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Latest revision as of 13:33, 15 April 2021

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. Causative criteria include three main groups, as well as infectious, immune-mediated, and toxic myocarditis. Based on the type of infiltrating cells myocarditis divided in lymphocytic, eosinophilic, polymorphic, giant cell myocarditis, and cardiac sarcoidosis. Acute, fulminant, chronic active, and chronic persistent are subtypes of clinicopathopogical classification.

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

Myocarditis can be classified based on the causative criteria into immune-mediated myocarditis, infectious myocarditis and toxic myocarditis. bkjvskaljbkjbkjbakj

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

Infection-negative giant cell

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

•Beriberi

•Radiation

•Electric shock

•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

Cardiac sarcoidosis

Clinicopathological criteria

Fulminant myocarditis: Fulminant myocarditis occurs following a viral prodrome. Fulminant myocarditis presents as acute severe cardiovascular compromise with ventricular dysfunction. On endomyocardial biopsy, there are multiple foci of inflammation.^[15]^[16]

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 develop after 2 to 4 years.

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.^[14]

Classification based on clinicopathological criteria

Fulminant myocarditis

Acute myocarditis

Chronic active myocarditis

Chronic persistent myocarditis

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.

Template:WS Template:WH

[1] "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.

[LeoneVeinot2012-2] 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.

[KindermannBarth2012-3] 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.

[SagarLiu2012-4] 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.

[DennertCrijns2008-5] 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.

[MaronTowbin2006-6] 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.

[BockKlingel2010-7] 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.

[8] 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)

[CambridgeMacArthur1979-9] 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.

[10] 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)

[GoreSaphir1947-11] Gore, Ira; Saphir, Otto (1947). "Myocarditis". American Heart Journal. 34 (6): 827–830. doi:10.1016/0002-8703(47)90147-6. ISSN 0002-8703.

[FelkerBoehmer2000-12] 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.

[PinamontiAlberti1988-13] 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.

[LiebermanHutchins1991-14] 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.

[pmid1960305-15] 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.

