Clinicopathologic description of myocarditis

Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland.

Histologic evidence of myocarditis was demonstrated in 35 of 348 patients submitted to endomyocardial biopsy over 5 years. Analysis of the histologic findings and clinical course of these patients resulted in a new clinicopathologic classification of myocarditis in which four distinct subgroups are identified. Patients with fulminant myocarditis become acutely ill after a distinct viral prodrome, have severe cardiovascular compromise, multiple foci of active myocarditis by histologic study and ventricular dysfunction that either resolves spontaneously or results in death. Patients with acute, chronic active and chronic persistent myocarditis have a less distinct onset of illness. Patients with acute myocarditis present with established ventricular dysfunction and may respond to immunosuppressive therapy or their condition may progress to dilated cardiomyopathy. Those with chronic active myocarditis initially respond to immunosuppressive therapy, but they have clinical and histologic relapses and develop ventricular dysfunction associated with chronic inflammatory changes including giant cells on histologic study. Chronic persistent myocarditis is characterized by a persistent histologic infiltrate, often with foci of myocyte necrosis but without ventricular dysfunction despite other cardiovascular symptoms such as chest pain or palpitation.

This article has been cited by other articles:

				M. S. Sabatine, K.-K. Poh, J. L. Mega, J.-A. O. Shepard, J. R. Stone, and M. P. Frosch Case 36-2007 -- A 31-Year-Old Woman with Rash, Fever, and Hypotension N. Engl. J. Med., November 22, 2007; 357(21): 2167 - 2178. [Full Text] [PDF]

				H. Mahrholdt, A. Wagner, C. C. Deluigi, E. Kispert, S. Hager, G. Meinhardt, H. Vogelsberg, P. Fritz, J. Dippon, C. -T. Bock, et al. Presentation, Patterns of Myocardial Damage, and Clinical Course of Viral Myocarditis Circulation, October 10, 2006; 114(15): 1581 - 1590. [Abstract] [Full Text] [PDF]

				N Amabile, A Fraisse, J Bouvenot, P Chetaille, and C Ovaert Outcome of acute fulminant myocarditis in children Heart, September 1, 2006; 92(9): 1269 - 1273. [Abstract] [Full Text] [PDF]

				J. W. Magnani and G. W. Dec Myocarditis: Current Trends in Diagnosis and Treatment Circulation, February 14, 2006; 113(6): 876 - 890. [Full Text] [PDF]

				K. L. Baughman Diagnosis of Myocarditis: Death of Dallas Criteria Circulation, January 31, 2006; 113(4): 593 - 595. [Full Text] [PDF]

				Y. Asaumi, S. Yasuda, I. Morii, H. Kakuchi, Y. Otsuka, A. Kawamura, Y. Sasako, T. Nakatani, H. Nonogi, and S. Miyazaki Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation Eur. Heart J., October 2, 2005; 26(20): 2185 - 2192. [Abstract] [Full Text] [PDF]

				H. Abdel-Aty, P. Boye, A. Zagrosek, R. Wassmuth, A. Kumar, D. Messroghli, P. Bock, R. Dietz, M. G. Friedrich, and J. Schulz-Menger Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis: Comparison of Different Approaches J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1815 - 1822. [Abstract] [Full Text] [PDF]

				Y.-S. Chen and H.-Y. Yu Choice of mechanical support for fulminant myocarditis: ECMO vs. VAD? Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 931 - 932. [Full Text] [PDF]

				B. J. Maron, M. J. Ackerman, R. A. Nishimura, R. E. Pyeritz, J. A. Towbin, and J. E. Udelson Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1340 - 1345. [Full Text] [PDF]

				J.-M. Grinda, P. Chevalier, N. D'Attellis, M.-O. Bricourt, A. Berrebi, P. Guibourt, J.-N. Fabiani, and A. Deloche Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1169 - 1173. [Abstract] [Full Text] [PDF]

				M. Nishii, T. Inomata, H. Takehana, I. Takeuchi, H. Nakano, T. Koitabashi, J.-i. Nakahata, N. Aoyama, and T. Izumi Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1292 - 1297. [Abstract] [Full Text] [PDF]

