Myocarditis:view on pathogenesis and treatment

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Myocarditis:view on pathogenesis and treatment

Post by Yvonne » Wed 27 Feb 2008 12:45

Myocarditis: the immunologist’s view on pathogenesis and treatment

Julia Buriana,c, Peter Buserb, Urs Erikssona, c
a Experimental Critical Care Medicine, Department of Research, University Hospital,
Basel, Switzerland
b Clinical Cardiology, Department of Internal Medicine, University Hospital, Basel, Switzerland
c Medicine A, Department of Internal Medicine, University Hospital, Basel, Switzerland


Viral myocarditis is a frequent and often unrecognised
cause of post-inflammatory cardiomyopathy.
The role of viral persistence and heartspecific
autoimmunity in the development of
myocarditis and heart failure is still controversial.
This review updates the current view on the immunological
mechanisms of disease development
and addresses the current and future role of immunomodulation
and immunosuppression as
treatment options for defined subgroups of
patients with myocarditis or dilated cardiomyopathy


Clinical symptomatic myocarditis, ie inflammation
of the heart muscle, is not a common diagnosis.
Nevertheless, epidemiological data suggest
that myocarditis is an important cause of sudden
death in the younger population [1, 2]. Furthermore
several lines of evidence imply that most
cases of dilated cardiomyopathy [3], the most common
cause of heart failure and transplantation in
children and patients below the age of 40, are the
consequence of a preceding myocarditis.

Disease course

Myocarditis represents a clinically and pathogenetically
highly variable disease entity. Whereas
some patients follow a fulminant disease course
with acute heart failure and severe arrhythmias,
most present with minimal symptoms or are entirely
asymptomatic. Nevertheless, even asymptomatic
patients are at risk for unexplained sudden
death. In fact, data from necropsy studies suggest
that undiagnosed or asymptomatic myocarditis is
not a rare cause of death with the prevalence up to 1%


Worldwide, infections with the parasitic protozoan
Trypanosoma Cruzi (Chagas disease),
which is endemic in Southern America, are the
leading cause of myocarditis [5]. In Europe and
North America, however, enteroviruses, such as
Coxsackievirus B3 [6–8] and to a lesser extent Adenovirus
[4, 8], have been suggested as the most
common micro-organisms inducing inflammatory
heart disease. Other common cardiotropic microorganisms
include Cytomegalo- [8, 9], Parvo- [8,
Hepatitis C- [11, 12], Human Immunodeficiency-
[13] and Epstein-Barr Virus [12, 14]. Recent
findings, however, suggest that cardiotropic
bacteria such as Chlamydia Pneumonia or Borrelia
Burgdorferi might play a yet underestimated
role in the development of post-inflammatory
heart failure [8].
Non-infectious myocarditis denotes cardiac
inflammation with no evidence of myocardial infection,
for example in the context of autoimmune
diseases, drug-induced hypersensitivity, neoplasia
and/or other systemic disorders [6, 15]. Giant-cell
myocarditis is a rare, idiopathic and histological
distinct disease entity with a very poor prognosis,
which often affects patients with latent or symptomatic
autoimmune diseases

For Pathogenesis, Diagnosis and Immunosuppression etc. see:
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

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