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Published on: May 5, 2022
[Myocarditis in 2020]
Valérian Valiton1, David Carballo1, Jörg D Seebach2
1Service de Cardiologie, HUG, 1211 Genève 14.
Insights
Myocarditis, an inflammation of the heart muscle often caused by viruses, presents a diagnostic challenge. Cardiovascular magnetic resonance imaging is key for identifying myocardial inflammation, guiding patient management.
Area of Science:
- Cardiology
- Immunology
- Infectious Diseases
Background:
- Myocarditis is myocardial inflammation with diverse causes, primarily viral infections and autoimmunity.
- Clinical symptoms vary from chest pain to severe outcomes like cardiogenic shock and arrhythmias.
- Dilated cardiomyopathy can arise as a long-term consequence.
Purpose of the Study:
- To outline the diagnostic challenges and current imaging modalities for myocarditis.
- To emphasize the role of cardiovascular magnetic resonance in diagnosing myocardial inflammation.
- To discuss the symptomatic management of myocarditis and its complications.
Main Methods:
- Review of diagnostic strategies for myocarditis.
- Emphasis on electrocardiogram (ECG), echocardiography, troponin levels, and coronary angiography for exclusion.
- Highlighting cardiovascular magnetic resonance (CMR) as a primary diagnostic tool.
- Mentioning endomyocardial biopsy as the gold standard.
Main Results:
- Diagnosis of myocarditis is complex, requiring a multi-faceted approach.
- Cardiovascular magnetic resonance (CMR) offers superior accuracy in detecting myocardial inflammation compared to other non-invasive methods.
- Early identification and management of complications are crucial for patient outcomes.
Conclusions:
- Myocarditis diagnosis necessitates a combination of clinical evaluation and advanced imaging.
- Cardiovascular magnetic resonance (CMR) is the most valuable tool for characterizing myocardial inflammation.
- Symptomatic treatment focusing on heart failure and arrhythmias is the cornerstone of management.
Abstract:
Myocarditis is an inflammatory disease of the myocardium caused by various etiologies with a dominance of viral infections and potential post-infectious autoimmunity. The clinical presentation ranges from chest pain to severe complications including cardiogenic shock, ventricular arrhythmias, and progression to dilated cardiomyopathy. The diagnostic approach is challenging and includes several investigations, such as an ECG, an echocardiography, troponin testing and the exclusion of coronary artery disease. Although endomyocardial biopsy remains the gold standard, cardiovascular magnetic resonance is now the most valuable tool to accurately characterize myocardial tissue inflammation. The management is mainly symptomatic and consists in early detection and treatment of complications including heart failure and arrhythmias.
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