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Review
. 2008 Sep;29(17):2073-82.
doi: 10.1093/eurheartj/ehn296. Epub 2008 Jul 9.

Acute viral myocarditis

Robert Dennert  1 , Harry J Crijns, Stephane Heymans
Affiliations
Review

Acute viral myocarditis

Robert Dennert et al. Eur Heart J. 2008 Sep.

Abstract

Acute myocarditis is one of the most challenging diagnosis in cardiology. At present, no diagnostic gold standard is generally accepted, due to the insensitivity of traditional diagnostic tests. This leads to the need for new diagnostic approaches, which resulted in the emergence of new molecular tests and a more detailed immunohistochemical analysis of endomyocardial biopsies. Recent findings using these new diagnostic tests resulted in increased interest in inflammatory cardiomyopathies and a better understanding of its pathophysiology, the recognition in overlap of virus-mediated damage, inflammation, and autoimmune dysregulation. Novel results also pointed towards a broader spectrum of viral genomes responsible for acute myocarditis, indicating a shift of enterovirus and adenovirus to parvovirus B19 and human herpes virus 6. The present review proposes a general diagnostic approach, focuses on the viral aetiology and associated autoimmune processes, and reviews treatment options for patients with acute viral myocarditis.

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Figures

Figure 1
Figure 1
Pathophysiological process of virus myocarditis.
Figure 2
Figure 2
Evolution of acute viral myocarditis. DCM, dilated cardiomyopathy.
Figure 3
Figure 3
Proposal of diagnostic approach for patients with suspected myocarditis. Asterisk indicates that when informed consent is obtained to perform endomyocardial biopsy at presentation, the procedure is continued, if not proceed with the steps as suggested in the flowchart. CMR, cardiovascular magnetic imaging; EMB, endomyocardial biopsy.
Figure 4
Figure 4
Electrocardiogram showing PQ-segment depression and diffusely elevated ST-T-segments at presentation (A) and evolution after 1 day (B).
Figure 5
Figure 5
Cardiovascular magnetic resonance image. Short-axis cardiac magnetic resonance imaging of a patient with acute myocarditis (A) T2-weighted image, showing regional oedema of the lateral left ventricle predominantly subepicardial involvement (arrow). (B) Late enhancement image, demonstrating high signal intensity in the epicardial region of the lateral wall of the left ventricle (arrow).
Figure 6
Figure 6
Proposal of treatment algorithm based on endomyocardial biopsy results. Immuno. infl., immunohistological inflammation; AHA, anti-heart auto-antibodies; pos, positive; neg, negative; HF, heart failure.
See this image and copyright information in PMC

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