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Myocarditis
| Myocarditis | |
|---|---|
| Other names | Inflammatory cardiomyopathy (infectious) |
.JPG) | |
| A microscope image of myocarditis at autopsy in a person with acute onset of heart failure | |
| Specialty | Infectious disease, cardiology |
| Symptoms | Shortness of breath, chest pain, decreased ability to exercise, irregular heartbeat[1] |
| Complications | Heart failure due to dilated cardiomyopathy, cardiac arrest[1] |
| Duration | Hours to months[1] |
| Causes | Usually viral infection, also bacterial infections, certain medications, autoimmune disorders[1][2] |
| Diagnostic method | Electrocardiogram, blood troponin, heart MRI, heart biopsy[1][2] |
| Treatment | Medications, implantable cardiac defibrillator, heart transplant[1][2] |
| Medication | ACE inhibitors, beta blockers, diuretics, corticosteroids, intravenous immunoglobulin[1][2] |
| Prognosis | Variable[3] |
| Frequency | 2.5 million with cardiomyopathy (2015)[4] |
| Deaths | 354,000 with cardiomyopathy (2015)[5] |
Myocarditis is defined as inflammation of the myocardium. Myocarditis can progress to inflammatory cardiomyopathy when there are associated ventricular remodeling and cardiac dysfunction due to chronic inflammation.[6][7] Symptoms can include shortness of breath, chest pain, decreased ability to exercise, and an irregular heartbeat.[1] The duration of problems can vary from hours to months. Complications may include heart failure due to dilated cardiomyopathy or cardiac arrest.[1]
Myocarditis is most often due to a viral infection.[1] Other causes include bacterial infections, certain medications, toxins and autoimmune disorders.[1][2] A diagnosis may be supported by an electrocardiogram (ECG), increased troponin, heart MRI, and occasionally a heart biopsy.[1][2] An ultrasound of the heart is important to rule out other potential causes such as heart valve problems.[2]
Treatment depends on both the severity and the cause.[1][2] Medications such as ACE inhibitors, beta blockers, and diuretics are often used.[1][2] A period of no exercise is typically recommended during recovery.[1][2] Corticosteroids or intravenous immunoglobulin (IVIG) may be useful in certain cases.[1][2] In severe cases an implantable cardiac defibrillator or heart transplant may be recommended.[1][2]
In 2013, about 1.5 million cases of acute myocarditis occurred.[8] While people of all ages are affected, the young are most often affected.[9] It is slightly more common in males than females.[1] Most cases are mild.[2] In 2015 cardiomyopathy, including myocarditis, resulted in 354,000 deaths up from 294,000 in 1990.[10][5] The initial descriptions of the condition are from the mid-1800s.[11]
- ^ a b c d e f g h i j k l m n o p q r Cooper LT (April 2009). "Myocarditis". The New England Journal of Medicine. 360 (15): 1526–1538. doi:10.1056/nejmra0800028. PMC 5814110. PMID 19357408.
- ^ a b c d e f g h i j k l m Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M, Yilmaz A, et al. (February 2012). "Update on myocarditis". Journal of the American College of Cardiology. 59 (9): 779–792. doi:10.1016/j.jacc.2011.09.074. PMID 22361396.
- ^ Stouffer G, Runge MS, Patterson C (2010). Netter's Cardiology E-Book. Elsevier Health Sciences. p. 181. ISBN 978-1-4377-3650-2.
- ^ Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
- ^ a b Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
- ^ Suresh, Abhilash; Martens, Pieter; Tang, W. H. Wilson (October 2022). "Biomarkers for Myocarditis and Inflammatory Cardiomyopathy". Current Heart Failure Reports. 19 (5): 346–355. doi:10.1007/s11897-022-00569-8. ISSN 1546-9530. PMC 9340754. PMID 35913661.
- ^ Tschöpe, Carsten; Ammirati, Enrico; Bozkurt, Biykem; Caforio, Alida L. P.; Cooper, Leslie T.; Felix, Stephan B.; Hare, Joshua M.; Heidecker, Bettina; Heymans, Stephane; Hübner, Norbert; Kelle, Sebastian; Klingel, Karin; Maatz, Henrike; Parwani, Abdul S.; Spillmann, Frank (March 2021). "Myocarditis and inflammatory cardiomyopathy: current evidence and future directions". Nature Reviews Cardiology. 18 (3): 169–193. doi:10.1038/s41569-020-00435-x. ISSN 1759-5002. PMC 7548534. PMID 33046850.
- ^ Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. (Global Burden of Disease Study 2013 Collaborators) (August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4. PMC 4561509. PMID 26063472.
- ^ Willis M, Homeister JW, Stone JR (2013). Cellular and Molecular Pathobiology of Cardiovascular Disease. Academic Press. p. 135. ISBN 978-0-12-405525-4. Archived from the original on 2017-11-05.
- ^ Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. (GBD 2013 Mortality and Causes of Death Collaborators) (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
- ^ Cunha BA (2009). Infectious Diseases in Critical Care Medicine. CRC Press. p. 263. ISBN 978-1-4200-1960-5. Archived from the original on 2017-11-05.
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