Myocarditis classification: Difference between revisions

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==Overview==
==Overview==
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]].


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.
==Classification ==


==Overview==
* Myocarditis can be [[Classification|classified]] based on the [[Causes|causative]], [[histological]], and clinicopathological [[criteria]].
There is no established system for the classification of [disease name].
* 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
 
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].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
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:<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
  | author = [[P. Liu]], [[T. Martino]], [[M. A. Opavsky]] & [[J. Penninger]]
  | author = [[P. Liu]], [[T. Martino]], [[M. A. Opavsky]] & [[J. Penninger]]
  | title = Viral myocarditis: balance between viral infection and immune response
  | title = Viral myocarditis: balance between viral infection and immune response
Line 50: Line 20:
  | pmid = 9191484
  | 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>
}}</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
**[[Infectious]] myocarditis
**Immune-mediated myocarditis
**[[Immune-mediated disease|Immune-mediated]] myocarditis
**Toxic myocarditis
**[[Toxic]] myocarditis


* Myocarditis may be classified according to histological criteria into five groups:<ref>{{Cite journal
* 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]]
  | 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
  | title = Myocarditis. A histopathologic definition and classification
Line 65: Line 35:
  | pmid = 3455232
  | 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>
}}</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
**[[Lymphatic]] myocarditis
**Eosinophilic myocarditis
**[[Eosinophilic]] myocarditis
**Polymorphic myocarditis
**[[Polymorphic]] myocarditis
**Giant cell myocarditis
**[[Giant cell]] myocarditis
**Cardiac sarcoidosis
**[[Cardiac sarcoidosis]]


* Myocarditis may be 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>
* 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
**[[Fulminant]] myocarditis
**Acute myocarditis
**[[Acute (medicine)|Acute]] myocarditis
**Chronic active myocarditis
**[[Chronic (medical)|Chronic]] active myocarditis
**Chronic persistent myocarditis
**[[Chronic]] persistent myocarditis


==Causative criteria==
==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.
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | B01 | | | | | |B01=Immune-mediated myocarditis}}
{{familytree | | | | | | | | | | | | | | B01 | | | | | |B01=Immune-mediated myocarditis}}
Line 306: Line 276:


==Histological criteria==
==Histological criteria==
* Myocarditis can be classified based on the type of infiltrating cells in lymphocytic, eosinophilic, polymorphic, giant cell myocarditis, and cardiac sarcoidosis.
* 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/start}}
Line 312: Line 283:
{{familytree | | |,|-|-|-|-|-|v|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|-|.| | | | }}
{{familytree | | |,|-|-|-|-|-|v|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|-|.| | | | }}
{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | | | B14 | | |B10=Lymphocytic|B11=Eosinophilic|B12=Polymorphic|B13=Giant cell myocarditis|B14=Cardiac sarcoidosis}}
{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | | | B14 | | |B10=Lymphocytic|B11=Eosinophilic|B12=Polymorphic|B13=Giant cell myocarditis|B14=Cardiac sarcoidosis}}
{{familytree/end}}
{{familytree/end}}<br />
 
==Clinicopathological criteria==
==Clinicopathological criteria==



Revision as of 05:24, 7 January 2020

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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. 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

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


-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


 
 
 
 
 
 
 
 
 
 
 
 
 
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

  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.
  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.
  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.
  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.
  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.
  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.
  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)
  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)
  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.
  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.
  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.
  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.
  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.
  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.
  17. 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.

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