The heart in Wegener's granulomatosis

Revision as of 03:29, 25 March 2009 by Zorkun (talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

WikiDoc Resources for The heart in Wegener's granulomatosis

Articles

Most recent articles on The heart in Wegener's granulomatosis

Most cited articles on The heart in Wegener's granulomatosis

Review articles on The heart in Wegener's granulomatosis

Articles on The heart in Wegener's granulomatosis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on The heart in Wegener's granulomatosis

Images of The heart in Wegener's granulomatosis

Photos of The heart in Wegener's granulomatosis

Podcasts & MP3s on The heart in Wegener's granulomatosis

Videos on The heart in Wegener's granulomatosis

Evidence Based Medicine

Cochrane Collaboration on The heart in Wegener's granulomatosis

Bandolier on The heart in Wegener's granulomatosis

TRIP on The heart in Wegener's granulomatosis

Clinical Trials

Ongoing Trials on The heart in Wegener's granulomatosis at Clinical Trials.gov

Trial results on The heart in Wegener's granulomatosis

Clinical Trials on The heart in Wegener's granulomatosis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on The heart in Wegener's granulomatosis

NICE Guidance on The heart in Wegener's granulomatosis

NHS PRODIGY Guidance

FDA on The heart in Wegener's granulomatosis

CDC on The heart in Wegener's granulomatosis

Books

Books on The heart in Wegener's granulomatosis

News

The heart in Wegener's granulomatosis in the news

Be alerted to news on The heart in Wegener's granulomatosis

News trends on The heart in Wegener's granulomatosis

Commentary

Blogs on The heart in Wegener's granulomatosis

Definitions

Definitions of The heart in Wegener's granulomatosis

Patient Resources / Community

Patient resources on The heart in Wegener's granulomatosis

Discussion groups on The heart in Wegener's granulomatosis

Patient Handouts on The heart in Wegener's granulomatosis

Directions to Hospitals Treating The heart in Wegener's granulomatosis

Risk calculators and risk factors for The heart in Wegener's granulomatosis

Healthcare Provider Resources

Symptoms of The heart in Wegener's granulomatosis

Causes & Risk Factors for The heart in Wegener's granulomatosis

Diagnostic studies for The heart in Wegener's granulomatosis

Treatment of The heart in Wegener's granulomatosis

Continuing Medical Education (CME)

CME Programs on The heart in Wegener's granulomatosis

International

The heart in Wegener's granulomatosis en Espanol

The heart in Wegener's granulomatosis en Francais

Business

The heart in Wegener's granulomatosis in the Marketplace

Patents on The heart in Wegener's granulomatosis

Experimental / Informatics

List of terms related to The heart in Wegener's granulomatosis

Cardiology Network

Discuss The heart in Wegener's granulomatosis further in the WikiDoc Cardiology Network
Adult Congenital
Biomarkers
Cardiac Rehabilitation
Congestive Heart Failure
CT Angiography
Echocardiography
Electrophysiology
Cardiology General
Genetics
Health Economics
Hypertension
Interventional Cardiology
MRI
Nuclear Cardiology
Peripheral Arterial Disease
Prevention
Public Policy
Pulmonary Embolism
Stable Angina
Valvular Heart Disease
Vascular Medicine

Template:WikiDoc Cardiology News Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor: Cafer Zorkun, M.D., Ph.D. [2]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

Cardiac involvement in Wegener's granulomatosis is not as uncommon as generally thought, and ranges in prevalence from 6 to 44% of patients. It may take many forms and varies from the principal clinical manifestation of the disease to a mild or subclinical manifestation of the disease. Cardiac involvement should be actively sought in patients with Wegener's granulomatosis and should be considered in patients with non specific illness.[1] [2] [3] [4] [5] [6] [7]

Pericarditis

Pericarditis and effusion have been reported either as the sole manifestation of the disease or in conjunction with other cardiac abnormalities. Pericardial involvement may be found unexpectedly on postmortem examination, it may present acutely as tamponade or it may present as chronic constrictive pericarditis. In a some cases, pericarditis may not be a primary manifestation of the disease but may be a secondary manifestation due to myocardial infarction or uremia due to renal involvement.

Arteritis

Generalized arteritis may be associated with a systemic illness with fever, malaise, and weight loss, which may mimic infective endocarditis. A more localized form of arteritis has also been recognized, which affects for instance the coronary arteries and may produce coronary artery stenoses, myocardial infarction and even death in rare cases.

Aortitis

Inflammation may also involve the aorta both proximally, causing dilatation and distally, causing retroperitoneal inflammation. Diagnosing of proximal aortic involvement was previously noted at postmortem examination before newer imaging modalities as MSCT, MRI and transesophageal echocardiography.

Myocarditis

Myocarditis with granulomata can be associated with acute congestive heart failure. It may later progress to cardiomyopathy. The carditis may also affect the atria or produce mass lesions within the ventricles. These in turn may result in arrhythmia or obstruction. Some patients develop both a tachyarrhythmia and a detectable gradient across the left ventricular outflow tract.

To date few patients with a cardiac mass due to Wegener's granulomatosis have undergone surgical resection, although appropriate chemotherapy may induce regression of the mass.

Valvulitis

Valve abnormalities may occur secondary to dilatation of the aortic root or left ventricle, but primary valvulitis has also been reported. It occurs both alone and as part of either widespread endocarditis or pancarditis. This form of the disease may result in a mistaken diagnosis of culture negative infective endocarditis which fails to respond to antibiotic therapy and may delay the initiation of appropriate and potentially lifesaving treatment.

Cardiac Arrhythmias

Conduction abnormalities have been reported, possibly as a result of granuloma involving the conduction system or arteritis of the atrioventricular nodal artery. All degrees of conduction defect are recognized, from intraventricular conduction delays through first and second degree heart block to complete heart block. These may require permanent pacing but will occasionally respond to pharmacotherapy.

The most common arrhythmias are atrial tachycardia and atrial fibrillation or flutter. Ventricular arrhythmia has been noted in association with dilated cardiomyopathy, ischemia and secondary to cardiac masses.

References

  1. Goodfield N E R, Bhandari S, Plant W D, Morley-Davies A, Sutherland G R, Cardiac involvement in Wegener's granulomatosis, Br Heart J 1995;73:110-115
  2. ACP Medicine, 2007, Dale D C, Federman D D
  3. Mayo linic Cardiology, Concise Textbook, 3rd edition, 2007
  4. Hurst's The Heart, Fuster V, 11th (printed) and 12th (online) editions, 2004-2008
  5. NMS Medicine, 6th Edition, 2008
  6. Oxford Textbook of Medicine 4th edition (March 2003)
  7. Harris: Kelley's Textbook of Rheumatology, 7th ed. 2005

Template:SIB


Template:WikiDoc Sources