Autoimmune heart disease

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Autoimmune heart diseases are the effects of the body's own immune defense system mistaking cardiac antigens as foreign and attacking them leading to inflammation of the heart as a whole, or in parts. The commonest form of autoimmune heart disease is rheumatic heart disease or rheumatic fever.

Cause

Aetiologically, these are most commonly seen in children with a history of sore throat caused by a streptococcal infection. This is similar to the post-streptococcal glomerulonephritis. Here, the anti-bacterial antibodies cross react with the heart antigens causing inflammation.^{[citation needed]}

Inflammatory damage leads to the following:^[1]^[2]

Pericarditis: Here the pericardium gets inflamed. Acutely, it can cause pericardial effusion leading to cardiac tamponade and death. After healing, there may be fibrosis and adhesion of the pericardium with the heart leading to constriction of the heart and reduced cardiac function.
Myocarditis: Here the muscle bulk of the heart gets inflamed. Inflamed muscles have reduced functional capacity. This may be fatal, if left untreated as is in a case of pancarditis. On healing, there will be fibrosis and reduced functional capacity.
Endocarditis: Here the inner lining of the heart is inflamed, including the heart valves. This may cause a valve prolapse, adhesion of the adjacent cusps of these valves and occlusion of the flow tracts of blood through the heart causing diseases called valve stenosis.

Mechanism

These are the typical mechanisms of autoimmunity. Autoantibodies or auto-toxic T-lymphocyte mediated tissue destruction. The process is aided by neutrophils, the complement system, tumor necrosis factor alpha, etc.^{[citation needed]}

Diagnosis

Types

These depend on the amount of inflammation. These are covered in their relevant articles.

Acute: Heart failure; pericardial effusion; etc.
Chronic: Valve diseases as noted above; Reduced cardiac output; Exercise intolerance.

Treatment

Intensive cardiac care and immunosuppressives including corticosteroids are helpful in the acute stage of the disease. Colchicine can also be used to help prevent recurrences in Pericarditis.

When the condition becomes chronic, treatment can include debility control and supportive care.

References

^ Mezzetti, Eleonora; Costantino, Andrea; Leoni, Matteo; Pieretti, Rebecca; Di Paolo, Marco; Frati, Paola; Maiese, Aniello; Fineschi, Vittorio (2023-07-25). "Autoimmune Heart Disease: A Comprehensive Summary for Forensic Practice". Medicina. 59 (8): 1364. doi:10.3390/medicina59081364. ISSN 1648-9144. PMC 10456745. PMID 37629654.
^ Rose, Noel R. (2015-06-23), "Cardiac Disease, Autoimmune", Encyclopedia of Immunotoxicology, Berlin, Heidelberg: Springer Berlin Heidelberg, pp. 143–145, doi:10.1007/978-3-642-54596-2_209, ISBN 978-3-642-54595-5

Harrison's Guide to Internal Medicine.
Robin's Pathology. ISBN 1416025340

[1] Mezzetti, Eleonora; Costantino, Andrea; Leoni, Matteo; Pieretti, Rebecca; Di Paolo, Marco; Frati, Paola; Maiese, Aniello; Fineschi, Vittorio (2023-07-25). "Autoimmune Heart Disease: A Comprehensive Summary for Forensic Practice". Medicina. 59 (8): 1364. doi:10.3390/medicina59081364. ISSN 1648-9144. PMC 10456745. PMID 37629654.

[2] Rose, Noel R. (2015-06-23), "Cardiac Disease, Autoimmune", Encyclopedia of Immunotoxicology, Berlin, Heidelberg: Springer Berlin Heidelberg, pp. 143–145, doi:10.1007/978-3-642-54596-2_209, ISBN 978-3-642-54595-5

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