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Rheumatic Heart Disease I: Introduction

Rheumatic Heart Disease I: Introduction

Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...

Rheumatic Heart Disease III: Medical Management

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...

Myocarditis III: Medical Management

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Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...

Cardiomyopathy IV: Restrictive Cardiomyopathy

Cardiomyopathy IV: Restrictive Cardiomyopathy

Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...

Myocarditis I: Introduction

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Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...

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Updated: May 18, 2026

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

Rituximab-induced coronary vasospasm.

Linda Lee¹, Vishal Kukreti

¹Department of Oncology, Niagara Health System, St. Catharines, ON, Canada L2R 2Z7.

Case Reports in Hematology

|September 7, 2012

Summary

Rituximab infusion can cause coronary vasospasm, a rare adverse effect. Identifying the cause of ischemia is crucial for determining if patients can safely receive rituximab therapy again.

Area of Science:

Oncology
Cardiology
Pharmacology

Background:

Rituximab is a key therapy for B-cell non-Hodgkin lymphomas.
While effective, rituximab carries risks of serious adverse events, including cardiac issues.
Infusion reactions can manifest as hemodynamic compromise or cardiac arrhythmias.

Observation:

A case of coronary vasospasm during rituximab infusion is presented.
The patient had minimal tumor burden and no pre-existing cardiac risk factors.
This event occurred despite rituximab generally being well-tolerated.

Findings:

Coronary vasospasm was identified as a potential adverse effect of rituximab.
The patient experienced ischemia during the rituximab infusion process.

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Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration

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The specific cause of the cardiac event was investigated.

Implications:

This case underscores the importance of diagnosing the etiology of ischemia in patients receiving rituximab.
Identifying the cause may allow for successful retreatment in select patients.
Further investigation into rituximab-induced cardiac events is warranted.