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European Heart Journal Advance Access originally published online on July 9, 2008
European Heart Journal 2008 29(17):2073-2082; doi:10.1093/eurheartj/ehn296
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

Acute viral myocarditis

Robert Dennert, Harry J. Crijns and Stephane Heymans*

Department of Cardiology, CARIM, University Hospital Maastricht, The Netherlands

Received 9 January 2008; revised 5 June 2008; accepted 11 June 2008; online publish-ahead-of-print 9 July 2008.

* Corresponding author: Experimental and Molecular Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands. Tel: +31 43 3882950, Fax: +31 43 3871055, Email: s.heymans{at}cardio.unimaas.nl

Acute myocarditis is one of the most challenging diagnosis in cardiology. At present, no diagnostic gold standard is generally accepted, due to the insensitivity of traditional diagnostic tests. This leads to the need for new diagnostic approaches, which resulted in the emergence of new molecular tests and a more detailed immunohistochemical analysis of endomyocardial biopsies. Recent findings using these new diagnostic tests resulted in increased interest in inflammatory cardiomyopathies and a better understanding of its pathophysiology, the recognition in overlap of virus-mediated damage, inflammation, and autoimmune dysregulation. Novel results also pointed towards a broader spectrum of viral genomes responsible for acute myocarditis, indicating a shift of enterovirus and adenovirus to parvovirus B19 and human herpes virus 6. The present review proposes a general diagnostic approach, focuses on the viral aetiology and associated autoimmune processes, and reviews treatment options for patients with acute viral myocarditis.

Key Words: Myocarditis • Virus • Heart failure • Inflammation


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