tetano
Editor, Senior Moderator
By Keith Darcé, UNION-TRIBUNE STAFF WRITER
Tuesday, February 23, 2010 at 9:49 p.m.
Eduardo Contreras / Union-Tribune
Doctors at Rady Children’s Hospital have detailed the cases of four San Diego County children who developed heart infections after becoming ill with swine flu, a life-threatening complication that has received scant attention.
The death of one of the patients, a 5-year-old Chula Vista girl named Alitza Ortiz Sanchez, generated intensive media coverage locally. But the other cases weren’t publicly disclosed until they appeared this month in the online version of the Journal of the American College of Cardiology.
Two of those children, identified as a 3-month-old girl and a 9-month-old girl, survived their ordeals after suffering heart failure and spending a week on a heart-lung machine in October, said Dr. András Bratincsák, the lead author of the study.
Many viruses are known to attack heart muscle tissue, but such invasions from strains of influenza are rare, cardiac specialists said.
The report sheds light on a problem that has been overshadowed by respiratory failure resulting from fluid buildup in the lungs, a far more common complication linked to many of the 16,000 swine-flu deaths recorded worldwide since April. About 63 million Americans have been infected with the disease, also called H1N1 influenza A, researchers from the University of Pittsburgh said this week.
“It’s an important study and an important complication,” said Dr. Sherif Zaki, chief of infectious disease pathology for the federal Centers for Disease Control and Prevention.
The condition, known as myocarditis, occurs when a virus penetrates heart muscles and sets off a defensive response from the body.
That counterattack can be deadly in people with robust immune systems.
As messenger cytokine cells flood into the heart, they activate an army of white blood cells that lay waste to the viruses as well as healthy tissue. The collateral damage can cause the heart to swell, send the pulse racing and short-circuit the delicate electrical system that keeps the organ pumping blood throughout the body.
Physicians treat severe forms of myocarditis with drugs designed to shut down the immune-system response or with devices that oxygenate the blood so the heart can rest and recuperate from the damage.
No one knows how many swine-flu patients have suffered from myocarditis, mainly because doctors don’t always recognize the condition. The complication is present in about 10 percent of patients who die from more common strains of influenza A and about 30 percent of fatal cases involving influenza B, Zaki said.
In flu patients, myocarditis frequently goes undiagnosed until it reaches serious levels, said Dr. Nassir Azimi, an interventional cardiologist affiliated with Sharp Grossmont Hospital in La Mesa. At that point, damage to the heart is often beyond repair.
“They usually come in (to the hospital) very sick,” Azimi said. “The way to get these guys better is to diagnose them early. Time is of the essence.”
A few clues, including chest pain and an irregular heartbeat, can suggest that flu viruses have moved into the heart, Azimi said. Patients who temporarily recover from the flu and then suddenly start feeling sick again also should be screened for the complication.
“If you’re not really thinking of it, then it can catch you by surprise,” Zaki said.
Within five days of Alitza’s death from heart failure at Rady Children’s Hospital in San Diego on Oct. 10, a second H1N1 patient — the 3-month-old girl — went into cardiac arrest.
“When these two patients happened one right after the other, we got really suspicious that the H1N1 virus could compromise blood circulation and affect the heart,” Bratincsák said.
Within a few weeks, a third flu patient — the 9-month-old girl — also suffered heart failure and a 9-year-old boy was diagnosed with a milder form of the complication.
Although the surviving patients have fully recovered, it’s unclear whether the two girls suffered any permanent brain damage from the cardiac crisis, said Dr. Howaida El-Said, one of five co-authors of the journal article.
For Alitza’s parents, the report’s cautionary message arrived too late.
When they brought Alitza to Rady, they weren’t thinking about H1N1 because their daughter’s symptoms — a terrible headache, a rapid pulse and purplish swelling around her eyes — weren’t classic signs of the flu.
More than four months later, the girl’s death remains perplexing to her family.
“We still can’t get it into our head how it happened,” said aunt Melina Hernandez of Chula Vista.
Every weekend, the family gathers at Monte de los Olivos cemetery in southeastern Tijuana to tend Alitza’s grave.
Last Sunday, the girl’s parents, Itzya Sanchez and Miguel Ortiz, planted pastel-colored pinwheels in the grass around the site and placed chocolate eggs and stuffed bunnies on a small tombstone altar.
Sanchez said the report offers at least one measure of comfort — that Alitza’s demise put doctors and nurses at Rady on high alert for the myocarditis cases that followed.
