La Miocarditis es una condición de difícil diagnóstico, en la búsqueda de facilitar su rápido tratamiento y así mejorar la calidad de vida del paciente, siempre se buscan los mejores medios y criterios para lograr descubrirla.
El diagnóstico patológico ha sido el único formalmente aprobado, por ende la biopsia es la prueba dx estándar. Los criterios Dallas constan siemplemente de dos hallazgos:
1. Presencia de células inflamatorias.
2. Necrosis del tejido celular.
Otros criterios usados en clínica se muestran en esta tabla, extraída del libro de Cardiología de Braunwald 8ed.
TABLE 66-2 -- Expanded Criteria for Diagnosis of Myocarditis
| Suspicious for myocarditis = 2 positive categories |
| Compatible with myocarditis = 3 positive categories |
| High probability of being myocarditis = all 4 categories positive |
| (Any matching feature in category = positive for category) |
| | | Category I: Clinical Symptoms |
| | | Clinical heart failure |
| | | Fever |
| | | Viral prodrome |
| | | Fatigue |
| | | Dyspnea on exertion |
| | | Chest pain |
| | | Palpitations |
| | | Presyncope or syncope |
|
| | | Category II: Evidence of Cardiac Structural/Functional Perturbation in the Absence of Regional Coronary Ischemia |
| | | Echocardiography evidence |
| | | Regional wall motion abnormalities |
| | | Cardiac dilation |
| | | Regional cardiac hypertrophy |
| | | Troponin release |
| | | High sensitivity (>0.1 ng/ml) |
| | | Positive indium-111 antimyosin scintigraphy |
| | | and |
| | | Normal coronary angiography or |
| | | Absence of reversible ischemia by coronary distribution on perfusion scan |
|
| | | Category III: Cardiac Magnetic Resonance Imaging |
| | | Increased myocardial T2 signal on inversion recovery sequence |
| | | Delayed contrast enhancement following gadolinium-DTPA infusion |
|
| | | Category IV: Myocardial Biopsy—Pathological or Molecular Analysis |
| | | Pathology findings compatible with Dallas criteria |
| | | Presence of viral genome by polymerase chain reaction or in situ hybridization |
|
Un dato útil:
Myocarditis as a diagnosis should be suspected when a young patient presents with unexplained symptoms of heart failure or chest pain, but the coronary arteries are found to be normal on angiography.
No hay comentarios:
Publicar un comentario