis = ( 1 - ( minimal\ diameter ) / ( poststenotic\ diameter ) ) x 100%.</math> |
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| With a bit of allegbra one can show:<br> | | With a bit of algebra one can show:<br> |
| <math>A_x=x^2 A_o</math><br> | | <math>A_x=x^2 A_o</math><br> |
| Where: | | Where: |
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| *Hypertrophic [[cardiomyopathy]] (usually eccentric). | | *Hypertrophic [[cardiomyopathy]] (usually eccentric). |
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| | <gallery> |
| | Image: Heart_left_ventricular_hypertrophy_sa.jpg | Concentric LVH. (WC) |
| | </gallery> |
| ====Eccentric left ventricular hypertrophy==== | | ====Eccentric left ventricular hypertrophy==== |
| *[[Hypertrophic cardiomyopathy]], includes [[hypertrophic obstructive cardiomyopathy]] (HOCM). | | *[[Hypertrophic cardiomyopathy]], includes [[hypertrophic obstructive cardiomyopathy]] (HOCM). |
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| ===Congenital heart disease=== | | ===Congenital heart disease=== |
| {{main|Congenital heart disease}} | | {{main|Congenital heart disease}} |
| Congential heart disease... a domain of paediatric cardiac surgery and occasionally adult cardiac surgery.
| | Congenital heart disease... a domain of pediatric cardiac surgery and occasionally adult cardiac surgery. |
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| The article covers shunts, both left-to-right and right-to-left. | | The article covers shunts, both left-to-right and right-to-left. |
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| {{main|Sarcoidosis}} | | {{main|Sarcoidosis}} |
| ===General=== | | ===General=== |
| *Can be in insolation or part of systemic sarcoidosis.<ref name=pmid9608713>{{cite journal |author=Veinot JP, Johnston B |title=Cardiac sarcoidosis--an occult cause of sudden death: a case report and literature review |journal=J. Forensic Sci. |volume=43 |issue=3 |pages=715–7 |year=1998 |month=May |pmid=9608713 |doi= |url=}}</ref> | | *Can be in isolation or part of systemic sarcoidosis.<ref name=pmid9608713>{{cite journal |author=Veinot JP, Johnston B |title=Cardiac sarcoidosis--an occult cause of sudden death: a case report and literature review |journal=J. Forensic Sci. |volume=43 |issue=3 |pages=715–7 |year=1998 |month=May |pmid=9608713 |doi= |url=}}</ref> |
| *May mimic hypertrophic [[cardiomyopathy]] clinically.<ref name=pmid10981852>{{cite journal |author=Matsumori A, Hara M, Nagai S, ''et al.'' |title=Hypertrophic cardiomyopathy as a manifestation of cardiac sarcoidosis |journal=Jpn. Circ. J. |volume=64 |issue=9 |pages=679–83 |year=2000 |month=September |pmid=10981852 |doi= |url=}}</ref> | | *May mimic hypertrophic [[cardiomyopathy]] clinically.<ref name=pmid10981852>{{cite journal |author=Matsumori A, Hara M, Nagai S, ''et al.'' |title=Hypertrophic cardiomyopathy as a manifestation of cardiac sarcoidosis |journal=Jpn. Circ. J. |volume=64 |issue=9 |pages=679–83 |year=2000 |month=September |pmid=10981852 |doi= |url=}}</ref> |
| *Clinical: associated with heart block.<ref name=pmid9608713/> | | *Clinical: associated with heart block.<ref name=pmid9608713/> |
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| Notes: | | Notes: |
| *Myocyte necrosis and eosinophils are features of ''granulomatous myocarditis''.<ref name=pmid19660614/> | | *Myocyte necrosis and [[eosinophil]]s are features of ''granulomatous myocarditis''.<ref name=pmid19660614/> |
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| ==Myocarditis== | | ==Myocarditis== |
| ===General===
| | {{Main|Myocarditis}} |
| *Uncommon.
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| ===Gross===
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| *Not apparent on gross.
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| Grossing:
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| *Requires 10 sections to exclude;<ref>KC. 1 October 2010.</ref> sections should include right ventricle and left ventricle.
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| **It is often missed with five.<ref name=pmid9559966>{{Cite journal | last1 = Kubo | first1 = N. | last2 = Morimoto | first2 = S. | last3 = Hiramitsu | first3 = S. | last4 = Uemura | first4 = A. | last5 = Kimura | first5 = K. | last6 = Shimizu | first6 = K. | last7 = Hishida | first7 = H. | title = Feasibility of diagnosing chronic myocarditis by endomyocardial biopsy. | journal = Heart Vessels | volume = 12 | issue = 4 | pages = 167-70 | month = | year = 1997 | doi = | PMID = 9559966 }}</ref>
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| ===Microscopic===
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| Features:
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| *Inflammation.
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| *Myocyte necrosis (disputed<ref name=pmid16449736>{{Cite journal | last1 = Baughman | first1 = KL. | title = Diagnosis of myocarditis: death of Dallas criteria. | journal = Circulation | volume = 113 | issue = 4 | pages = 593-5 | month = Jan | year = 2006 | doi = 10.1161/CIRCULATIONAHA.105.589663 | PMID = 16449736 }}</ref>).
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| ====Classification====
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| Classified by the inflammatory cells present:<ref name=emedicine1612533>[http://emedicine.medscape.com/article/1612533-overview http://emedicine.medscape.com/article/1612533-overview]</ref>
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| *Eosinophilic - ''hypersensitivity myocarditis'' - most common.