“In a way, it’s good that she helped the other kids,” the mother said.
http://www.signonsandiego.com/news/2010/feb/23/h1n1-flu-can-attack-heart/
Tuesday, February 23, 2010 at 9:49 p.m.
Eduardo Contreras / Union-Tribune
Doctors at Rady Children’s Hospital have detailed the cases of four San Diego County children who developed heart infections after becoming ill with swine flu, a life-threatening complication that has received scant attention.
The death of one of the patients, a 5-year-old Chula Vista girl named Alitza Ortiz Sanchez, generated intensive media coverage locally. But the other cases weren’t publicly disclosed until they appeared this month in the online version of the Journal of the American College of Cardiology.
Two of those children, identified as a 3-month-old girl and a 9-month-old girl, survived their ordeals after suffering heart failure and spending a week on a heart-lung machine in October, said Dr. András Bratincsák, the lead author of the study.
Many viruses are known to attack heart muscle tissue, but such invasions from strains of influenza are rare, cardiac specialists said.
The report sheds light on a problem that has been overshadowed by respiratory failure resulting from fluid buildup in the lungs, a far more common complication linked to many of the 16,000 swine-flu deaths recorded worldwide since April. About 63 million Americans have been infected with the disease, also called H1N1 influenza A, researchers from the University of Pittsburgh said this week.
“It’s an important study and an important complication,” said Dr. Sherif Zaki, chief of infectious disease pathology for the federal Centers for Disease Control and Prevention.
The condition, known as myocarditis, occurs when a virus penetrates heart muscles and sets off a defensive response from the body.
That counterattack can be deadly in people with robust immune systems.
As messenger cytokine cells flood into the heart, they activate an army of white blood cells that lay waste to the viruses as well as healthy tissue. The collateral damage can cause the heart to swell, send the pulse racing and short-circuit the delicate electrical system that keeps the organ pumping blood throughout the body.
Physicians treat severe forms of myocarditis with drugs designed to shut down the immune-system response or with devices that oxygenate the blood so the heart can rest and recuperate from the damage.
No one knows how many swine-flu patients have suffered from myocarditis, mainly because doctors don’t always recognize the condition. The complication is present in about 10 percent of patients who die from more common strains of influenza A and about 30 percent of fatal cases involving influenza B, Zaki said.
In flu patients, myocarditis frequently goes undiagnosed until it reaches serious levels, said Dr. Nassir Azimi, an interventional cardiologist affiliated with Sharp Grossmont Hospital in La Mesa. At that point, damage to the heart is often beyond repair.
“They usually come in (to the hospital) very sick,” Azimi said. “The way to get these guys better is to diagnose them early. Time is of the essence.”
A few clues, including chest pain and an irregular heartbeat, can suggest that flu viruses have moved into the heart, Azimi said. Patients who temporarily recover from the flu and then suddenly start feeling sick again also should be screened for the complication.
“If you’re not really thinking of it, then it can catch you by surprise,” Zaki said.
Within five days of Alitza’s death from heart failure at Rady Children’s Hospital in San Diego on Oct. 10, a second H1N1 patient — the 3-month-old girl — went into cardiac arrest.
“When these two patients happened one right after the other, we got really suspicious that the H1N1 virus could compromise blood circulation and affect the heart,” Bratincsák said.
Within a few weeks, a third flu patient — the 9-month-old girl — also suffered heart failure and a 9-year-old boy was diagnosed with a milder form of the complication.
Although the surviving patients have fully recovered, it’s unclear whether the two girls suffered any permanent brain damage from the cardiac crisis, said Dr. Howaida El-Said, one of five co-authors of the journal article.
For Alitza’s parents, the report’s cautionary message arrived too late.
When they brought Alitza to Rady, they weren’t thinking about H1N1 because their daughter’s symptoms — a terrible headache, a rapid pulse and purplish swelling around her eyes — weren’t classic signs of the flu.
More than four months later, the girl’s death remains perplexing to her family.
“We still can’t get it into our head how it happened,” said aunt Melina Hernandez of Chula Vista.
Every weekend, the family gathers at Monte de los Olivos cemetery in southeastern Tijuana to tend Alitza’s grave.
Last Sunday, the girl’s parents, Itzya Sanchez and Miguel Ortiz, planted pastel-colored pinwheels in the grass around the site and placed chocolate eggs and stuffed bunnies on a small tombstone altar.
Sanchez said the report offers at least one measure of comfort — that Alitza’s demise put doctors and nurses at Rady on high alert for the myocarditis cases that followed.
“In a way, it’s good that she helped the other kids,” the mother said.
http://www.signonsandiego.com/news/2010/feb/23/h1n1-flu-can-attack-heart/
