represents an inflammation of the heart muscle (Figure
56e), in many cases due to multiple infectious agents. The
most common cause is Coxsackie B virus infection. Other viruses
include ECHO, Influenza (A, B), Epstein-Barr, Mumps, Hepatitis
C and HIV.
Bacterial (brucella,c.diphtheriae. haemophilus influenzae, mycoplasma
pneumoniae streptococcus pneumoniae etc), rickettsial (coxiella
burnetii etc), and spirochetal infections (borrelia,leptospia)
may also occur.
Trypanosoma cruzi (Chagas' disease,endemic in rural Central
and South America) and toxoplasma gondii) are two of the Protozoal
Metazoal infections include trichinosis and echinococcosis.
Fungusinfections (actinomyces, cooccidiodes, histoplasma, nocardia)
can occur as well.
There are toxic agents, which are causative such as anthracyclines
(doxorubicin), ethanol, cytoxan and cocaine, catecholamines,
interleukin-2, Alpha2 interferon, and allergic reactions to
prescription (thiazides, acetazolamide, reserpine etc) and over-the-counter
metals like iron,copper ,and lead may be causative.
( like inflammatory bowel disease, polymyositis, scleroderma,
systemic lupus erythematosis) are examples of causative factors.
gold standard for the diagnosis of myocarditis is the endocardial
biopsy (Figure 56e). Other diagnostic
tests include assays for autoimmune serum markers to identify
kinase andtroponin levels may be elevated and should be determined
in patients suspected of myocarditis,as well as sedimementation
rate, and rheumatologic screening .
Testing for the presence ofviral genome in endocardial
specimen is recommended to differentiate autoimmune from viral
HIV testing is also recommended routinely.
Also actimyosin scintigrahy may be helful.
Treatment include supportive care , diuretics
angiotensin-converting - inhibitor and a beta-blocker. Hospitalization
may be required. Intravenous inotropic therapy or implantationof
a pacemaker may be needed.
Immonosuppressive drugs have been helpful (not
recommended for routine use) as has intravenous immune gamma
Patients with fulminant myocarditis may beneiitfrom
short -term left ventricular support.