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This article discusses the diagnosis and management of myocarditis and pericarditis (both acute and recurrent), as well as other pericardial diseases.
Myocarditis is the term used to indicate acute infective, toxic or autoimmune inflammation of the heart. Reversible toxic myocarditis occurs in diphtheria and sometimes in infective endocarditis when autoimmune mechanisms may also contribute. Persistent viral infection of the myocardium was first demonstrated a decade ago.1 Slow growing organisms such as chlamydia and trypanosomal infection in Chagas' disease are causes of chronic myocarditis. Non-infective causes in sarcoidosis and the collagen vascular diseases need to be sought.
Acute myocarditis and acute pericarditis are not always associated (likewise meningitis and encephalitis do not always occur together) and the clinical emphasis is usually on one or the other.
Myocarditis can be caused by many different viruses and the microbial pathogenesis may be complex. Most cases of myocarditis with onset in otherwise healthy people probably have an infectious origin, although the pathogenesis is not yet fully understood (such as the finding of a link between chlamydia and heart disease through antigenic mimicry). In western countries enteroviruses, especially coxsackie B 1–6 serotypes, are the most frequent, and the recent identification of a common coxsackie virus B and adenovirus receptor has explained why these very different virus types both cause myocarditis.2-4
Prevalence and clinical features
The prevalence of acute myocarditis is unknown because most cases are not recognised on account of non-specific or no symptoms (but sudden death may occur). Myocarditis may develop as a complication of an upper respiratory or gastrointestinal infection with general constitutional symptoms, particularly fever and skeletal myalgia, malaise, and anorexia. This systemic acute phase response increases energy production but compromises performance. Since myocarditis may not develop for several days or weeks after the symptoms and after a return to normal work and leisure …