Skip to main content
SpringerLink
Log in

102 Patienten mit Verdacht auf Myokarditis

Klinische Präsentation, Diagnostik, Therapie und Prognose

102 patients with suspected myocarditis

Clinical presentation, diagnostics, therapy and prognosis

  • Originalien
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Einleitung

Die Myokarditis ist eine schwer zu diagnostizierende Erkrankung, bei der das Risiko der Entwicklung einer dilatativen Kardiomyopathie und für den plötzlichen Herztod besteht.

Methoden und Patienten

In dieser Untersuchung wurden 102 Patienten, die bei Diagnose oder Verdachtsdiagnose einer Myokarditis im Department für Innere Medizin des Universitätsklinikums Halle (Saale) von 2003 bis 2013 behandelt worden waren, eingeschlossen.

Resultate

77,5 % der Studienteilnehmer waren männlich. Im Durchschnitt waren die Patienten 35,5 ± 14,1 Jahre alt. Als Symptome wurden in 46,1 % der Fälle Angina pectoris, in 38,2 % Dyspnoe, in 29,4 % Leistungsabfall, in 9,8 % Palpitationen und in 8,8 % Synkopen angegeben. Bei 45,1 % der Patienten ging ein Atemwegsinfekt voraus. Alle Patienten erhielten eine Echokardiographie, wobei sich bei 20,4 % ein Perikarderguss und bei 36,5 % Wandbewegungsstörungen nachweisen ließen. Eine Myokardbiopsie erfolgte bei 15,6 % der Patienten. Auf kardiotrope Viren wurde bei 37,3 % untersucht und bei 5,9 % der Gesamtgruppe nachgewiesen. Eine kardiale Magnetresonanztomographie (cMRT) erhielten 82 der Patienten, wobei sich in 33,3 % der Fälle ein „late enhancement“ und bei 11,9 % eine Wandbewegungsstörung zeigten. In dieser Studie verstarben 4 Patienten, alle männlich, 3 weitere erlitten eine erneute Myokarditis (Ende der Datenerhebung: September 2013).

Schlussfolgerung

In dieser Arbeit konnte die Symptombreite einer Myokarditis dargestellt werden. Eine Myokarditis manifestiert sich selten durch schwere Verläufe, in dieser Studie lag die Letalität bei 3,9 %. Für die weitere Optimierung der Diagnose- und Behandlungsalgorithmen wären prospektive, randomisierte Studien wünschenswert.

Abstract

Introduction

Myocarditis is a disease which is difficult to diagnose and which includes a risk of the development of dilated cardiomyopathy and sudden cardiac death.

Methods and patients

In this study 102 patients were included from the time period 2003–2013 after diagnosis or suspected diagnosis of myocarditis in the department of internal medicine at the University Hospital Halle (Saale).

Results

Of the study participants 77.5% were male and the average age was 35.5 ± 14.1 years. The symptoms reported by the patients were angina in 46.1%, dyspnea in 38.2%, performance deterioration in 29.4%, palpitations in 9.8% and syncope in 8.8%. In 45.1% of patients, symptoms were preceded by a respiratory infection. All patients underwent an echocardiogram and in 36.5% it was possible to demonstrate a regional wall motion abnormality and in 20.4% a pericardial effusion. A myocardial biopsy was performed in 15.6% of the patients. The presence of cardiotropic viruses was investigated in 37.3% of patients but was detected in only 5.9%. Cardiac magnetic resonance imaging (MRI) was performed in 82 patients of whom 33.3% showed a late enhancement and 11.9% a wall movement disorder. In this study four patients, all male, died and three suffered recurrent myocarditis.

Conclusion

This study showed the wide range of symptoms in myocarditis. Myocarditis is rarely severely manifested and in this study the mortality was 3.9%. For further optimization of the diagnostic and treatment algorithms, prospective, randomized studies would be desirable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Richardson P, McKenna W, Bristow M et al (1996) Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 93(5):841–842. doi:10.1161/01.CIR.93.5.841

    Article  CAS  PubMed  Google Scholar 

  2. Marin-Neto JA, Cunha-Neto E, Simoes MV (2007) Pathogenesis of chronic chagas heart disease. Circulation 115:1109–1123. doi:10.1161/CIRCULATIONAHA.106.624296

    Article  PubMed  Google Scholar 

  3. Pauschinger M, Doerner A, Kuehl U, Schwimmbeck PL et al (1999) Enteroviral RNA replication in the myocardium of patients with left ventricular dysfunction and clinically suspected myocarditis. Circulation 99:889–895. doi:10.1161/01.CIR.99.7.889

