Myocarditis
Classification & external resources

Histopathological image of viral myocarditis at autopsy in a patient with acute onset of congestive heart failure. Viral etiology, however, failed to be determined in postmortem serological study.
ICD-10	I09.0, I51.4
ICD-9	391.2, 422, 429.0
DiseasesDB	8716
MedlinePlus	000149
eMedicine	med/1569  emerg/326
MeSH	D009205

In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. It is generally due to infection (viral or bacterial). It may present with chest pain, rapid signs of heart failure, or sudden death. Image File history File linksMetadata No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Medicine is the science and art of maintaining andor restoring human health through the study, diagnosis, and treatment of patients. ... A diagram of a heart with an ECG indicator; diagrams like this are used in Cardiology. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Myocardium is the muscular tissue of the heart. ... The heart and lungs, from an older edition of Grays Anatomy. ... An infection is the detrimental colonization of a host organism by a foreign species. ... This article is about biological infectious particles. ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ...

Signs and symptoms

The signs and symptoms associated with myocardits are varied, and relate either to the actual inflammation of the myocardium, or the weakness of the heart muscle that is secondary to the inflammation. Signs and symptoms of myocarditis include:^[1]

• Chest pain (often described as "stabbing" in character)
• Congestive heart failure (leading to edema, breathlessness and hepatic congestion)
• Palpitations (due to arrhythmias)
• Sudden death (in young adults, myocarditis causes up to 20% of all cases of sudden death)^[2]
• Fever (especially when infectious, e.g. in rheumatic fever)

Since myocarditis is often due to a viral illness, many patients give a history of symptoms consistent with a recent viral infection, including fever, diarrhea, joint pains, and easy fatigueability. In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... This page is about the condition called edema. ... Dyspnea (Latin dyspnoea, emphysema, COPD, broken ribs, lung cancer, malignant hypertension, and so forth. ... The liver is an organ present in vertebrates and some other animals. ... This article does not cite any references or sources. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...

Myocarditis is often associated with pericarditis, and many patients present with signs and symptoms that suggest concurrent myocarditis and pericarditis. Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ...

Diagnosis

Myocardial inflammation can be suspected on the basis of electrocardiographic results (ECG), elevated CRP and/or ESR and increased IgM (serology) against viruses known to affect the myocardium. Markers of myocardial damage (troponin or creatine kinase cardiac isoenzymes) are elevated.^[1] “QRS” redirects here. ... C-reactive protein (CRP) is a plasma protein, an acute phase protein produced by the liver. ... The erythrocyte sedimentation rate(ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... IGM might be an acronym or abbreviation for: The polymeric immunoglobulin, IgM International Grandmaster, a chess ranking intergalactic medium Intragroup medium - see: Intracluster medium IG Metall - the dominant German metalworkers union IGM is an acronym created by Robinson Technologies for several early BBS door games, including Legend of the Red... Serology is the scientific study of blood serum. ... Myocardium is the muscular tissue of the heart. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ... Creatine Kinase Creatine kinase (CK), also known as phosphocreatine kinase or creatine phosphokinase (CPK) is an enzyme (EC 2. ...

The ECG findings most commonly seen in myocarditis are diffuse T wave inversions; saddle-shaped ST-segment elevations may be present (these are also seen in pericarditis).^[1] “QRS” redirects here. ... A terahertz (THz) is 1012 hertz or a thousand gigahertz, a measure of frequency. ...

The gold standard is still biopsy of the myocardium, generally done in the setting of angiography. A small tissue sample of the endocardium and myocardium is taken, and investigated by a pathologist by light microscopy and—if necessary—immunochemistry and special staining methods. Histopathological features are: myocardial interstitium with abundant edema and inflammatory infiltrate, rich in lymphocytes and macrophages. Focal destruction of myocytes explains the myocardial pump failure.^[1] In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ... Myocardium is the muscular tissue of the heart. ... Anatomic pathology is the branch of pathology that is concerned with the diagnosis of disease based on the gross and microscopic examination of cells and tissues. ... Microscopy is any technique for producing visible images of structures or details too small to otherwise be seen by the human eye. ... Immunochemistry is a branch of chemistry that involves the study of the reactions and components on the immune system. ... A scanning electron microscope (SEM) image of a single human lymphocyte. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, makros = long, phagein = eat) are white blood cells, more specifically phagocytes, acting in the nonspecific defense as well as the specific defense system of vertebrate animals. ...

