Myocarditis is an inflammation of the myocardium with necrosis of cardiomyocytes. Myocarditis can be caused by a variety of causes (eg, infectious diseases, cardiotoxins, drugs, systemic disorders such as sarcoidosis), but is often idiopathic. Symptoms can vary and include fatigue, shortness of breath, swelling, heart palpitations, and sudden death. Diagnosis is based on symptoms and clinical findings of an abnormal electrocardiogram, cardiac biomarkers, and cardiovascular imaging in the absence of cardiovascular risk factors. Endomyocardial biopsy confirms the clinical diagnosis of myocarditis. Treatment depends on the cause, but general measures include drugs to treat heart failure and arrhythmias, and rarely surgery (eg, intra-aortic balloon pump, left ventricular support device, transplant). Immunosuppression is used for some types of myocarditis (eg, hypersensitivity myocarditis, giant cell myocarditis, myocarditis due to sarcoidosis)
Myocarditis is an inflammation of the myocardium with necrosis of cardiomyocytes. Biopsy-confirmed myocarditis is usually an inflammatory myocardial infiltrate consisting of lymphocytes, neutrophils, eosinophils, giant cells, granulomas, or a mixture of cells.
The clinical manifestations of myocarditis are diverse. Patients may have minimal clinical manifestations or fulminant heart failure and lethal arrhythmias. Symptoms depend on both the etiology of myocarditis and the severity of myocardial damage.
Myocarditis can be acute, subacute, or chronic. There is no set time frame for each period of illness. The acute phase lasts for several days, while the subacute phase lasts from several weeks to several months. If myocarditis does not resolve after a few months, it is called chronic myocarditis. In some cases, myocarditis can lead to dilated cardiomyatathy.
Treatments for heart failure include diuretics and nitrates for symptomatic relief. In cases of fulminant heart failure, it may be necessary when
In cases of associated heart failure and arrhythmias, infectious myocarditis is usually treated with supportive care. Antiviral therapy has been shown to be useful in treating viral etiologies. The bacterial etiology can be treated with antibiotics, but this has not been proven to be effective, except perhaps in the acute infectious phase. Parasitic infection should be treated with appropriate antiparasitic agents.
Hypersensitivity myocarditis is treated with immediate discontinuation of the causative drug or cardiotoxin and corticosteroid therapy. Patients with giant cell myocarditis have better pro
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