    Article  CAS  PubMed  Google Scholar 

  4. Kandolf R (2004) Virus etiology of inflammatory cardiomyopathy. Dtsch Med Wochenschr 129:2187–2192. doi:10.1055/s-2004-831863

    Article  CAS  PubMed  Google Scholar 

  5. Frustaci A, Calabrese F, Chimenti C, Pieroni M et al (2002) Lone hepatitis C virus myocarditis responsive to immunosuppressive therapy. Chest 122:1348–1356. doi:10.1378/chest.122.4.1348

    Article  PubMed  Google Scholar 

  6. Fung G, Luo H, Qiu Y, Yang D, McManus B (2016) Myocarditis. Circ Res 118:496–514. doi:10.1161/CIRCRESAHA.115.306573

    Article  CAS  PubMed  Google Scholar 

  7. Caforio ALP, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J et al (2013) Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 34:2636–2648. doi:10.1093/eurheartj/eht210 (2648a–2648 d)

    Article  PubMed  Google Scholar 

  8. Constanzo-Nordin MR, O’Connell JB, Subramanian R, Robinson JA et al (1985) Myocarditis confirmed by biopsy presenting as acute myocardial infarction. Br Heart J 53(1):25–29. doi:10.1136/hrt.53.1.25

    Article  Google Scholar 

  9. Abelmann WH, Lorell BH (1989) The challenge of cardiomyopathy. J Am Coll Cardiol 13:1219–1239. doi:10.1016/0735-1097(89)90293-3

    Article  CAS  PubMed  Google Scholar 

  10. Dec GW, Fuster V (1994) Idiopathic dilated cardiomyopathy. N Engl J Med 331:1564–1575. doi:10.1056/NEJM199505183322015

    Article  CAS  PubMed  Google Scholar 

  11. Schwartzkopff B, Klein RM, Strauer BE (1995) Diagnostik und Therapie der Myokarditis. Internist 36:469–483

    CAS  PubMed  Google Scholar 

  12. Gravanis MB, Sternby NH (1991) Incidence of myocarditis. A 10-year autopsy study from Malmö, Sweden. Arch Pathol 115(4):390–399

    CAS  Google Scholar 

  13. Fabre A, Sheppard MN (2005) Sudden death syndrome and other non-ischaemic causes of sudden cardiac death. Heart 92(3):316–320. doi:10.1136/hrt.2004.045518

    Article  PubMed  PubMed Central  Google Scholar 

  14. Drory Y, Turetz Y, Hiss Y, Lev B et al (1991) Sudden unexpected death in persons less than 40 years of age. Am J Cardiol 68:1388–1392. doi:10.1016/0002-9149(91)90251-F

    Article  CAS  PubMed  Google Scholar 

  15. Friman G, Wesslen L (2000) Special feature for the olympics: effects of exercise on the immune system: infections and exercise in high-performance athletes. Immunol Cell Biol 78:510–522. doi:10.1111/j.1440-1711.2000.t01-12-.x

    Article  CAS  PubMed  Google Scholar 

  16. Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A et al (2005) Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:1422–1445. doi:10.1093/eurheartj/ehi325

    Article  PubMed  Google Scholar 

  17. Peters NS, Poole-Wilson PA (1991) Myocarditis continuing clinical and pathologic confusion. Am Heart J 121:942–947. doi:10.1016/0002-8703(91)90221-3

    Article  CAS  PubMed  Google Scholar 

  18. Spodick DH, Greene TO, Saperia G (1995) Images in cardiovascular medicine. Acute myocarditis masquerading as acute myocardial infarction. Circulation 91:1886–1887. doi:10.1161/01.CIR.91.6.1886

    Article  CAS  PubMed  Google Scholar 

  19. Bultmann BD, Klingel K, Sotlar K, Bock CT et al (2003) Fatal parvovirus B19-associated myocarditis clinically mimicking ischemic heart disease:an endothelial cell-mediated disease. Hum Pathol 34:92–95. doi:10.1053/hupa.2003.48

    Article  PubMed  Google Scholar 

  20. Celik T, Selimov N, Isik E (2006) Prognostic significance of electrocardiographic abnormalities in diphtheritic myocarditis after hospital discharge: a long term follow up. Ann Noninvasive Electrocardiol 11(1):28–33. doi:10.1111/j.1542-474X.2006.00062.x