[pmid10706898-16] 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.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Myocarditis}}
-{{CMG}} '''Associate Editor(s)-In-Chief:''' [[Varun Kumar]], M.B.B.S. {{Maliha}}
+{{CMG}} {{AE}} [[Varun Kumar]], M.B.B.S. {{Maliha}} {{Homa}}
 ==Overview==
-Myocarditis may be classified according to pathologic findings into 4 subtypes: fulminant myocarditis, acute myocarditis, chronic active myocarditis, and chronic persistent myocarditis.
+Myocarditis can be [[Classification|classified]] based on the [[Causes|causative]], [[histological]], and clinicopathological [[criteria]]. [[Causes|Causative]] [[criteria]] include three main groups, as well as [[infectious]], [[Immune-mediated disease|immune-mediated,]] and [[toxic]] myocarditis. Based on the type of [[Infiltration (medical)|infiltrating]] [[Cells (biology)|cells]] myocarditis divided in [[lymphocytic]], [[eosinophilic]], [[polymorphic]], [[giant cell]] myocarditis, and [[cardiac sarcoidosis]]. [[Acute]], [[fulminant]], [[chronic]] active, and [[Chronic (medicine)|chronic]] persistent are subtypes of clinicopathopogical [[classification]].
 ==Classification==
-* Myocarditis can be classified based on the causative, histological, and clinicopathological criteria.
+*Myocarditis can be [[Classification|classified]] based on the [[Causes|causative]], [[histological]], and clinicopathological [[criteria]].
-*The causative criteria define infectious agents (virus, protozoa, or bacteria) or non-infectious condition (autoimmune diseases, medications etc.) associated with myocarditis.
+*Myocarditis may be [[Classification|classified]] according to [[Causes|causative]] [[criteria]] into three groups:<ref>{{cite journal|title=Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies|journal=Circulation|volume=93|issue=5|year=1996|pages=841–842|issn=0009-7322|doi=10.1161/01.CIR.93.5.841}}</ref><ref name="LeoneVeinot2012">{{cite journal|last1=Leone|first1=Ornella|last2=Veinot|first2=John P.|last3=Angelini|first3=Annalisa|last4=Baandrup|first4=Ulrik T.|last5=Basso|first5=Cristina|last6=Berry|first6=Gerald|last7=Bruneval|first7=Patrick|last8=Burke|first8=Margaret|last9=Butany|first9=Jagdish|last10=Calabrese|first10=Fiorella|last11=d'Amati|first11=Giulia|last12=Edwards|first12=William D.|last13=Fallon|first13=John T.|last14=Fishbein|first14=Michael C.|last15=Gallagher|first15=Patrick J.|last16=Halushka|first16=Marc K.|last17=McManus|first17=Bruce|last18=Pucci|first18=Angela|last19=Rodriguez|first19=E. René|last20=Saffitz|first20=Jeffrey E.|last21=Sheppard|first21=Mary N.|last22=Steenbergen|first22=Charles|last23=Stone|first23=James R.|last24=Tan|first24=Carmela|last25=Thiene|first25=Gaetano|last26=van der Wal|first26=Allard C.|last27=Winters|first27=Gayle L.|title=2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology|journal=Cardiovascular Pathology|volume=21|issue=4|year=2012|pages=245–274|issn=10548807|doi=10.1016/j.carpath.2011.10.001}}</ref><ref name="KindermannBarth2012">{{cite journal|last1=Kindermann|first1=Ingrid|last2=Barth|first2=Christine|last3=Mahfoud|first3=Felix|last4=Ukena|first4=Christian|last5=Lenski|first5=Matthias|last6=Yilmaz|first6=Ali|last7=Klingel|first7=Karin|last8=Kandolf|first8=Reinhard|last9=Sechtem|first9=Udo|last10=Cooper|first10=Leslie T.|last11=Böhm|first11=Michael|title=Update on Myocarditis|journal=Journal of the American College of Cardiology|volume=59|issue=9|year=2012|pages=779–792|issn=07351097|doi=10.1016/j.jacc.2011.09.074}}</ref><ref name="SagarLiu2012">{{cite journal|last1=Sagar|first1=Sandeep|last2=Liu|first2=Peter P|last3=Cooper|first3=Leslie T|title=Myocarditis|journal=The Lancet|volume=379|issue=9817|year=2012|pages=738–747|issn=01406736|doi=10.1016/S0140-6736(11)60648-X}}</ref><ref name="DennertCrijns2008">{{cite journal|last1=Dennert|first1=R.|last2=Crijns|first2=H. J.|last3=Heymans|first3=S.