Update on myocarditis – review (RCD code: III-6A.1)
Myocardits is an inflammatory disease of the myocardium diagnosed by established histological and immunohistochemical criteria. The true incidence of myocarditis is unknown. There are numerous potential etiologic factors, however, in developed countries the most frequent cause of myocarditis are viral infections. The pathogenesis of viral myocarditis and subsequent dilated cardiomyopathy (DCM) is not fully understood and differ between viruses. The progression of acute cardiac inflammation to DCM is the three-phase process, including viral (cytopathic), (auto)-immunulogic, and recovery or myopathic phase. Cardiac symptoms are variable and include reduced functional capacity due to dyspnoe and/or fatigue, palpitations, precordial chest pain which result from associated pericarditis or coronary artery spasms.
Diagnostic work-up in myocarditis is multistage and requires integration of clinical symptoms, laboratory and imaging data, all of which have an adjunctive role to the endomyocardial biopsy (EMB), which is final and ultimately decisive diagnostic tool. All patients with clinically suspected myocarditis should undergo detailed echocardiographic examination to rule out other cardiac diseases and to assess and monitor changes in chamber size, wall thickness, ventricular systolic and diastolic function, or pericardial effusions. Nevertheless, cardiac magnetic resonance is superior to echocardiography in terms of non-invasive tissue characterization. Recent trails have provided substantial body of evidence for additional myocarditis-specific or tailored therapies, including anti-viral and immuno-modulating therapy such as high dose intravenous immunoglobulin, immunoadsorption, and immunosuppression. JRCD 2014; 1 (6): 4–9
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