    Article  PubMed  Google Scholar 

  21. Lauer B, Niederau C, Kühl U, Schannwell M et al (1997) Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 30:1354–1359. doi:10.1016/S0735-1097(97)00317-3

    Article  CAS  PubMed  Google Scholar 

  22. Smith SC, Ladenson JH, Mason JW, Jaffe AS (1997) Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation 95:163–168. doi:10.1161/01.CIR.95.1.163

    Article  CAS  PubMed  Google Scholar 

  23. Naparstek Y, Poltz PH (1993) The role of autoantibodies in autoimmune diseases. Annu Rev Immunol 11:79–104. doi:10.1146/annurev.iy.11.040193.000455

    Article  CAS  PubMed  Google Scholar 

  24. Mangin M, Mahrholdt H, Sechtem U (2006) Diagnosis of myocarditis: description and assessment of available methods. Dtsch Med Wochenschr 131:1228–1234. doi:10.1055/s-2006-941758

    Article  CAS  PubMed  Google Scholar 

  25. Cooper LT, Baughman KL, Feldman AM, Frustaci A et al (2007) The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 28:3076–3093. doi:10.1016/j.jacc.2007.09.008

    Article  PubMed  Google Scholar 

  26. Schultheiss HP, Kuehl U, Cooper LT (2011) The management of myocarditis. Eur Heart J 32:2616–2665. doi:10.1093/eurheartj/ehr165

    Article  PubMed  Google Scholar 

  27. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG et al (2015) ESC guidelines for the management of infective endocarditis. Eur Heart J 36(44):3075–3128. doi:10.1093/eurheartj/ehv319

    Article  PubMed  Google Scholar 

  28. Phillips M, Robinowitz M, Higgins JR, Boran KJ et al (1986) Sudden cardiac death in Air Force recruits. A 20-year review. JAMA 256:2696–2699. doi:10.1001/jama.1986.03380190066026

    Article  CAS  PubMed  Google Scholar 

  29. McCaffrey FM, Braden DS, Strong WB (1991) Sudden cardiac death in young athletes. A review. Am J Dis Child 145:177–183. doi:10.1001/archpedi.1991.02160020069020

    Article  CAS  PubMed  Google Scholar 

  30. Wesslen L, Pahlson C, Lindquist O, Hjelm E et al (1996) An increase in sudden unexpected cardiac deaths among young Swedish orienteers during 1979–1992. Eur Heart J 17(902):902–910

    Article  CAS  PubMed  Google Scholar 

  31. Robert Koch-Institut (2010) Myokarditis, Reihe Gesundheitsberichterstattung des Bundes, Diagnosedaten der Krankenhäuser ab 2000 (Eckdaten der vollstationären Patienten und Patientinnen). Gliederungsmerkmale: Jahre, Behandlungs-/Wohnort, ICD10 (Primärquelle: Statistisches Bundesamt, Mikrozensus). http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/dboowasys921.xwdevkit/xwd_init?gbe.isgbetol/xs_start_neu/&p_aid=i&p_aid=19746165&nummer=550&p_sprache=D&p_indsp=-&p_aid=24749302. Zugegriffen: 14. Dez 2014

  32. Hufnagel G, Pankuweit S, Richter A, Schonian U et al (2000) The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID). First epidemiological results. Herz 25(3):279–285. doi:10.1007/s000590050021

    Article  CAS  PubMed  Google Scholar 

  33. Cooper LT (2009) Myocarditis, medical progress. N Engl J Med 360:1526–1538. doi:10.1056/NEJMra0800028

    Article  CAS  PubMed  Google Scholar 

  34. Pinamonti B, Alberti E, Cigalotto A, Dreas L et al (1988) Echocardiographic findings in myocarditis. Am J Cardiol 62:285–291. doi:10.1016/0002-9149(88)90226-3

    Article  CAS  PubMed  Google Scholar 

  35. Hunold P, Schlosser T, Vogt FM, Eggebrecht H et al (2005) Myocardial late enhancement in contrast-enhanced cardiac MRI: distinction between infarction scar and non-infarction-related disease. AJR Am J Roentgenol 184:1420–1426. doi:10.2214/ajr.184.5.01841420

    Article  PubMed  Google Scholar 

  36. Aretz HT, Billingham ME, Edwards WD (1987) Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol 1(1):3–14

    CAS  PubMed  Google Scholar 

  37. Dec GW, Palacios IF, Fallon JT, Aretz HT et al (1985) Active myocarditis in the spectrum of acute dilated cardiomyopathies: clinical features, histologic correlates and clinical outcome. N Engl J Med 312:885–890. doi:10.1056/NEJM198504043121404

