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Jay W. Mason



Clinical Features – more on differentiation of myocarditis from myocardial infarction and use of cardiac MRI for diagnosis. Treatment – criteria for treatment expanded and discussed in the context of a new consensus statement from the European Society of Cardiology (ESC). Cardiac sarcoidosis and giant cell myocarditis – new clinical features added.

Updated on 27 Nov 2014. The previous version of this content can be found here.
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date: 24 April 2017

Myocarditis has many infectious and noninfectious aetiologies; in most regions, viral infections are the main cause, with notable exceptions such as Chagas myocarditis in South America. The condition often results in congestive heart failure and is a common cause of chronic dilated cardiomyopathy, and it can also present with chest pain and/or ventricular arrythmias.

Patients with lymphocytic myocarditis are usually young (average age in the forties) and often report an antecedent viral illness. The disease can be diagnosed specifically by demonstration of lymphocyte infiltration and adjacent myocyte damage on endomyocardial biopsy. Detection of viral genomic material and tissue markers of immune activation in biopsy specimens, MRI and other imaging techniques, and presence of circulating biomarkers are also helpful in establishing the diagnosis. Adverse immune activation is the primary cause of myocardial damage in most cases.

Appropriately timed immunosuppressive therapy, most commonly with a steroid (prednisolone), may improve outcome in some cases, but efficacy is limited to special cases. Other immunomodulatory therapies and antiviral therapies have also been used, usually in patients who are deteriorating, but without proof of benefit. Specific forms of myocarditis include peripartum myocarditis, Lyme carditis, cardiac sarcoidosis, giant cell myocarditis, and Chagas carditis, each of which requires specific diagnostic and therapeutic measures.

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