				K. U. Knowlton and T. Yajima Interleukin-10: Biomarker or pathologic cytokine in fulminant myocarditis? J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1298 - 1300. [Full Text] [PDF]

				P. Leprince, A. Combes, N. Bonnet, A. Ouattara, C. E. Luyt, P. Theodore, P. Leger, and A. Pavie Circulatory support for fulminant myocarditis: consideration for implantation, weaning and explantation Eur. J. Cardiothorac. Surg., September 1, 2003; 24(3): 399 - 403. [Abstract] [Full Text] [PDF]

				J.M. Hare and K.L. Baughman Fulminant and acute lymphocytic myocarditis: the prognostic value of clinicopathological classification Eur. Heart J., February 2, 2001; 22(4): 269 - 270. [PDF]

				K. Fuse, M. Kodama, Y. Okura, M. Ito, S. Hirono, K. Kato, H. Hanawa, and Y. Aizawa Predictors of Disease Course in Patients With Acute Myocarditis Circulation, December 5, 2000; 102(23): 2829 - 2835. [Abstract] [Full Text] [PDF]

				A. M. Feldman and D. McNamara Myocarditis N. Engl. J. Med., November 9, 2000; 343(19): 1388 - 1398. [Full Text] [PDF]

				G. M. Felker, J. P. Boehmer, R. H. Hruban, G. M. Hutchins, E. K. Kasper, K. L. Baughman, and J. M. Hare Echocardiographic findings in fulminant and acute myocarditis J. Am. Coll. Cardiol., July 1, 2000; 36(1): 227 - 232. [Abstract] [Full Text] [PDF]

				R. E. McCarthy, J. P. Boehmer, R. H. Hruban, G. M. Hutchins, E. K. Kasper, J. M. Hare, and K. L. Baughman Long-Term Outcome of Fulminant Myocarditis as Compared with Acute (Nonfulminant) Myocarditis N. Engl. J. Med., March 9, 2000; 342(10): 690 - 695. [Abstract] [Full Text] [PDF]

				J. S. Karliner Fulminant Myocarditis N. Engl. J. Med., March 9, 2000; 342(10): 734 - 735. [Full Text]

				G. M. Hutchins, R. Hanzlick, and and the Autopsy Committee of the College of Americ Case of the Month: Speculation and Competing Causes of Death Arch Intern Med, August 10, 1998; 158(15): 1593 - 1594. [Full Text]

				M. Okabe, K. Fukuda, K. Arakawa, and M. Kikuchi Chronic Variant of Myocarditis Associated With Hepatitis C Virus Infection Circulation, July 1, 1997; 96(1): 22 - 24. [Abstract] [Full Text]

				S. Ishiyama, M. Hiroe, T. Nishikawa, S. Abe, T. Shimojo, H. Ito, S. Ozasa, K. Yamakawa, M. Matsuzaki, M. U. Mohammed, et al. Nitric Oxide Contributes to the Progression of Myocardial Damage in Experimental Autoimmune Myocarditis in Rats Circulation, January 21, 1997; 95(2): 489 - 496. [Abstract] [Full Text]

				E. Cabrera-Pozuelo, J. F. Val-Bernal, J. M. Torre-Hernandez, R. Gomez-Izquierdo, and J. A. Gutierrez-Sanchez Idiopathic Giant Cell Myocarditis Diagnosed in the Native Explanted Heart: Case Report and Literature Review International Journal of Surgical Pathology, January 1, 1996; 4(3): 179 - 182. [Abstract] [PDF]

				G. M. Folger JR, E. A. Eltohami, and H. A. Hajar Acute Myocardial-Infarction-Like Findings with Myocarditis in Infancy: A Case Report Angiology, August 1, 1994; 45(8): 737 - 741. [Abstract] [PDF]

				L. G. Lange and G. F. Schreiner Immune Mechanisms of Cardiac Disease N. Engl. J. Med., April 21, 1994; 330(16): 1129 - 1135. [Full Text]