Recently, Cardiovascular Magnetic Resonance Imaging has been shown to be very useful in diagnosing myocarditis by visualizing markers for inflammation of the myocardium[1]. “MRI” redirects here. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Myocardium is the muscular tissue of the heart. ...

Causes

A large number of different causes have been identified as leading to myocarditis:^[1]

• Infectious:
  • Viral (e.g. enterovirus, Coxsackie virus, rubella virus, polio virus, cytomegalovirus, possibly hepatitis C)
  • Bacterial (e.g. brucella, Corynebacterium diphtheriae, gonococcus, Haemophilus influenzae, Actinomyces, Tropheryma whipplei, and Vibrio cholerae).
  • Spirochetal (Borrelia burgdorferi and leptospirosis)
  • Protozoal (Toxoplasma gondii and Trypanosoma cruzi)
  • Fungal (e.g. aspergillus)
  • Parasitic: ascaris, Echinococcus granulosus, Paragonimus westermani, schistosoma, Taenia solium, Trichinella spiralis, visceral larva migrans, and Wuchereria bancrofti
  • Rickettsial
• Immunological:
  • Allergic (e.g. acetazolamide, amitriptyline)
  • Rejection after a heart transplant
  • Autoantigens (e.g. systemic vasculitis such as Churg-Strauss syndrome, Wegener's granulomatosis)
• Toxic:
  • Drugs (e.g. anthracyclines and some other forms of chemotherapy, ethanol, and antipsychotics, e.g. clozapine)
  • Toxins (e.g. arsenic, carbon monoxide, snake venom)
  • Heavy metals (e.g. copper, iron)
• Physical agents (electric shock, hyperpyrexia, and radiation)

