Myocarditis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. Maliha Shakil, M.D. [2] Homa Najafi, M.D.[3]
Overview
Myocarditis can be classified based on the causative, histological, and clinicopathological criteria. Combination of the histologic data and clinical course of the disease resulted in clinicopathologic classification of myocarditis. Parameters such as onset of the disease, initial clinical and histological presentation, disease course and cardiac dysfunction define acute, fulminant, chronic active and chronic persistent subtypes of myocarditis. Acute myocarditis represents the most common type of myocarditis, in which symptoms last typically for days or weeks and the acute phase is followed by spontaneous improvement or development of stable DCM. In patients with fulminant myocarditis disease progresses rapidly resulting in severe heart failure and cardiogenic shock with mortality rate of 30–40% during the acute phase. Patients diagnosed with fulminant myocarditis surviving the acute phase have been instead suggested to have excellent long-term prognosis. In its chronic form, myocarditis is detected over a period of three or more months. Clinical and histologic relapses and development of ventricular dysfunction is characteristic for chronic active myocarditis, whereas chronic persistent myocarditis is characterized by persistent presence of inflammatory cells in the myocardium, but it is usually not associated with ventricular dysfunction.
Overview
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
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The staging of [malignancy name] is based on the [staging system].
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There is no established system for the staging of [malignancy name].
Classification
- Myocarditis can be classified based on the causative, histological, and clinicopathological criteria.
- Myocarditis may be classified according to causative criteria into three groups:[1][2][3][4][5][6][7][8][9]
- Infectious myocarditis
- Immune-mediated myocarditis
- Toxic myocarditis
- Myocarditis may be classified according to histological criteria into five groups:[10][11][2]
- Lymphatic myocarditis
- Eosinophilic myocarditis
- Polymorphic myocarditis
- Giant cell myocarditis
- Cardiac sarcoidosis
- Myocarditis may be classified according to clinicopathological four criteria into three groups:[12][13][14]
- Fulminant myocarditis
- Acute myocarditis
- Chronic active myocarditis
- Chronic persistent myocarditis
Causative criteria
| Immune-mediated myocarditis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Allergens | Alloantigens | Autoantigens | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| -Tetanus toxoid
-Vaccines -Serum sickness | Drugs:
-Penicillin -Cefaclor -Colchicine -Furosemide -Isoniazid -Lidocaine -Tetracycline -Sulfonamides -Phenytoin -Phenylbutazone -Methyldopa -Thiazide diuretics -Amitriptyline | Heart transplant rejection | -Infection-negative lymphocytic
| Autoimmune disorders:
SLE, -Rheumatoid arthritis -Churg-Strauss syndrome -Kawasaki's disease -IBD -Scleroderma -Polymyositis -Myasthenia gravis -DM type1 -Thyrotoxicosis -Sarcoidosis -Wegener's granulomatosis -Rheumatic heart disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Toxic myocarditis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Drugs | Heavy metals | Hormones | Physical agents | Miscellaneous | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| -Amphetamines
-Anthracyclines -Cocaine -Cyclophosphamide -Ethanol -Fluorouracil -Lithium -Catecholamines -Hematine -Interleukin-2 -Trastuzumab -Clozapine | -Copper
-Iron -Lead | -Phaeochromocytoma
| -Radiation
| -Scorpion sting
-Snake, and spider bites - Bee and wasp stings -Carbon monoxide -Inhalant -Phosphorus -Arsenic -Sodium azide | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Infectious myocarditis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bacterial | Spirochaetal | Fungal | Protozoal | Parasitic | Rickettsial | Viral | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| -Staphylococcus
-Streptococcus -Pneumococcus -Meningococcus -Gonococcus -Salmonella -Corynebacterium diphtheriae -Haemophilus influenzae -Mycobacterium tuberculosis -Mycoplasma pneumonia -Brucella | -Borrelia -Leptospira | - Aspergillus
-Actinomyces -Blastomyces -Candida -Coccidioides -Cryptococcus -Histoplasma -Mucormycosis -Nocardia -Sporothrix | -Trypanosoma cruzi
-Toxoplasma gondii -Entamoeba -Leishmania | -Trichinella spiralis
-Echinococcus granulosus -Taenia solium | -Coxiella burnetii
-R.rickettsii -R.tsutsugamushi | -Coxsackievirus
-Echoviruses -Polioviruses -Influenza A & B viruses -RSV -Mumps virus -Measles virus -Rubella virus -Hepatitis C virus -Dengue virus -Yellow fever virus -HIV-1 -Adenoviruses -Paravirus B19 -Cytomegalovirus -HSV-6 -EBV -VZV -HSV | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Histological criteria
- Myocarditis can be classified based on the type of infiltrating cells in lymphocytic, eosinophilic, polymorphic, giant cell myocarditis, and cardiac sarcoidosis.
