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Clinical aspects of virus/immune myocarditis

Summary

Although a cause-and-effect relationship between viral infection and myocarditis remains inferential, two distinct clinical syndromes can be identified. During the early viral phase, the cardiac manifestations emerge while the symptoms of active viral infection are also present. During the chronic phase, symptoms of the viral infection may be remote or nonexistent, and identification of active myocarditis is contingent upon an aggressive diagnostic approach with endomyocardial biopsy and gallium 67 imaging. The exact incidence of myocarditis in patients with heart failure of unknown cause is unclear due to lack of standardization of histologic parameters. There are no other clinical clues to the presence of myocarditis in those patients presenting with cardiomyopathy or ventricular arrhythmia. For further clarification of the incidence and various presentations of myocarditis a large multi-center trial is necessary.

References

  1. Sutton GC, et al (1967) Coxsackie B4 myocarditis in an adult: Successful isolation of virus from ventricular myocardium. Aerosp Med 38: 66–69

    Google Scholar 

  2. Longson M, Cole FM, Davies D (1969) Isolation of a Coxsackie virus group B, type 5, from the heart of a fatal case of myocarditis in an adult. J Clin Pathol 22: 654–658

    Google Scholar 

  3. Lowry PJ, Edwards CW, Nagle RE (1982) Herpes-like virus particles in myocardium of patient progressing to congestive cardiomyopathy. Br Heart J 48: 501–503

    Google Scholar 

  4. Costanzo-Nordin MR, O'Connell JB (1983) Animal models of immune-mediated myocardial disease, in Robinson JA, O'Connell JB (eds):Myocarditis: Precursor of Cardiomyopathy. Heath, Lexington, pp 29–47

    Google Scholar 

  5. Woodruff JF (1980) Viral myocarditis-A review. Am J Pathol 101: 427–479

    Google Scholar 

  6. Paque RE, et al (1978) Assessment of cell-mediated hypersensitivity against Coxsackievirus B3 viral-induced myocarditis utilizing hypertonic salt extracts of cardiac tissue. J Immunol 120: 1672–1678

    Google Scholar 

  7. Wilson FM, et al (1969) Residual pathologic changes following murine Coxsackie A and B myocarditis. Am J Pathol 55: 153–164

    Google Scholar 

  8. Reyes MP, Et al (1981) A mouse model of dilated type cardiomypathy due to Coxsackie virus B3. J Infect Dis 144: 232–236

    Google Scholar 

  9. Obeyesekere I, Hermon Y (1973) Arbovirus heart disease: Myocarditis and cardiomyopathy following dengue and chikungunya fever—A follow-up study. Am heart J 85: 186–194

    Google Scholar 

  10. Milei J, Bolomo NJ (1982) Myocardial damage in viral hemorrhagic fevers. Am Heart J 104: 1385–1391

    Google Scholar 

  11. Datta D, Zaida A, Brendan-Devlin H (1980) Carditis associated with coronavirus infection. Lancet II: 100–101

    Google Scholar 

  12. Toshima H, Ohkita Y, Shingu M (1979) Clinical features of acute Coxsackie B viral myocarditis. Jpn Circ J 43: 441–444

    Google Scholar 

  13. Koontz CH, Ray CG (1971) The role of Coxsackie group B virus infections in sporadic myocarditis. Am Heart J 82: 750–758

    Google Scholar 

  14. Smith WG (1970) Coxsackie B myopericarditis in adults. Am Heart J 80: 34–46

    Google Scholar 

  15. Fukuhara T, et al (1983) Myopericarditis associated with ECHO type 3 infection. Jpn Circ J 47: 1274–1280

    Google Scholar 

  16. Lansdown ABG (1978) Viral infections and diseases of the heart. Prog Med Virol 24: 70–113

    Google Scholar 

  17. Wink K, Schmitz H (1980) Cytomegalovirus myocarditis. Am Heart J 100: 667–671

    Google Scholar 

  18. Frishman W, et al (1977) Infectious mononucleosis and fatal myocarditis. Chest 72: 535–538

    Google Scholar 

  19. Hudgins JM (1976) Infectious monoucleosis complicated by myocarditis and pericarditis. JAMA 235: 2626–2627

    Google Scholar 

  20. Butler T, et al (1981) Infectious mononucleosis myocarditis. J Infect 3: 172–175

    Google Scholar 

  21. Bell RW, Murphy WM (1967) Myocarditis in young military personnel. Herpes simplex, trichinosis, meningococcemia, carbon tetrachloride, and idiopathic fibrous and giant cell types. Am Heart J 74: 309–323