Bacterial myocarditis is rare in patients without immunodeficiency. This false-colored electron micrograph shows a malaria sporozoite migrating through the midgut epithelia. ... This article is about biological infectious particles. ... Species Bovine enterovirus Coxsackie virus Human enterovirus A Human enterovirus B Human enterovirus C Human enterovirus D Human enterovirus E Poliovirus Porcine enterovirus A Porcine enterovirus B Swine vesicular disease virus The enteroviruses are a genus of (+)ssRNA viruses associated with several human and mammalian diseases. ... Coxsackie A virus is a cytolytic virus of the Picornaviridae family, a enterovirus (a group containing the polioviruses, coxsackieviruses, and echoviruses). ... Rubella (also known as epidemic roseola, German measles or three-day measles) is a disease caused by the Rubella virus. ... Poliomyelitis (polio) is a viral paralytic disease. ... Species see text Cytomegalovirus (CMV) (from the Greek cyto-, cell, and -mega-, large) is a viral genus of the Herpesviruses group: in humans it is commonly known as human herpesvirus 5 (HHV-5). ... Hepatitis C is a blood-borne, infectious, viral disease that is caused by a hepatotropic virus called Hepatitis C virus (HCV). ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... Brucellosis, also called undulant fever or Malta fever, is a zoonosis (infectious disease transmitted from animals to humans) caused by bacteria of the genus Brucella. ... Binomial name Corynebacterium diphtheriae Kruse, 1886 Corynebacterium diphtheriae is a pathogenic bacterium that causes diphtheria. ... Neisseria gonorrhoeae is a species of Gram-negative (see also Gram Stain) bacteria responsible for the disease gonorrhoea. ... Binomial name Haemophilus influenzae (Lehmann & Neumann 1896) Winslow 1917 Haemophilus influenzae, formerly called Pfeiffers bacillus or Bacillus influenzae, is a non-motile Gram-negative coccobacillus first described in 1892 by Dr. Richard Pfeiffer during an influenza pandemic. ... Species A. naeslundii Actinomyces is a genus of Gram-positive bacteria. ... Whipples disease is a rare disease caused by the bacteria Thropheryma whipplei. ... Binomial name Vibrio cholerae Pacini 1854 Vibrio cholerae is a gram negative bacterium with a curved-rod shape that causes cholera in humans. ... Families Brachyspiraceae Leptospiraceae Spirochaetaceae The spirochaetes are a phylum of distinctive bacteria, which have long, helically coiled cells. ... Binomial name Borrelia burgdorferi Johnson RC et al 1984 Borrelia burgdorferi is a spirochete bacteria and the causative agent of Lyme disease. ... Wikisource has an original article from the 1911 Encyclopædia Britannica about: Protozoa Protozoa (in Greek proto = first and zoa = animals) are single-celled eukaryotes (organisms whose cells have nuclei) that commonly show characteristics usually associated with animals, most notably mobility and heterotrophy. ... Binomial name Toxoplasma gondii (Nicolle & Manceaux), 1908 Toxoplasma is a genus of parasitic protozoa whose definitive host is cats but which can be carried by the vast majority of warm-blooded animals, including humans. ... Trypanosoma cruzi is a species of parasitic protozoan trypanosomes. ... Subkingdom/Phyla Chytridiomycota Blastocladiomycota Neocallimastigomycota Glomeromycota Zygomycota Dikarya (inc. ... Species Aspergillus caesiellus Aspergillus candidus Aspergillus carneus Aspergillus clavatus Aspergillus deflectus Aspergillus flavus Aspergillus fumigatus Aspergillus glaucus Aspergillus nidulans Aspergillus niger Aspergillus ochraceus Aspergillus oryzae Aspergillus parasiticus Aspergillus penicilloides Aspergillus restrictus Aspergillus sojae Aspergillus sydowi Aspergillus terreus Aspergillus ustus Aspergillus versicolor Aspergillus is a genus of around 200 filamentous fungi... A parasite is an organism that spends a significant portion of its life in or on the living tissue of a host organism and which causes harm to the host without immediately killing it. ... Species Ascaris lumbricoides Ascaris suum Ascaris is a genus of parasitic nematodes. ... Binomial name Echinococcus granulosus Echinococcus granulosus, also called the Hydatid worm, is a cyclophyllid cestode that parasitizes the small intestine of canids as an adult, but which has important intermediate hosts such as livestock and humans, where it causes hydatid disease. ... Species Paragonimus westermani Paragonimus westermani is the taxonomic name of an important lung fluke. ... A genus of trematodes, Schistosoma spp. ... Stained proglottid. ... Binomial name (Owen, 1835) The species Trichinella spiralis is an important parasite, occurring in rats, pigs, and humans, and is responsible for the disease trichinosis. ... Visceral larva migrans is a condition in children caused by the migratory larvae of nematodes like Toxocara vitulloram, Toxocara canis etc. ... Wuchereria bancrofti (named for O.E.H. Wucheria and Joseph Bancroft), a parasitic filarial nematode, affects over 120 million people, and is spread by mosquitoes. ... Species Rickettsia felis Rickettsia prowazekii Rickettsia rickettsii Rickettsia typhi Rickettsia conorii Rickettsia africae etc. ... Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. ... An allergy is an abnormal, acquired sensitivity to a given substance, including pollen, drugs, or numerous environmental triggers. ... Acetazolamide, sold under the trade name Diamox®, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, benign intracranial hypertension and altitude sickness. ... Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl) is a tricyclic antidepressant drug. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ... Churg-Strauss syndrome is a necrotizing vasculitis characterized by eosinophilia. ... In medicine (rheumatology), Wegeners granulomatosis is a form of vasculitis that affects the lungs, kidneys and other organs. ... Toxicology (from the Greek words toxicos and logos [1]) is the study of the adverse effects of chemicals on living organisms [2]. It is the study of symptoms, mechanisms, treatments and detection of poisoning, especially the poisoning of people. ... This article does not cite any references or sources. ... Anthracycline - Wikipedia, the free encyclopedia /**/ @import /skins-1. ... Chemotherapy is the use of chemical substances to treat disease. ... Ethanol, also known as ethyl alcohol, drinking alcohol or grain alcohol, is a flammable, colorless, slightly toxic chemical compound, and is best known as the alcohol found in alcoholic beverages. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Clozapine (sold as Clozaril®, Leponex®, Fazaclo®) was the first of the atypical antipsychotics to be developed. ... This article or section does not cite any references or sources. ... General Name, Symbol, Number arsenic, As, 33 Chemical series metalloids Group, Period, Block 15, 4, p Appearance metallic gray Standard atomic weight 74. ... Carbon monoxide, with the chemical formula CO, is a colorless, odorless, and tasteless gas. ... // Snake venom is a highly modified saliva that is produced by special glands. ... A heavy metal is any of a number of higher atomic weight elements, which has the properties of a metallic substance at room temperature. ... For other uses, see Copper (disambiguation). ... General Name, symbol, number iron, Fe, 26 Chemical series transition metals Group, period, block 8, 4, d Appearance lustrous metallic with a grayish tinge Standard atomic weight 55. ... Sign warning of possible electric shock hazard An electric shock can occur upon contact of a human or animal body with any source of voltage high enough to cause sufficient current flow through the muscles or nerves. ... This article needs additional references or sources for verification. ... Radiation as used in physics, is energy in the form of waves or moving subatomic particles. ... In medicine, immune deficiency (or immunodeficiency) is a state where the immune system is incapable of defending the organism from infectious disease. ...