|title=Acute viral myocarditis|journal=European Heart Journal|volume=29|issue=17|year=2008|pages=2073–2082|issn=0195-668X|doi=10.1093/eurheartj/ehn296}}</ref><ref name="MaronTowbin2006">{{cite journal|last1=Maron|first1=Barry J.|last2=Towbin|first2=Jeffrey A.|last3=Thiene|first3=Gaetano|last4=Antzelevitch|first4=Charles|last5=Corrado|first5=Domenico|last6=Arnett|first6=Donna|last7=Moss|first7=Arthur J.|last8=Seidman|first8=Christine E.|last9=Young|first9=James B.|title=Contemporary Definitions and Classification of the Cardiomyopathies|journal=Circulation|volume=113|issue=14|year=2006|pages=1807–1816|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.174287}}</ref><ref name="BockKlingel2010">{{cite journal|last1=Bock|first1=Claus-Thomas|last2=Klingel|first2=Karin|last3=Kandolf|first3=Reinhard|title=Human Parvovirus B19–Associated Myocarditis|journal=New England Journal of Medicine|volume=362|issue=13|year=2010|pages=1248–1249|issn=0028-4793|doi=10.1056/NEJMc0911362}}</ref><ref>{{Cite journal
-*Identification of the infectious agent or potential non-infectious trigger may be indicative not only for disease etiology.
+ | author = [[P. Liu]], [[T. Martino]], [[M. A. Opavsky]] & [[J. Penninger]]
-*In addition to identification of the causative agent, histological and immunohistological analyses are performed to categorize myocarditis based on the presence, morphology and type of inflammatory infiltrates in the myocardium.
+ | title = Viral myocarditis: balance between viral infection and immune response
-*Lymphocytic myocarditis characterized by extensive infiltration of lymphocytes and monocytes with signs of cardiomyocyte necrosis (active lymphocytic myocarditis) represents the most frequent type of myocarditis.
+ | journal = [[The Canadian journal of cardiology]]
-*Lymphocytic myocarditis is often observed in myocardium tested positive for viral persistence.
+ | volume = 12
-*Less common forms of myocarditis represent giant cell myocarditis and eosinophilic myocarditis.
+ | issue = 10
-*Giant cell myocarditis is characterized by the presence of multinucleated giant cells and lymphocytes on heart biopsies.
+ | pages = 935–943
-*Presence of giant cells within non-caseating granulomas, usually associated with myocardial fibrosis is referred to as cardiac sarcoidosis.
+ | year = 1996
-*The characteristic feature of eosinophilic myocarditis is the presence of eosinophil-rich infiltrates in the myocardium and extensive myocyte necrosis, which is accompanied with elevated level of circulating eosinophils.
+ | month = October
-*Giant cell myocarditis and eosinophilic myocarditis are associated with particularly poor prognosis.
+ | pmid = 9191484
+}}</ref><ref name="CambridgeMacArthur1979">{{cite journal|last1=Cambridge|first1=G|last2=MacArthur|first2=C G|last3=Waterson|first3=A P|last4=Goodwin|first4=J F|last5=Oakley|first5=C M|title=Antibodies to Coxsackie B viruses in congestive cardiomyopathy.|journal=Heart|volume=41|issue=6|year=1979|pages=692–696|issn=1355-6037|doi=10.1136/hrt.41.6.692}}</ref>
+**[[Infectious]] myocarditis
+**[[Immune-mediated disease|Immune-mediated]] myocarditis
+**[[Toxic]] myocarditis
+*Myocarditis may be [[Classification|classified]] according to [[histological]] [[criteria]] into five groups:<ref>{{Cite journal
+ | author = [[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]]
+ | title = Myocarditis. A histopathologic definition and classification
+ | journal = [[The American journal of cardiovascular pathology]]
+ | volume = 1
+ | issue = 1
+ | pages = 3–14
+ | year = 1987
+ | month = January
+ | pmid = 3455232
