Myocarditis confirmed by biopsy presenting as acute myocardial infarction.

Costanzo-Nordin, Maria Rosa; O’Connell, John B.; Subramanian, Ramiah; Robinson, John A.; Scanlon, Patrick J.

doi:10.1136/hrt.53.1.25

Cited by 47 publications

(11 citation statements)

References 14 publications

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“…These findings correspond in part to changes observed in the ECG, which early in the disease also reflects a more focal involvement of the myocardium and even mimics acute myocardial infarction. 17,18 Analysis of the data with exclusion of the three patients with negative biopsy findings did not change the result.…”

Section: Endomyocardial Biopsymentioning

confidence: 83%

Contrast Media–Enhanced Magnetic Resonance Imaging Visualizes Myocardial Changes in the Course of Viral Myocarditis

et al. 1998

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Section: Endomyocardial Biopsymentioning

confidence: 83%

Contrast Media–Enhanced Magnetic Resonance Imaging Visualizes Myocardial Changes in the Course of Viral Myocarditis

et al. 1998

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“…However, when rigorous histological criteria are used, myocarditis is seldom diagnosed in patients with a clinical picture of dilated cardiomyopathy [6,9,10] . Another presentation of myocarditis more or less mimicks acute myocardial infarction [11][12][13][14] . In patients with this form, chest pain is the leading symptom, electrocardiography displays ST-segment elevations and markers of myocardial injury are found in the blood.…”

Section: Introductionmentioning

confidence: 99%

Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience

Karjalainen

Heikkilä

1999

European Heart Journal

106

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AimsThe incidence of myocarditis is uncertain as diagnostic criteria have been vague. We evaluated the incidence of myocarditis presenting in three well defined forms (mimicking myocardial infarction, presenting as dilated cardiomyopathy, and as a cause of sudden death) in young men in military service over a 20-year period. Methods and ResultsThe study population consisted of 672 672 Finnish men at a mean age of 20 years conscripted from 1977-1996. All those suspected of having myocardial disease were studied prospectively in the same institution. A clinical diagnosis of myocarditis mimicking myocardial infarction required ECG signs (ST-segment elevation followed by T-wave inversion) and a simultaneous detection of serum markers of acute myocardial injury (CK-MB and/or troponin T) in an infectious patient with chest pain. This form of myocarditis was diagnosed in 98 men, the incidence being 0·17 (95% CI 0·14-0·21) . 1000 manyears 1 . Causative microbes were those commonly infecting the conscripts, but Coxsackievirus aetiology could be confirmed in only 4% of the cases. Nine patients presented with dilated cardiomyopathy of recent origin (incidence 0·02 . 1000 man-years 1 ). None had histopathological evidence of myocarditis. Myocarditis caused one of the 10 sudden unexpected deaths (incidence 0·002 . 1000 man-years 1 ). ConclusionsThe usual presentation of acute myocarditis in young men mimicks alterations evoked by myocardial infarction but not those of dilated cardiomyopathy.(Eur Heart J 1999; 20: 1120-1125)

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“…[23][24][25] Nevertheless, the sensitivity of EMB remains low, which is explained by the focal manifestation of myocarditis. 10,26,27 EMB specimens are small 22 and are normally taken from the RV portion of the IVS without information about the localization of inflammatory foci. Therefore, it is likely that sampling errors are responsible for the low sensitivity and low negative predictive value reported.…”

Section: Endomyocardial Biopsymentioning

confidence: 99%

Cardiovascular Magnetic Resonance Assessment of Human Myocarditis

Mahrholdt

Goedecke²,

Wagner³

et al. 2004

Circulation

926

236

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Background-Myocarditis can occasionally lead to sudden death and may progress to dilated cardiomyopathy in up to 10% of patients. Because the initial onset is difficult to recognize clinically and the diagnostic tools available are unsatisfactory, new strategies to diagnose myocarditis are needed. Methods and Results-Cardiovascular MR imaging (CMR) was performed in 32 patients who were diagnosed with myocarditis by clinical criteria. To determine whether CMR visualizes areas of active myocarditis, endomyocardial biopsy was taken from the region of contrast enhancement and submitted to histopathologic analysis. Follow-up was performed 3 month later. Contrast enhancement was present in 28 patients (88%) and was usually seen with one or several foci in the myocardium. Foci were most frequently located in the lateral free wall. In the 21 patients in whom biopsy was obtained from the region of contrast enhancement, histopathologic analysis revealed active myocarditis in 19 patients (parvovirus B19, nϭ12; human herpes virus type 6 [HHV 6], nϭ5). Conversely, in the remaining 11 patients, in whom biopsy could not be taken from the region of contrast enhancement, active myocarditis was found in one case only (HHV6). At follow-up, the area of contrast enhancement decreased from 9Ϯ11% to 3Ϯ4% of left ventricular mass as the left ventricular ejection fraction improved from 47Ϯ19% to 60Ϯ10%. Conclusions-Contrast enhancement is a frequent finding in the clinical setting of suspected myocarditis and is associated with active inflammation defined by histopathology. Myocarditis occurs predominantly in the lateral free wall. Contrast CMR is a valuable tool for the evaluation and monitoring of inflammatory heart disease.

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Myocarditis confirmed by biopsy presenting as acute myocardial infarction.

Cited by 47 publications

References 14 publications

Contrast Media–Enhanced Magnetic Resonance Imaging Visualizes Myocardial Changes in the Course of Viral Myocarditis

Contrast Media–Enhanced Magnetic Resonance Imaging Visualizes Myocardial Changes in the Course of Viral Myocarditis

Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience

Cardiovascular Magnetic Resonance Assessment of Human Myocarditis

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