Miyokardit

Miyokardit, kalp kasının yangısal hastalığıdır. Canlı etkenler, otoimmun hastalıklar (kollagen hastalıkları), genetik faktörler ve çevresel etkiler miyokarditlerin başlıca nedenleridir. Bebeklerde ve çocuklarda görülen (pediatrik) olguların %82'sinin nedeni anlaşılamamaktadır (idiopatik).

İnfeksiyon hastalıklarında görülen miyokarditler

Miyokardit, çok sayıda infeksiyon hastalığında kalp yetmezliği ve ölüme neden olan bir komplikasyondur.[1][2][3]

Viral miyokardit

Çok sayıda virüs miyokardit yapabilmektedir: Enterovirus, coxsackie B, adenovirus, influenza, çocuk felci (poliomyelitis), HIV, virüs hepatitleri, kabakulak, kızamık, zona, çiçek hastalığı, arbovirus, respiratory syncytial virus, herpes virüsler (uçuk, cytomegalovirus, EBV), sarı humma, kuduz, parvovirus.

Viral myocardit patolojisi

Kalp bulguları viral infeksiyonun ilk günlerde başlar; miyokarditin oluşma mekanizmasında (patofizyolojisinde) canlı etkenin doğrudan etkisi kadar kalp kası dokusuyla immunolojik çapraz reaksiyona girmesi önem kazanır. Son yıllarda özellikle dikkatleri üzerinde toplayan HIV infeksiyonunda (AIDS) oluşan miyokarditlerde, virüsün doğrudan etkisinin yanı sıra çıkarcı mikropların infeksiyonları da etkilidir.

Bakteriyel miyokarditler

Difteri, tüberküloz, streptokoklar, meningokoklar, bruselloz, clostridia, stafilokoklar, melioidosis, Mycoplasma pneumoniae, psittakoz, spiroketler (sifilis, leptospiroz/Weil hastalığı, Borreliosis), riketsiya infeksiyonları (tifüs, Rocky Mountain lekeli humması, Q humması) miyokardit oluşmasında etkili bakterilerdir.

Mantar miyokarditleri

Candidiasis, aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, coccidioidomycosis, mucormycosis miyokardit yapabilen mantarların başlıcalarıdır.

Parazitik miyokarditler

Mikroparazitler olan protozoonların neden olduğu Chagas hastalığı, toksoplasmozis, trypanosomiasis, malarya, leishmaniasis, balantidiasis, sarcosporidiosis olgularında miyokardit oluşabilmektedir. Makroparazit olan helmintlerin etkili olduğu miyokarditler trişinoz, ekinokokkoz, schistosomiasis, cysticercosis, viseral larva migrans, filariazis gibi infeksiyonlarda görülür. Örnek: Trypanosoma cruzi parazitinin neden olduğu Chagas hastalığında hastaların çoğunda miyokardit bulguları gelişir. Hastaların %10'u akut evrede kaybedilir; %90'ında 10-20 yıl içinde kalp yetmezliği gelişebilir.

İnfeksiyon olmaksızın görülen yangısal miyokarditler

İmmun kökenli (romatizmal ateş, SLE, RA, aşırıduyarlık miyokarditi) miyokarditlerdir. Başlıcaları:[1][2][3]

Kaynakça

  1. ^ a b Ponikowski P, Voors AA, Anker SD, et al.  2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure (Review), 18 (8): 891–975, 2016
  2. ^ a b Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th edt., Elsevier Saunders, Philadelphia, 2015
  3. ^ a b Lilly LS. Pathophysiology of heart disease, 5th edition, Harvard Medical School, Wolters, Baltimore, 2011
  4. ^ Yücesoy G, Bodur H, Özkan S, Tekin A. HELLP Sendromlu ve Ağır Preeklamptik İki Farklı Olguda Peripartum Kardiyomyopati. Türkiye Klinikleri J Gynecol Obst., 15(6):328-332, 2005

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