    Google Scholar 

  22. Hackel DB (1953) Myocarditis in association with varicella. Am J Pathol 29: 369–373

    Google Scholar 

  23. Karjalainen J, Nieminen MS, Heikkla J (1980) Influenza Al myocarditis in conscripts. Acta Med Scand 207: 27–30

    Google Scholar 

  24. Walsh J, et al (1958) A study of the effects of type A (Asian strain) influenza on the cardiovascular system of man. Ann Intern Med 49: 402–528

    Google Scholar 

  25. Roberts WC, Fox SM III (1965) Mumps of the heart. Clinical and pathologic features. Circulation 32: 342–345

    Google Scholar 

  26. Ainger LE, Lawyer G, Figtch DW (1966) Neonatal rubella myocarditis. Br Heart J 28: 691–697

    Google Scholar 

  27. Grayston JT, Mordhorst CH, Wang S-P (1981) Childhood myocarditis associated with chlamydia trachomatis infection. JAMA 246: 2823–2827

    Google Scholar 

  28. Yamane Y, Kawai C (1978) A case of myocarditis caused by Mycoplasma pneumoniae. Jpn Circ J 42: 1279–1286

    Google Scholar 

  29. Sands MJ, et al (1977) Pericarditis and perimyocarditis associated with active Mycoplasma pneumoniae infection. Ann Intern Med 86: 544–548

    Google Scholar 

  30. Lewes D, Rainford DJ, Lane WF (1974) Symptomless myocarditis and myalgia in viral and Mycoplasma pneumoniae infections. Br Heart J 36: 924–932

    Google Scholar 

  31. Bradford WD, Hackel DB (1978) Myocardial involvement in Rocky Mountain Spotted Fever. Arch Pathol Lab Med 102: 357–359

    Google Scholar 

  32. Walker DH, Paletta CE, Cain BG (1980) Pathogenesis of myocarditis in Rocky Mountain Spotted Fever. Arch Pathol Lab Med 106: 171–174

    Google Scholar 

  33. Lerner AM, Wilson FM, Reyes MP (1975) Enteroviruses and the heart (with special emphasis on the probable role of Coxsackieviruses group B, types 1–5) II. Observations in humans. Mod Concepts Cardiovasc Dis 44: 11–15

    Google Scholar 

  34. Gittleman IW, Thorner MC, Griffith GC (1951) The Q-T interval of the electrocardiogram in acute myocarditis in adults, with autopsy correlation. Am Heart J 41: 78–90

    Google Scholar 

  35. Gibson TC, et al (1959) Electrocardiographic studies in Asian influenza. Am Heart J 57: 661–668

    Google Scholar 

  36. Helin M, Savola J, Lapinleimu K (1968) Cardiac manifestations during a Coxsackie B5 epidemic. Br Med J 3: 97–99

    Google Scholar 

  37. Heikkila J, Karjalainen J (1982) Evaluation of mild acute infectious myocarditis. Br Heart J 47: 381–391

    Google Scholar 

  38. Sun NC, Smith VM (1966) Hepatitis associated with myocarditis. Unusual manifestation of infection with Coxsackie virus group B, type 3. N Engl J Med 274: 190–193

    Google Scholar 

  39. Freiji L, Norrby R, Olsson B (1970) A small outbreak of Coxsackie B5 infection with two cases of cardiac involvement and orchitis followed by testicular atrophy. Acta Med Scand 187: 177–181