| Classification based on histological criteria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lymphocytic | Eosinophilic | Polymorphic | Giant cell myocarditis | Cardiac sarcoidosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Clinicopathological criteria
- Fulminant myocarditis: Fulminant myocarditis occurs following a viral prodrome. Fulminant myocarditis presents as acute severe cardiovascular compromise with ventricular dysfunction.[15][16] On endomyocardial biopsy, there are multiple foci of inflammation.
Fulminant myocarditis has a distinct onset usually within 2 weeks of presentation. Patients present with profound left ventricular dysfunction but usually not left ventricular dilatation. The endomyocardial biopsy shows multiple foci of active inflammation and necrosis. Patients recover or die within 2 weeks with complete histological and functional recovery of the myocardium in survivors[17]
- Acute myocarditis: Acute myocarditis presents with a less distinct onset of the illness. When the patient does present, there is already a decline in left ventricular dysfunction. Acute myocarditis may progress to dilated cardiomyopathy.
- Chronic active myocarditis: Chronic active myocarditis has a less distinct onset of the illness. There are clinical and histologic relapses and the development of ventricular dysfunction. Histologically, chronic inflammatory changes with mild to moderate fibrosis may be present.
Chronic active myocarditis has an indistinct onset with moderate ventricular dysfunction on presentation and active or borderline myocarditis by biopsy. These patients display ongoing inflammation and fibrosis resulting in the development of a restrictive cardiomyopathy usually 2 to 4 years after presentation[14]
- Chronic persistent myocarditis: Chronic persistent myocarditis has a less distinct onset of the illness. Histologically it is characterized by persistent infiltration and myocyte necrosis. Despite the presence of symptoms, ventricular dysfunction is absent.
References
- ↑ "Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies". Circulation. 93 (5): 841–842. 1996. doi:10.1161/01.CIR.93.5.841. ISSN 0009-7322.
- ↑ 2.0 2.1 Leone, Ornella; Veinot, John P.; Angelini, Annalisa; Baandrup, Ulrik T.; Basso, Cristina; Berry, Gerald; Bruneval, Patrick; Burke, Margaret; Butany, Jagdish; Calabrese, Fiorella; d'Amati, Giulia; Edwards, William D.; Fallon, John T.; Fishbein, Michael C.; Gallagher, Patrick J.; Halushka, Marc K.; McManus, Bruce; Pucci, Angela; Rodriguez, E. René; Saffitz, Jeffrey E.; Sheppard, Mary N.; Steenbergen, Charles; Stone, James R.; Tan, Carmela; Thiene, Gaetano; van der Wal, Allard C.; Winters, Gayle L. (2012). "2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology". Cardiovascular Pathology. 21 (4): 245–274. doi:10.1016/j.carpath.2011.10.001. ISSN 1054-8807.
- ↑ Kindermann, Ingrid; Barth, Christine; Mahfoud, Felix; Ukena, Christian; Lenski, Matthias; Yilmaz, Ali; Klingel, Karin; Kandolf, Reinhard; Sechtem, Udo; Cooper, Leslie T.; Böhm, Michael (2012). "Update on Myocarditis". Journal of the American College of Cardiology. 59 (9): 779–792. doi:10.1016/j.jacc.2011.09.074. ISSN 0735-1097.
- ↑ Sagar, Sandeep; Liu, Peter P; Cooper, Leslie T (2012). "Myocarditis". The Lancet. 379 (9817): 738–747. doi:10.1016/S0140-6736(11)60648-X. ISSN 0140-6736.