+}}</ref><ref name="GoreSaphir1947">{{cite journal|last1=Gore|first1=Ira|last2=Saphir|first2=Otto|title=Myocarditis|journal=American Heart Journal|volume=34|issue=6|year=1947|pages=827–830|issn=00028703|doi=10.1016/0002-8703(47)90147-6}}</ref><ref name="LeoneVeinot2012">{{cite journal|last1=Leone|first1=Ornella|last2=Veinot|first2=John P.|last3=Angelini|first3=Annalisa|last4=Baandrup|first4=Ulrik T.|last5=Basso|first5=Cristina|last6=Berry|first6=Gerald|last7=Bruneval|first7=Patrick|last8=Burke|first8=Margaret|last9=Butany|first9=Jagdish|last10=Calabrese|first10=Fiorella|last11=d'Amati|first11=Giulia|last12=Edwards|first12=William D.|last13=Fallon|first13=John T.|last14=Fishbein|first14=Michael C.|last15=Gallagher|first15=Patrick J.|last16=Halushka|first16=Marc K.|last17=McManus|first17=Bruce|last18=Pucci|first18=Angela|last19=Rodriguez|first19=E. René|last20=Saffitz|first20=Jeffrey E.|last21=Sheppard|first21=Mary N.|last22=Steenbergen|first22=Charles|last23=Stone|first23=James R.|last24=Tan|first24=Carmela|last25=Thiene|first25=Gaetano|last26=van der Wal|first26=Allard C.|last27=Winters|first27=Gayle L.|title=2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology|journal=Cardiovascular Pathology|volume=21|issue=4|year=2012|pages=245–274|issn=10548807|doi=10.1016/j.carpath.2011.10.001}}</ref>
+**[[Lymphatic]] myocarditis
+**[[Eosinophilic]] myocarditis
+**[[Polymorphic]] myocarditis
+**[[Giant cell]] myocarditis
+**[[Cardiac sarcoidosis]]
+*Myocarditis may be [[Classification|classified]] according to clinicopathological four [[criteria]] into three groups:<ref name="FelkerBoehmer2000">{{cite journal|last1=Felker|first1=G.Michael|last2=Boehmer|first2=John P|last3=Hruban|first3=Ralph H|last4=Hutchins|first4=Grover M|last5=Kasper|first5=Edward K|last6=Baughman|first6=Kenneth L|last7=Hare|first7=Joshua M|title=Echocardiographic findings in fulminant and acute myocarditis|journal=Journal of the American College of Cardiology|volume=36|issue=1|year=2000|pages=227–232|issn=07351097|doi=10.1016/S0735-1097(00)00690-2}}</ref><ref name="PinamontiAlberti1988">{{cite journal|last1=Pinamonti|first1=Bruno|last2=Alberti|first2=Ezip|last3=Cigalotto|first3=Alessandro|last4=Dreas|first4=Lorella|last5=Salvi|first5=Alessandro|last6=Silvestri|first6=Furio|last7=Camerini|first7=Fulvio|title=Echocardiographic findings in myocarditis|journal=The American Journal of Cardiology|volume=62|issue=4|year=1988|pages=285–291|issn=00029149|doi=10.1016/0002-9149(88)90226-3}}</ref><ref name="LiebermanHutchins1991">{{cite journal|last1=Lieberman|first1=Eric B.|last2=Hutchins|first2=Grover M.|last3=Herskowitz|first3=Ahvie|last4=Rose|first4=Noel R.|last5=Baughman|first5=Kenneth L.|title=Clinicopathoiogic description of myocarditis|journal=Journal of the American College of Cardiology|volume=18|issue=7|year=1991|pages=1617–1626|issn=07351097|doi=10.1016/0735-1097(91)90493-S}}</ref>
+**[[Fulminant]] myocarditis
+**[[Acute (medicine)|Acute]] myocarditis
+**[[Chronic (medical)|Chronic]] active myocarditis
+**[[Chronic]] persistent myocarditis
+==Causative criteria==
+*Myocarditis can be [[Classification|classified]] based on the [[Causes|causative]] [[criteria]] into [[Immune-mediated disease|immune-mediated]] myocarditis, [[infectious]] myocarditis and [[toxic]] myocarditis. bkjvskaljbkjbkjbakj
+<br />{{familytree/start}}
+{{familytree | | | | | | | | | | | | | | B01 | | | | | |B01=Immune-mediated myocarditis}}
+{{familytree | | | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|.| }}
+{{familytree | | | | | |!| | | | | | | | |!| | | | | | | | |!| }}
+{{familytree | | | | | C01 | | | | | | | C02 | | | | | | | C03 |C01=Allergens|C02=Alloantigens|C03=Autoantigens}}
+{{familytree | | | | | |!| | | | | | | | |!| | | | | | | | |!| | | | | |}}
+{{familytree | | |,|-|-|^|-|-|.| | | | | |!| | | | | |,|-|-|^|-|-|.| | |}}
+{{familytree | | D01 | | | | D02 | | | | D03 | | | | D04 | | | | D05 | |D01=•Tetanus toxoid
+•Vaccines
+•Serum sickness|D02='''Drugs:'''
+•Penicillin
+•Cefaclor
+•Colchicine
+•Furosemide
+•Isoniazid
+•Lidocaine
+•Tetracycline
+•Sulfonamides
+•Phenytoin
+•Phenylbutazone
+•Methyldopa
+•Thiazide diuretics