    Article  PubMed  Google Scholar 

  38. Kühl U, Pauschinger M, Seeberg B, Lassner D et al (2005) Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 112:1965–1970. doi:10.1161/CIRCULATIONAHA.105.548156

    Article  PubMed  Google Scholar 

  39. Koide H, Kitaura Y, Deguchi H, Ukimura A et al (1992) Genomic detection of enteroviruses in the myocardium: studies on animal hearts with coxsackievirus B3 myocarditis and endomyocardial biopsies from patients with myocarditis and dilated cardiomyopathy. Jpn Circ J 52:1081–1093. doi:10.1253/jcj.56.1081

    Article  Google Scholar 

  40. Grasso M, Arbustini E, Silini E, Diegoli M et al (1992) Search for coxsackievirus B3 RNA in idiopathic dilated cardiomyopathy using gene amplification by polymerase chain reaction. Am J Cardiol 69:658–664. doi:10.1016/0002-9149(92)90160-Z

    Article  CAS  PubMed  Google Scholar 

  41. Maisch B, Hufnagel G, Schonian U, Hengstenberg C (1995) The European Study of Epidemiology and Treatment of Cardiac Inflammatory Disease (ESETCID). Eur Heart J 16(Suppl O):173–175. doi:10.1093/eurheartj/16.suppl_O.

    Article  PubMed  Google Scholar 

  42. Osterziel KJ, Dietz R (1997) Therapie der Herzinsuffizienz mit ß‑Blockern. Z Kardiol 86:1–8. doi:10.1007/PL00007336

    Article  CAS  PubMed  Google Scholar 

  43. Burch GE, Giles TD (1972) Prolonged bed rest in the management of patients with cardiomyopathy. Cardiovasc Clin 4(1):375–387

    CAS  PubMed  Google Scholar 

  44. D’Ambrosio A, Patti G, Manzoli A, Sinagra G et al (2001) The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. Heart 85(5):499–504. doi:10.1136/heart.85.5.499

    Article  PubMed  PubMed Central  Google Scholar 

  45. Magnani JW, Danik HJ, Dec GW, Jared W et al (2006) Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. Am Heart J 151(2):463–470. doi:10.1016/j.ahj.2005.03.037

    Article  PubMed  Google Scholar 

  46. McCarthy RE, Boehmer JP, Hrubran RH (2000) Longterm outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 342:690–695. doi:10.1056/NEJM200003093421003

    Article  PubMed  Google Scholar 

  47. Why HJF, Meany BT, Richardson PJ, Olson EGJ et al (1994) Clinical and prognostic significance of detection of enteroviral RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy. Circulation 89:2582–2258. doi:10.1161/01.CIR.89.6.2582

    Article  CAS  PubMed  Google Scholar 

  48. Feldman AM, McNamara D (2000) Myocarditis. N Engl J Med 343:1388–1398. doi:10.1056/NEJM200011093431908

    Article  CAS  PubMed  Google Scholar 

  49. Caforio AL, Calabrese F, Angelini A (2007) A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 28:1326–1333. doi:10.1093/eurheartj/ehm076

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Brandenburgklinik Bernau, Bernau, Deutschland

    S. Streuber

  2. Klinik und Poliklinik für Innere Medizin I und Zentrale Notaufnahme, Universitätsklinikum Halle (Saale), Halle/Saale, Deutschland

    F. Noack

  3. Klinik und Poliklinik für diagnostische Radiologie, Universitätsklinikum Halle (Saale), Halle/Saale, Deutschland

    D. Stoevesandt

  4. Paracelsus Harz-Klinik Bad Suderode, Paracelsusstr. 1, 06485, Quedlinburg, Deutschland

    A. Schlitt

  5. Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland

    A. Schlitt

Authors
  1. S. Streuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Noack
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Stoevesandt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Schlitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Schlitt.

Ethics declarations

Interessenkonflikt

S. Streuber, F. Noack, D. Stoevesandt und A. Schlitt geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Streuber, S., Noack, F., Stoevesandt, D. et al. 102 Patienten mit Verdacht auf Myokarditis. Herz 43, 69–77 (2018). https://doi.org/10.1007/s00059-016-4524-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-016-4524-3

Schlüsselwörter

Keywords

Search

Navigation