[The heart in viral infections]

Area of Science:

• Cardiology
• Virology
• Immunology

Context:

• Inflammatory heart muscle disease (myocarditis) can progress to dilated cardiomyopathy (DCM) in 10-20% of patients.
• Viral infections are a primary cause of myocarditis, leading to myocardial damage.
• Previously identified viruses (enterovirus, adenovirus) and newly detected cardiotropic pathogens (parvovirus B19, EBV, HHV-6) are implicated in DCM development.

Purpose:

• To investigate the role of viral persistence and autoimmune phenomena in the progression of myocarditis to dilated cardiomyopathy.
• To highlight the correlation between viral persistence in the myocardium and declining cardiac function.
• To emphasize the importance of eradicating viruses and managing inflammation to prevent end-stage cardiac insufficiency.

Summary:

• Acute myocarditis can transition through viral, autoimmune, and inflammatory phases, culminating in dilated cardiomyopathy.
• Viral persistence in the myocardium is linked to reduced cardiac pumping capability within six months.
• Autoimmune responses and persistent cardiac inflammation worsen prognosis during the disease's progression.

Impact:

• Understanding the multi-phase progression of myocarditis to DCM is vital for timely diagnosis and intervention.
• Targeting viral eradication and suppressing inflammatory responses may prevent the progression to terminal heart failure.
• This research underscores the need for comprehensive diagnostic and therapeutic strategies for inflammatory cardiomyopathies.