    Google Scholar 

  40. Burch GE, Colcolough HL (1969) Progressive Coxsackie viral pancarditis and nephritis. Ann Intern Med 71: 963–970

    Google Scholar 

  41. Abelmann WH (1966) Myocarditis. N Engl J Med 275: 832–834

    Google Scholar 

  42. Gardiner AJS, Short D (1973) Four faces of acute myopericarditis. Br Heart J 35: 433–442

    Google Scholar 

  43. Oda T, Hamamoto K, Morinaga H (1982) Left ventricular hypertrophy in non-rheumatic myocarditis in children. Jpn Circ J 46: 1235–1238

    Google Scholar 

  44. Hauser AM, et al (1983) Severe transient left ventricular “hypertrophy” occurring during acute myocarditis. Chest 83: 275–277

    Google Scholar 

  45. Miklozek CL, et al (1980) Unsuspected cardiac dysfunction in viral myopericarditis. Clin Res 28: 616 (Abstract)

    Google Scholar 

  46. Case Records of the Massachusetts General Hospital (1982) Weekly clinicopathological exercises. Case 20-1982 (Abelmann WH discussant). N Engl J Med 306: 1215–1223

    Google Scholar 

  47. Sekiguchi M, et al (1980) Clinical and histopathological profile of sarcoidosis of the heart and acute idiopathic myocarditis. Concepts through a study employing endomyocardial biopsy. II. Myocarditis. Jpn Circ J 44: 264–273

    Google Scholar 

  48. Bullon FS, et al (1980) Disappearing signs of acute myocardial infarction in a patient with viral myocarditis. Cardiovasc Dis Bull Texas Heart Inst 7: 66–73

    Google Scholar 

  49. Miklozek CL, Abelmann WH (1981) Viral myopericarditis presenting as acute myocardial infarction. Circulation 64: IV-25 (Abstract).

  50. Nemickas R, et al (1978) Massive myocardial necrosis in a young woman. Am Heart J 95: 766–774

    Google Scholar 

  51. Kron J, et al (1983) Myocardial infarction following an acute viral illness. Arch Intern Med 143: 1466–1467

    Google Scholar 

  52. Saffitz JE, et al (1983) Coxsackie viral myocarditis causing transmural right and left ventricular infarction without coronary narrowing. Am J Cardiol 52: 644–647

    Google Scholar 

  53. Chandraratan PAN, et al (1983) Left ventricuar asynergy in acute myocarditis. Simulation of acute myocardial infarction. JAMA 250: 1428–1430

    Google Scholar 

  54. Burch GE, Shewey LL (1976) Viral coronary arteritis and myocardial infarction. Am Heart J 92: 11–14

    Google Scholar 

  55. El-Khatib MR, Chason JL, Lerner AM (1979) Ventricular aneurysms complicating Coxsackievirus group B, types I and 4 murine myocarditis. Circulation 59: 412–416

    Google Scholar 

  56. Costanzo-Nordin MR, et al (in press) Biopsy-proven myocarditis presenting as acute myocardial infarction. Br Heart J

  57. Noren GR, et al (1977) Occurrence of myocarditis in sudden death in children. J Forensic Sci 22: 188–196

    Google Scholar 

  58. O'Connell JB, et al (1984) Endodmyocardial biopsy: Techniques and applications in heart disease of unknown cause. Heart Transplant 3: 132–144

    Google Scholar 

  59. Mason JW, Billingham ME, Ricci DR (1980) Treatment of acute inflammatory myocarditis assisted by endomyocardial biopsy. Am J Cardiol 45: 1037–1044

    Google Scholar 

  60. Kunkel B, et al (1978) Light-microscopic evaluation of myocardial biopsies, in In: Kaltenbach M, Loogen F, Olsen ECG (eds) Cardiomyopathy and myocardial biopsy. Springer, Berlin Heidelberg New York, pp 62–70

    Google Scholar 

  61. Noda S (1980) Histopathology of endomyocardial biopsies from patients with idiopathic cardiomyopathy: Quantitative evaluation based on multivariate statistical analysis. Jpn Circ J 44: 95–116

    Google Scholar 

  62. Baandrup U, Olsen EGJ (1981) Critical analysis of endomyocardial biopsies for patients suspected of having cardiomyopathy. I: Morphological and morphometric aspects. Br Heart J 45: 475–486

