ramipril and Myocarditis

We report of a 26-year-old female patient who was referred to our centre with congestive heart failure (CHF). Acute myocarditis with a high Parvovirus B19 virus load was diagnosed by myocardial biopsy. CHF improved after start of ramipril 5 mg/d, metoprolol, diuretics, immunoglobins, and a 24-hour infusion of levosimendan. Soon after initiation of medical therapy, the patient started to expectorate bronchial casts with varying frequencies (three times per week to five times daily). Thorough pneumological workup, including histology of the casts, microbiology, and a CT scan of the lungs, did not reveal any cause for bronchial cast formation. Inhalative corticoids were started without any benefit. Two years later, cardiac catheterisation demonstrated normalised left ventricular function. LV end-diastolic pressure, however, was still elevated at 14 mmHg. Endomyocardial biopsies at this time were negative for virus genome. Finally, we changed afterload reduction therapy from ramipril to candesartan. Within 24 hours, expectoration of bronchial casts terminated. Four weeks later, re-exposition to ramipril prompted immediate re-appearance of cast formation, which again stopped with switching back to candesartan. Finally, we were to prove that treatment with ramipril resulted in bronchial cast formation in this patient.

Topics: Adrenergic beta-1 Receptor Antagonists; Adult; Angiotensin-Converting Enzyme Inhibitors; Bronchi; Female; Heart Failure; Humans; Metoprolol; Myocarditis; Parvoviridae Infections; Parvovirus B19, Human; Ramipril

Topics: Adult; Colitis; Electrocardiography; Humans; Male; Myocarditis; Pericarditis; Ramipril; Sulfasalazine; Treatment Outcome

Case report A 28 year old gentleman presented after an episode of collapse with loss of consciousness. He gave a history of non-specific malaise and myalgia over the previous 7 days, with fever, a generalised rash and a non productive cough. He developed progressive shortness of breath with sharp, pleuritic chest pain that was unresponsive to antibiotics in the community.

Topics: Adult; Bisoprolol; Blood Chemical Analysis; Drug Therapy, Combination; Echocardiography, Doppler; Electrocardiography; Emergency Service, Hospital; Follow-Up Studies; Heart Failure, Systolic; Humans; Magnetic Resonance Imaging; Male; Myocarditis; Radiography, Thoracic; Ramipril; Risk Factors; Stroke Volume; Syncope; Treatment Outcome; Ventricular Dysfunction, Left

The case of woman with dysfunction of left ventricle (LV) possible due to Hodgkin's lymphoma treatment and following myocarditis is presented. Triple therapy with carvedilol, ramipril and spironolactone was continued to prevent further LV remodeling. During 3-years follow-up repeated echocardiographic examinations revealed gradual improvement of LV function and clinical condition of the patient. Results of current studies suggest benefits of early implementation of aldosterone antagonist therapy in addition to ACE-inhibitors/angiotensin receptors blockers and beta-blockers in patients with chronic heart failure.

Topics: Adrenergic beta-Antagonists; Adult; Angiotensin-Converting Enzyme Inhibitors; Carbazoles; Carvedilol; Drug Therapy, Combination; Female; Follow-Up Studies; Hodgkin Disease; Humans; Mineralocorticoid Receptor Antagonists; Myocarditis; Propanolamines; Ramipril; Spironolactone; Ventricular Dysfunction, Left; Ventricular Function, Left

Topics: Acute Disease; Adolescent; Electrocardiography; Humans; Ibuprofen; Influenza A Virus, H1N1 Subtype; Influenza, Human; Male; Myocarditis; Pandemics; Ramipril; Treatment Outcome