Document Detail

Parvovirus B19 infection mimicking acute myocardial infarction.
MedLine Citation:
PMID:  12925460     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Enteroviruses (EVs) and adenoviruses (ADVs) have been considered common causes of myocarditis and dilated cardiomyopathy. In the present study, we report on the association of parvovirus B19 (PVB19) genomes in the clinical setting of acute myocarditis. METHODS AND RESULTS: This study included 24 consecutive patients admitted to our hospital within 24 hours after onset of chest pain. Acute myocardial infarction had been excluded in all patients by coronary angiography. Endomyocardial biopsies were analyzed by nested polymerase chain reaction/reverse transcriptase-polymerase chain reaction for EV, ADV, PVB19, human cytomegalovirus, Epstein-Barr virus, Chlamydia pneumoniae, influenza virus A and B, and Borrelia burgdorferi genomes, respectively, followed by direct sequencing of the amplification products. All patients presented with acute onset of angina pectoris and ST-segment elevations or T-wave inversion mimicking acute myocardial infarction. Mean baseline peak creatinine kinase and creatine kinase-isoenzyme fraction were 342+/-241 U/L and 32+/-20 U/L, respectively. Mean troponin T was increased to 7.5+/-15.0 ng/mL and C-reactive protein to 91+/-98 mg/mL. Eighteen patients had global or regional wall motion abnormalities (ejection fraction 62.5+/-15.5%). Histological analysis excluded the presence of active or borderline myocarditis in all but one patient. PVB19, EV, and ADV genomes were detected in the myocardium of 12, 3, and 2 patients, respectively (71%). Follow-up biopsies of virus-positive patients (11 of 17) demonstrated persistence of PVB19 genomes in 6 of 6 patients, EV genomes in 2 of 3 patients, and ADV genomes in 1 of 2 patients, respectively. CONCLUSIONS: Virus genomes can be demonstrated in 71% of patients with normal coronary anatomy, clinically mimicking acute myocardial infarction. In addition to EVs and ADVs, PVB19 was the most frequent pathogen.
Uwe Kühl; Matthias Pauschinger; Thomas Bock; Karin Klingel; C Peter Lothar Schwimmbeck; Bettina Seeberg; Lars Krautwurm; Wolfgang Poller; Heinz-Peter Schultheiss; Reinhard Kandolf
Publication Detail:
Type:  Case Reports; Journal Article     Date:  2003-08-18
Journal Detail:
Title:  Circulation     Volume:  108     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-26     Completed Date:  2003-09-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  945-50     Citation Subset:  AIM; IM    
Medical Clinic II, Department of Cardiology, University Hospital Benjamin Franklin, Berlin, Germany.
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MeSH Terms
Acute Disease
Angina Pectoris / etiology
Chest Pain / etiology
Coronary Angiography
DNA, Viral / analysis,  genetics
Diagnosis, Differential
Follow-Up Studies
Heart / virology
Middle Aged
Myocardial Infarction / complications,  diagnosis*,  virology
Myocarditis / complications,  diagnosis*,  virology
Myocardium / pathology
Parvoviridae Infections / complications,  diagnosis*,  virology
Parvovirus B19, Human / genetics,  isolation & purification*
Polymerase Chain Reaction
Viruses / genetics,  isolation & purification*
Reg. No./Substance:
0/DNA, Viral
Comment In:
Circulation. 2004 Apr 13;109(14):e179   [PMID:  15078808 ]

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