MYOCARDITIS: PATHOPHYSIOLOGY, CLINICAL PRESENTATION, AND MANAGEMENT
Keywords:
Myocarditis, cardiac inflammation, heart failure, viral infection, immunosuppression, cardiac MRI, endomyocardial biopsy, cardiomyopathy.Abstract
Myocarditis is an inflammatory disorder of the myocardium caused by a variety of infectious and non-infectious agents. It is characterized by the infiltration of inflammatory cells into the heart muscle and subsequent myocardial injury. Clinically, it can range from an asymptomatic course to fulminant heart failure and sudden cardiac death. The most frequent etiological agents are viruses, but autoimmune diseases, drugs, and toxins can also be responsible. The pathophysiology involves direct damage to cardiac cells and immune-mediated mechanisms. Diagnostic tools include cardiac biomarkers, imaging (especially cardiac MRI), and endomyocardial biopsy. Management is guided by the underlying cause and the severity of cardiac dysfunction, and may involve supportive care, immunosuppressive agents, and mechanical circulatory support. Despite progress, challenges remain in early diagnosis and effective treatment. This article aims to provide a comprehensive review of the current understanding of myocarditis, including its pathogenesis, clinical features, diagnostic strategies, and therapeutic approaches.
References
1.Bozkurt, B., Colvin, M., Cook, J., Cooper, L. T., Deswal, A., Fonarow, G. C., ... & Yancy, C. W. (2016). Current diagnostic and treatment strategies for specific dilated cardiomyopathies: a scientific statement from the American Heart Association. Circulation, 134(23), e579–e646. https://doi.org/10.1161/CIR.0000000000000455
2.Caforio, A. L., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S. B., ... & Charron, P. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the ESC Working Group. European Heart Journal, 34(33), 2636–2648. https://doi.org/10.1093/eurheartj/eht210
3.Kindermann, I., Barth, C., Mahfoud, F., Ukena, C., Lenski, M., Yilmaz, A., ... & Böhm, M. (2012). Update on myocarditis. Journal of the American College of Cardiology, 59(9), 779–792. https://doi.org/10.1016/j.jacc.2011.09.074
4.Pollack, A., Kontorovich, A. R., Fuster, V., & Dec, G. W. (2015). Viral myocarditis—diagnosis, treatment options, and current controversies. Nature Reviews Cardiology, 12(11), 670–680. https://doi.org/10.1038/nrcardio.2015.108
5.Tschöpe, C., Ammirati, E., Bozkurt, B., Caforio, A. L., Cooper, L. T., Felix, S. B., ... & Seferovic, P. M. (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nature Reviews Cardiology, 18(3), 169–193. https://doi.org/10.1038/s41569-020-00435-x
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