English Version
Myocarditis may present with a wide range of symptoms, ranging from mild dyspnea or chest pain that resolves without specific therapy to cardiogenic shock and death. Dilated cardiomyopathy with chronic heart failure is the major long-term sequela of myocarditis. Most often, myocarditis results from common viral infections; less commonly, specific forms of myocarditis may result from other pathogens, toxic or hypersensitivity drug reactions, giant-cell myocarditis, or sarcoidosis. The prognosis and treatment of myocarditis vary according to the cause, and clinical and hemodynamic data usually provide guidance to decide when to refer a patient to a specialist for endomyocardial biopsy. The aim of this review is to provide a practical and current approach to the evaluation and treatment of suspected myocarditis.
Definition
The standard Dallas pathological criteria for the definition of myocarditis require that an inflammatory cellular infiltrate with or without associated myocyte necrosis be present on conventionally stained heart-tissue sections (Figure 1A). These criteria are limited by variability in interpretation, lack of prognostic value, and low sensitivity, in part due to sampling error. These limitations have led to alternative pathological classifications with criteria that rely on cell-specific immunoperoxidase stains for surface antigens, such as anti-CD3, anti-CD4, anti-CD20, anti-CD68, and anti–human leukocyte antigen (Figure 1B). Criteria that are based on immunoperoxidase staining have greater sensitivity and may have prognostic value.
Journals for full download on the link below
The standard Dallas pathological criteria for the definition of myocarditis require that an inflammatory cellular infiltrate with or without associated myocyte necrosis be present on conventionally stained heart-tissue sections (Figure 1A). These criteria are limited by variability in interpretation, lack of prognostic value, and low sensitivity, in part due to sampling error. These limitations have led to alternative pathological classifications with criteria that rely on cell-specific immunoperoxidase stains for surface antigens, such as anti-CD3, anti-CD4, anti-CD20, anti-CD68, and anti–human leukocyte antigen (Figure 1B). Criteria that are based on immunoperoxidase staining have greater sensitivity and may have prognostic value.
Journals for full download on the link below
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