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| **May be assoc. with peripheral blood eosinophilia.<ref name=pmid20181108>{{cite journal |author=Amini R, Nielsen C |title=Eosinophilic myocarditis mimicking acute coronary syndrome secondary to idiopathic hypereosinophilic syndrome: a case report |journal=J Med Case Reports |volume=4 |issue= |pages=40 |year=2010 |pmid=20181108 |pmc=2830978 |doi=10.1186/1752-1947-4-40 |url=}}</ref>
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| *Lymphocytic - viral, autoimmune.
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| *Granulomatous - infectious, [[idiopathic granulomatous myocarditis|idiopathic]].
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| *Neutrophilic.
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| *Reperfusion (associated with myocardial infarction).
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Viral_myocarditis_%281%29.JPG Myocarditis (viral) - 1 (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Viral_myocarditis_%282%29.JPG Myocarditis (viral) - 2 (WC)].
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| *[http://jmedicalcasereports.com/content/4/1/40/figure/F5 Eosinophilic myocarditis (jmedicalcasereports.com)].<ref name=pmid20181108>{{cite journal |author=Amini R, Nielsen C |title=Eosinophilic myocarditis mimicking acute coronary syndrome secondary to idiopathic hypereosinophilic syndrome: a case report |journal=J Med Case Reports |volume=4 |issue= |pages=40 |year=2010 |pmid=20181108 |pmc=2830978 |doi=10.1186/1752-1947-4-40 |url=}}</ref>
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| ==Idiopathic granulomatous myocarditis== | | ==Idiopathic granulomatous myocarditis== |
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| ==Chagas disease== | | ==Chagas disease== |
| *[[AKA]] ''American trypanosomiasis''. | | *[[AKA]] ''American trypanosomiasis''. |
| | | {{Main|Chagas disease}} |
| ===General===
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| *Essentially a South American disease.
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| *Etiology: protozoa ''Trypanosoma cruzi'' - transmitted by ''reduvid bugs'',<ref name=PMH0002348>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002348/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002348/]. Accessed on: 4 December 2011.</ref> also known as ''kissing bug''.<ref>URL: [http://www.who.int/topics/chagas_disease/en/ http://www.who.int/topics/chagas_disease/en/]. Accessed on: 1 December 2011.</ref>
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| Clinical:<ref name=pmid17072450>{{Cite journal | last1 = Teixeira | first1 = AR. | last2 = Nascimento | first2 = RJ. | last3 = Sturm | first3 = NR. | title = Evolution and pathology in chagas disease--a review. | journal = Mem Inst Oswaldo Cruz | volume = 101 | issue = 5 | pages = 463-91 | month = Aug | year = 2006 | doi = | PMID = 17072450 |URL = http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762006000500001&lng=en&nrm=iso&tlng=en }}</ref>
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| *Depends on phase of infection.
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| *[[cardiac arrhythmia|Arrhythmia]]s (late).
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| Dx:<ref>URL: [http://www.cdc.gov/parasites/chagas/diagnosis.html http://www.cdc.gov/parasites/chagas/diagnosis.html]. Accessed on: 4 December 2011.</ref>
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| *Usually serology.
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| *Thin blood smear.
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| Tx:
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| *Antimicrobials: benznidazole, nifurtimox.<ref name=PMH0002348/>
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| ===Microscopic===
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| Features:
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| *Inflammation - main finding.<ref name=pmid17072450/>
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| *Intramuscular organisms (without an inflammatory response).
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| *Neuronal loss in atrial ganglia.<ref name=pmid17339569/>
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| DDx:
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| *[[Toxoplasmosis]].<ref>URL: [http://path.upmc.edu/cases/case160/micro.html http://path.upmc.edu/cases/case160/micro.html]. Accessed on: 8 January 2012.</ref> (???)
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| Images:
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| *[http://www.uaz.edu.mx/histo/pathology/ed/ch_9c/c9c_chagas.htm Chagas disease (uaz.edu.mx)].
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| *[http://cardiovascres.oxfordjournals.org/content/60/1/96/F1.expansion.html Chagas disease (oxfordjournals.org)].<ref>{{Cite journal | last1 = Higuchi | first1 = Mde L. | last2 = Benvenuti | first2 = LA. | last3 = Martins Reis | first3 = M. | last4 = Metzger | first4 = M. | title = Pathophysiology of the heart in Chagas' disease: current status and new developments. | journal = Cardiovasc Res | volume = 60 | issue = 1 | pages = 96-107 | month = Oct | year = 2003 | doi = | PMID = 14522411 }}</ref>
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| ===IHC===
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| *Anti–T cruzi immunoperoxidase.<ref name=pmid17339569>{{Cite journal | last1 = Marin-Neto | first1 = JA. | last2 = Cunha-Neto | first2 = E. | last3 = Maciel | first3 = BC. | last4 = Simões | first4 = MV. | title = Pathogenesis of chronic Chagas heart disease. | journal = Circulation | volume = 115 | issue = 9 | pages = 1109-23 | month = Mar | year = 2007 | doi = 10.1161/CIRCULATIONAHA.106.624296 | PMID = 17339569 |URL = http://circ.ahajournals.org/content/115/9/1109.long }}</ref>
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| ==Cardiac amyloidosis== | | ==Cardiac amyloidosis== |