Myocarditis classification: Difference between revisions
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* Myocarditis can be classified based on the causative, histological, and clinicopathological criteria. | * Myocarditis can be classified based on the 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. | *The causative criteria define infectious agents (virus, protozoa, or bacteria) or non-infectious condition (autoimmune diseases, medications etc.) associated with myocarditis. | ||
Identification of the infectious agent or potential non-infectious trigger may be indicative not only for disease etiology, but also helps to choose the most effective therapeutic strategy for the affected patients. | *Identification of the infectious agent or potential non-infectious trigger may be indicative not only for disease etiology, | ||
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. | but also helps to choose the most effective therapeutic strategy for the affected patients. | ||
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. | *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. | ||
Lymphocytic myocarditis is often observed in myocardium tested positive for viral persistence. | *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. | ||
Less common forms of myocarditis represent giant cell myocarditis and eosinophilic myocarditis. | *Lymphocytic myocarditis is often observed in myocardium tested positive for viral persistence. | ||
Giant cell myocarditis is characterized by the presence of multinucleated giant cells and lymphocytes on heart biopsies. | *Less common forms of myocarditis represent giant cell myocarditis and eosinophilic myocarditis. | ||
Presence of giant cells within non-caseating granulomas, usually associated with myocardial fibrosis is referred to as cardiac sarcoidosis. | *Giant cell myocarditis is characterized by the presence of multinucleated giant cells and lymphocytes on heart biopsies. | ||
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 | *Presence of giant cells within non-caseating granulomas, usually associated with myocardial fibrosis is referred to as cardiac sarcoidosis. | ||
Giant cell myocarditis and eosinophilic myocarditis are associated with particularly poor prognosis | *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. | ||
*Giant cell myocarditis and eosinophilic myocarditis are associated with particularly poor prognosis. | |||
Myocarditis may be classified according to pathologic findings into 4 subtypes:<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> | Myocarditis may be classified according to pathologic findings into 4 subtypes:<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> | ||
*'''Fulminant myocarditis:''' Fulminant myocarditis occurs following a viral prodrome. Fulminant myocarditis presents as acute severe cardiovascular compromise with ventricular dysfunction.<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.<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. | ||
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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]
Overview
Myocarditis may be classified according to pathologic findings into 4 subtypes: fulminant myocarditis, acute myocarditis, chronic active myocarditis, and chronic persistent myocarditis.
Media:Example.ogg==Classification==
Classification
- Myocarditis can be classified based on the 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.
- Identification of the infectious agent or potential non-infectious trigger may be indicative not only for disease etiology,
but also helps to choose the most effective therapeutic strategy for the affected patients.
- 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.
- 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.
- Lymphocytic myocarditis is often observed in myocardium tested positive for viral persistence.
- Less common forms of myocarditis represent giant cell myocarditis and eosinophilic myocarditis.
- Giant cell myocarditis is characterized by the presence of multinucleated giant cells and lymphocytes on heart biopsies.
- Presence of giant cells within non-caseating granulomas, usually associated with myocardial fibrosis is referred to as cardiac sarcoidosis.
- 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.
- Giant cell myocarditis and eosinophilic myocarditis are associated with particularly poor prognosis.
Myocarditis may be classified according to pathologic findings into 4 subtypes:[1]
- Fulminant myocarditis: Fulminant myocarditis occurs following a viral prodrome. Fulminant myocarditis presents as acute severe cardiovascular compromise with ventricular dysfunction.[2] On endomyocardial biopsy, there are multiple foci of inflammation.
- 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 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
- ↑ 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.