Epidemiology

The exact incidence of myocarditis is unknown. However, in series of routine autopsies, 1–9% of all patients had evidence of myocardial inflammation. In young adults, up to 20% of all cases of sudden death are due to myocarditis. Post-mortem, postmortem and post mortem redirect here. ...

In South America, Chagas' disease (caused by Trypanosoma cruzi) is the main cause of myocarditis. South America South America is a continent crossed by the equator, with most of its area in the Southern Hemisphere. ... Trypanosoma cruzi is a species of parasitic protozoan trypanosomes. ...

Therapy

Bacterial infections are treated with antibiotics, dependent on the nature of the pathogen and its sensitivity to antibiotics. As most viral infections cannot be treated with directed therapy, symptomatic treatment is the only form of therapy for those forms of myocarditis, e.g. NSAIDs for the inflammatory component and diuretics and/or inotropes for ventricular failure. ACE inhibitor therapy may aid in the healing process. Staphylococcus aureus - Antibiotics test plate. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... A diuretic (colloquially called a water pill) is any drug or herb that elevates the rate of bodily urine excretion (diuresis). ... An inotrope is an agent which increases or decreases the force or energy of muscular contractions. ... Captopril, the first ACE inhibitor ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ...

Famous deaths

• Rod Donald
• Andrea Dworkin
• Andy Gibb
• Janet Munro

Rod David Donald (10 October 1957 - 6 November 2005), was a New Zealand politician who co-led the Green Party of Aotearoa New Zealand along with Jeanette Fitzsimons. ... Andrea Dworkin speaking to a federal commission on pornography in New York in January 1986 Andrea Rita Dworkin (September 26, 1946 – April 9, 2005) was an American radical feminist and writer best known for her criticism of pornography, which she linked with rape and other forms of violence against women. ... Andrew Roy Gibb (March 5, 1958 – March 10, 1988) was an English-born Australian singer and teen idol, and the younger brother of Barry, Robin and Maurice Gibb, also known as the Bee Gees. ... Janet Neilson Horsburgh (September 28, 1934 - December 6, 1972) was a British actress. ...

Reference

1. ^ ^{a b c d e} Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000;343:1388-98. PMID 11070105.
2. ^ Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004;141:829-34. PMID 15583223.

The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ...

External links

• Histopathology images of myocarditis
• eMedicine: Myocarditis
• Carditis related antibody