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Highlights & Basics
- Myocarditis describes a heterogeneous group of disorders characterized by myocardial inflammation in the absence of predominant acute or chronic ischemia.
- Can affect all age groups with an apparent slightly higher incidence in males than females and equal incidence in black people and white people.
- May present as fulminant, acute, or chronic myocarditis.
- Treatment is usually supportive care and conventional heart failure therapy. More severe presentations may need aggressive pharmacologic treatment with escalation to mechanical circulatory support. Occasionally, certain cases do not respond to conventional therapy and progress to heart transplantation or death.
- Prognosis is variable but is related to presentation and underlying etiology. Most cases of viral myocarditis are asymptomatic and spontaneously resolve. Patients who present with mild to moderate heart failure tend to improve or recover but may progress to chronic severe heart failure. Surprisingly, patients who present with fulminant, acutely decompensated heart failure almost universally recover back to baseline function, if death is prevented through management in the acute phase.
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Histologic findings in a patient with giant cell myocarditis. A: severe myocardial necrosis and fibrotic replacement of the cardiomyocytes with granulation tissue and fibrosis is present in a section from the anterolateral left ventricular wall; B: a sharp demarcating border between vital and necrotic myocardium is seen, confirmed by additional immunohistochemical staining for myoglobin; C: at the inflammatory border, cells consisting of prominent multinucleated giant cells, macrophages, lymphocytes, and eosinophilic granulocytes are seen in close proximity to vital myocardium; D: immunohistochemical staining for complement 4d is positive in all vessels, suggestive of complement cascade activation
Autopsy findings in a patient with myocarditis. The explanted heart (A and B) is enlarged and thinned with dilatation mainly of the right ventricle. The right atrium is moderately dilated and the left atrium is not enlarged (B)
Apical 4-chamber transthoracic echocardiogram in a patient with myocarditis. The right ventricle is dilated with hypokinesis. Triscupid regurgitation is present with a reduced continuous wave Doppler gradient indicating right ventricular failure
Apical 4-chamber echocardiogram in a patient presenting with myocarditis showing a slightly dilated left ventricle with spontaneous ultrasonic contrast indicating severely impaired left ventricular systolic function
Citations
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