[Endomyocardial biopsy-guided diagnosis and treatment of inflammatory cardiomyopathies]

Over 50 % of cases of inflammatory cardiomyopathy are caused by bacterial or viral infection, the latter frequently Parvovirus B19, enterovirus (Coxsackie B virus) or adenovirus. Regarding the pathogenesis of the disease, its early phase is dominated by the infectious pathogen, which directly damages the myocardium, while in the second phase an important role is played by activation of the immune system and the antiviral immune response with immunological processes.

A 24-year-old woman (height 175 cm, weight 88 kg) was admitted because of recurrent exertional dyspnea. She also reported increased feeling of weakness, fainting and vertigo for the preceding six months. She reported an influenza-like infection just before the onset of these symptoms.

No abnormalities were found on physical examination. But echocardiography revealed markedly reduced ventricular contractility with an ejection fraction (EF) of 30 %. A cardiac catheterization was performed, as part of which a myocardial biopsy was obtained.

The biopsies showed an inflammatory cardiomyopathy and Parvovirus B19 was demonstrated. The patient received the accepted management of heart failure plus hyper-immunoglobins, 2 x 10 g i. v. on days 1 and 3. This treatment resulted in marked and lasting improvement of the clinical symptoms. After 36 months the clinical status was only slightly reduced, the EF being 40 % and the LV end-diastolic dimension 56 mm.

Without an endomyocardial biopsy it would have been impossible to establish the diagnosis of inflammatory cardiomyopathy due to Parvovirus B19. It was only through the demonstration of the causative pathogen in myocardium that it was possible to provide aetiologically targeted treatment.