+•Amitriptyline|D03=Heart transplant rejection|D04=•Infection-negative lymphocytic
+Infection-negative giant cell|D05='''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|}}
+{{familytree/end}}
+{{familytree/start}}
+{{familytree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | A01=Toxic myocarditis}}
+{{familytree | | |,|-|-|-|-|-|v|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|-|.| | | | }}
+{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | | | B14 | | |B10=Drugs|B11=Heavy metals|B12=Hormones|B13=Physical agents|B14=Miscellaneous}}
+{{familytree | | |!| | | | | |!| | | | | |!| | | | | |!| | | | | |!| | | | }}
+{{familytree | | C10 | | | | C11 | | | | C12 | | | | C13 | | | | C14 | | |C10=•Amphetamines
+•Anthracyclines
+•Cocaine
+•Cyclophosphamide
+•Ethanol
+•Fluorouracil
+•Lithium
+•Catecholamines
+•Hematine
+•Interleukin-2
+•Trastuzumab
+•Clozapine|C11=•Copper
+•Iron
+•Lead|C12=•Phaeochromocytoma
+•Beriberi|C13=•Radiation
+•Electric shock|C14=•Scorpion sting
+•Snake, and spider bites
+•Bee and wasp stings
+•Carbon monoxide
+•Inhalant
+•Phosphorus
+•Arsenic
+•Sodium azide}}
+{{familytree/end}}
+<br />{{familytree/start}}
+{{familytree | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=Infectious myocarditis}}
+{{familytree | | |,|-|-|-|-|v|-|-|-|-|v|-|-|-|-|+|-|-|-|-|v|-|-|-|-|v|-|-|-|-|.| }}
+{{familytree | | C01 | | | C02 | | | C03 | | | C04 | | | C05 | | | C06 | | | C07 | | |C01=Bacterial|C02=Spirochaetal|C03=Fungal|C04=Protozoal|C05=Parasitic|C06=Rickettsial|C07=Viral}}
+{{familytree | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | }}
+{{familytree | | D01 | | | D02 | | | D03 | | | D04 | | | D05 | | | D06 | | | D07 | ||D01=•Staphylococcus
+•Streptococcus
+•Pneumococcus
+•Meningococcus
+•Gonococcus
+•Salmonella
+•Corynebacterium diphtheriae
+•Haemophilus influenzae
+•Mycobacterium tuberculosis
+•Mycoplasma pneumonia
+•Brucella|D02=•Borrelia
+•Leptospira|D03=•Aspergillus
+•Actinomyces
+•Blastomyces
+•Candida
+•Coccidioides
+•Cryptococcus
+•Histoplasma
+•Mucormycosis
+•Nocardia
+•Sporothrix|D04=•Trypanosoma cruzi
+•Toxoplasma gondii
+•Entamoeba
+•Leishmania|D05=•Trichinella spiralis
+•Echinococcus granulosus
+•Taenia solium|D06=•Coxiella burnetii
+•R.rickettsii
+•R.tsutsugamushi|D07=•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}}
+{{familytree/end}}
+==Histological criteria==
+*Myocarditis can be [[Classification|classified]] based on the type of [[Infiltration (medical)|infiltrating]] [[Cells (biology)|cells]] in [[lymphocytic]], [[eosinophilic]], [[polymorphic]], [[giant cell]] myocarditis, and [[cardiac sarcoidosis]].
+{{familytree/start}}
+{{familytree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | A01=Classification based on histological criteria}}
+{{familytree | | |,|-|-|-|-|-|v|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|-|.| | | | }}
+{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | | | B14 | | |B10=Lymphocytic|B11=Eosinophilic|B12=Polymorphic|B13=Giant cell|B14=Cardiac sarcoidosis}}
+{{familytree/end}}<br />
 ==Clinicopathological criteria==
-*'''Fulminant myocarditis:''' Fulminant myocarditis occurs following a viral prodrome.  Fulminant myocarditis presents as acute severe cardiovascular compromise with ventricular dysfunction.<ref name="pmid1960305">{{cite journal| author=Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL| title=Clinicopathologic description of myocarditis. | journal=J Am Coll Cardiol | year= 1991 | volume= 18 | issue= 7 | pages= 1617-26 | pmid=1960305 | doi= | pmc= | url= }} </ref><ref name="pmid10706898">{{cite journal| author=McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM et al.| title=Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 10 | pages= 690-5 | pmid=10706898 | doi=10.1056/NEJM200003093421003 | pmc= | url= }} </ref>  On [[endomyocardial biopsy]], there are multiple foci of inflammation.