    Google Scholar 

  63. Edwards WD, Holmes Jr DR, Reeder GS (1982) Diagnosis of active lymphocytic myocarditis by endomyocardial biopsy. Quantitative criteria for light microscopy. Mayo Clin Proc 57: 521–425

    Google Scholar 

  64. Fenoglio Jr JJ, et al (1983) Diagnosis and classification of myocarditis by endomyocardial biopsy. N Engl J Med 308: 12–18

    Google Scholar 

  65. Hess ML, Hastillo A, Mohanty PK (1983) Inflammatory myocarditis: Incidence and response to T-lymphocyte depletion. J Am Coll Cardiol 1: 584 (Abstract).

    Google Scholar 

  66. Strain JE, et al (1983) Atypical presentations of myocarditis. Circulation 68: III-27 (Abstract)

  67. Unverferth DV, et al (1984) Human myocardial histologic characteristics in congestive heart failure. Circulation 68: 1194–1200

    Google Scholar 

  68. Parillo JE, et al (1984) The results of transvenous endomyocardial biopsy can frequently be used to diagnose myocardial disease in patients with idiopathic heart failure. Endomyocardial biopsies in 100 consecutive patients revealed a substantial incidence of myocarditis. Circulation 69: 93–101

    Google Scholar 

  69. Zee-Cheng C-S, et al (1984) High incidence of myocarditis by endomyocardial biopsy in patients with idiopathic congestive cardiomyopathy. J Am Coll Cardiol 3: 63–70

    Google Scholar 

  70. O'Connell JB, et al (1984) Gallium-67 imaging in patients with dilated cardiomyopathy and biopsy-proven myocarditis. Circulation 70: 58–62

    Google Scholar 

  71. Daly K, et al (1984) Acute myocarditis. Role of histological and virological examination in the diagnosis and assessment of immunosuppressive treatment. Br Heart J 51: 30–35

    Google Scholar 

  72. Bolte H-D, Ludwig B (1984) Viral myocarditis: Symptomatology, clinical diagnostics and haemodynamics. In: Bolte H-D (ed) Viral heart disease. Springer, Berlin Heidelbery New York Tokyo, pp 177–187

    Google Scholar 

  73. Mills AS, Hastillo A, Hess ML (1984) Lymphocytic infiltration of the myocardium in idiopathic dilated cardiomyopathy: Underestimation of myocarditis with endomyocardial biopsy. Circulation 70: II-401 (Abstract)

  74. Weiland DS, Donalson RF, Isner JM (1984) How well does the endomyocardial biopsy represent the state of the heart. Circulation 70: II-401 (Abstract)

  75. Robinson JA, et al (1979) Gallium-67 imaging in cardiomyopathy. Ann Intern Med 90: 198–199

    Google Scholar 

  76. O'Connell JB, et al (1981) Immunosuppressive therapy in patients with congestive cardiomyoathy and myocardial uptake of gallium-67. Circulation 64: 780–686

    Google Scholar 

  77. O'Connell JB, et al (1984) Clinical and pathologic findings of myocarditis in two families with dilated cardiomyopathy. Am Heart J 107: 127–135

    Google Scholar 

  78. Melvin KR, et al (1982) Peripartum cardiomyopathy due to myocardtiis. N Engl J Med 307: 731–734

    Google Scholar 

  79. O'Connell JB, et al (1984) Peripartum cardiomyopathy: Unique features. Circulation 70: II-152 (Abstract).

  80. Vignola PA, et al (1984) Lymphocytic myocarditis presenting as unexplained ventricular arrhythmias: Diagnosis with endomyocardial biopsy and response to immunosuppression. J Am Coll Cardiol 4: 812–819

    Google Scholar 

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Supported in part by the Earl M. Bane Charitable Trust

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O'Connell, J.B., Robinson, J.A., Gunnar, R.M. et al. Clinical aspects of virus/immune myocarditis. Heart Vessels 1, 102–106 (1985). https://doi.org/10.1007/BF02072373

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Keywords

  • Viral Infection
  • Cardiomyopathy
  • Gallium
  • Ventricular Arrhythmia
  • Myocarditis