- ↑ Dennert, R.; Crijns, H. J.; Heymans, S. (2008). "Acute viral myocarditis". European Heart Journal. 29 (17): 2073–2082. doi:10.1093/eurheartj/ehn296. ISSN 0195-668X.
- ↑ Maron, Barry J.; Towbin, Jeffrey A.; Thiene, Gaetano; Antzelevitch, Charles; Corrado, Domenico; Arnett, Donna; Moss, Arthur J.; Seidman, Christine E.; Young, James B. (2006). "Contemporary Definitions and Classification of the Cardiomyopathies". Circulation. 113 (14): 1807–1816. doi:10.1161/CIRCULATIONAHA.106.174287. ISSN 0009-7322.
- ↑ Bock, Claus-Thomas; Klingel, Karin; Kandolf, Reinhard (2010). "Human Parvovirus B19–Associated Myocarditis". New England Journal of Medicine. 362 (13): 1248–1249. doi:10.1056/NEJMc0911362. ISSN 0028-4793.
- ↑ P. Liu, T. Martino, M. A. Opavsky & J. Penninger (1996). "Viral myocarditis: balance between viral infection and immune response". The Canadian journal of cardiology. 12 (10): 935–943. PMID 9191484. Unknown parameter
|month=ignored (help) - ↑ Cambridge, G; MacArthur, C G; Waterson, A P; Goodwin, J F; Oakley, C M (1979). "Antibodies to Coxsackie B viruses in congestive cardiomyopathy". Heart. 41 (6): 692–696. doi:10.1136/hrt.41.6.692. ISSN 1355-6037.
- ↑ H. T. Aretz, M. E. Billingham, W. D. Edwards, S. M. Factor, J. T. Fallon, J. J. Jr Fenoglio, E. G. Olsen & F. J. Schoen (1987). "Myocarditis. A histopathologic definition and classification". The American journal of cardiovascular pathology. 1 (1): 3–14. PMID 3455232. Unknown parameter
|month=ignored (help) - ↑ Gore, Ira; Saphir, Otto (1947). "Myocarditis". American Heart Journal. 34 (6): 827–830. doi:10.1016/0002-8703(47)90147-6. ISSN 0002-8703.
- ↑ Felker, G.Michael; Boehmer, John P; Hruban, Ralph H; Hutchins, Grover M; Kasper, Edward K; Baughman, Kenneth L; Hare, Joshua M (2000). "Echocardiographic findings in fulminant and acute myocarditis". Journal of the American College of Cardiology. 36 (1): 227–232. doi:10.1016/S0735-1097(00)00690-2. ISSN 0735-1097.
- ↑ Pinamonti, Bruno; Alberti, Ezip; Cigalotto, Alessandro; Dreas, Lorella; Salvi, Alessandro; Silvestri, Furio; Camerini, Fulvio (1988). "Echocardiographic findings in myocarditis". The American Journal of Cardiology. 62 (4): 285–291. doi:10.1016/0002-9149(88)90226-3. ISSN 0002-9149.
- ↑ 14.0 14.1 Lieberman, Eric B.; Hutchins, Grover M.; Herskowitz, Ahvie; Rose, Noel R.; Baughman, Kenneth L. (1991). "Clinicopathoiogic description of myocarditis". Journal of the American College of Cardiology. 18 (7): 1617–1626. doi:10.1016/0735-1097(91)90493-S. ISSN 0735-1097.
- ↑ Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL (1991). "Clinicopathologic description of myocarditis". J Am Coll Cardiol. 18 (7): 1617–26. PMID 1960305.
- ↑ McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM; et al. (2000). "Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis". N Engl J Med. 342 (10): 690–5. doi:10.1056/NEJM200003093421003. PMID 10706898.
- ↑ McCarthy, Robert E.; Boehmer, John P.; Hruban, Ralph H.; Hutchins, Grover M.; Kasper, Edward K.; Hare, Joshua M.; Baughman, Kenneth L. (2000). "Long-Term Outcome of Fulminant Myocarditis as Compared with Acute (Nonfulminant) Myocarditis". New England Journal of Medicine. 342 (10): 690–695. doi:10.1056/NEJM200003093421003. ISSN 0028-4793.