+*'''Fulminant myocarditis:''' [[Fulminant]] myocarditis occurs following a [[viral]] [[prodrome]].  [[Fulminant]] myocarditis presents as [[acute]] severe [[cardiovascular]] compromise with [[ventricular dysfunction]]. On [[endomyocardial biopsy]], there are multiple foci of [[inflammation]].<ref name="pmid1960305">{{cite journal| author=Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL| title=Clinicopathologic description of myocarditis. | journal=J Am Coll Cardiol | year= 1991 | volume= 18 | issue= 7 | pages= 1617-26 | pmid=1960305 | doi= | pmc= | url= }} </ref><ref name="pmid10706898">{{cite journal| author=McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM et al.| title=Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 10 | pages= 690-5 | pmid=10706898 | doi=10.1056/NEJM200003093421003 | pmc= | url= }} </ref>
-*'''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]].
+*'''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 (medicine)|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:''' [[Chronic (medical)|Chronic]] active myocarditis has a less distinct onset of the [[illness]].  There are [[clinical]] and [[Histological|histologic]] [[Relapse|relapses]] and the [[development]] of [[ventricular dysfunction]].  [[Histologically]], [[Chronic (medicine)|chronic]] [[inflammatory]] changes with mild to moderate [[fibrosis]] may be [[Development (biology)|develop]] after 2 to 4 years.
-*'''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.
+*'''Chronic persistent myocarditis:''' [[Chronic (medical)|Chronic]] persistent myocarditis has a less distinct onset of the illness. [[Histologically]] it is [[Characterization (mathematics)|characterized]] by persistent [[Infiltration (medical)|infiltration]] and [[myocyte]] [[necrosis]].  Despite the presence of [[symptoms]], [[ventricular dysfunction]] is absent.<ref name="LiebermanHutchins1991">{{cite journal|last1=Lieberman|first1=Eric B.|last2=Hutchins|first2=Grover M.|last3=Herskowitz|first3=Ahvie|last4=Rose|first4=Noel R.|last5=Baughman|first5=Kenneth L.|title=Clinicopathoiogic description of myocarditis|journal=Journal of the American College of Cardiology|volume=18|issue=7|year=1991|pages=1617–1626|issn=07351097|doi=10.1016/0735-1097(91)90493-S}}</ref>
-==Causative criteria==
-*Virus: coxsackievirus B3, adenoviruses or herpesviruses and other
-*Protozoa: Trypanosoma cruzi (Chagas disease)
-*Bacteria: Borrelia burgdorferi (Lyme disease) and other
-*Immune checkpoint inhibitors: anti-CTLA-4, anti-PD-1 or anti-PD-L1 therapy
-*Systemic autoimmune diseases: Systemic lupus erythematosus, myasthenia gravis and other
-==Histological criteria==
+{{familytree/start}}
+{{familytree | | | | | | | | | | | A01 | | | | | | | | | | | | | | | A01=Classification based on clinicopathological criteria}}
-*Active myocarditis: cardiac inflammation with apparent cardiomyocyte necrosis
+{{familytree | | |,|-|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|.| | | | }}
-*Borderline myocarditis: cardiac inflammation without evident cardiomyocyte necrosis
+{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | |B10=Fulminant myocarditis|B11=Acute myocarditis|B12=Chronic active myocarditis|B13=Chronic persistent myocarditis}}
-*Lymphocytic myocarditis: extensive infiltration of lymphocytes and monocytes
+{{familytree/end}}
-*Giant cell myocarditis: multinucleated giant cells and lymphocytes on heart biopsies
-*Eosinophilic myocarditis: eosinophil-rich infiltrates with extensive myocyte necrosis
 ==References==
 {{reflist|2}}
+{{WS}}
+{{WH}}
+[[Category:Medicine]]
 [[Category:Cardiology]]
-[[Category:Cardiovascular diseases]]
+[[Category:Up-To-Date]]
-[[Category:Inflammations]]
-[[Category:Infectious diseases]]
 [[Category:Emergency medicine]]
-[[Category:Disease]]
+[[Category:Intensive care medicine]]
-[[Category:Up-To-Date]]
-[[Category:Up-To-Date cardiology]]
-{{WS}}
-{{WH}}