Elsevier

International Journal of Cardiology

Volume 294, 1 November 2019, Pages 61-64
International Journal of Cardiology

Story telling of myocarditis

https://doi.org/10.1016/j.ijcard.2019.07.046Get rights and content

Highlights

  • Myocarditis was discovered as heart disease at autopsy with the use of microscope.

  • In 1900, Carl Ludwig Alfred Fiedler first reported with the name of acute interstitial myocarditis a sudden heart failure.

  • Histology, immunohistochemistry and PCR are now considered a gold standard tool for the diagnosis of viral myocarditis.

  • Cardiac resonance magnetic may be of help in identifying inflammatory edema.

Abstract

Myocarditis was discovered as heart disease at autopsy with the use of microscope.

In 1900, with the name of acute interstitial myocarditis, Carl Ludwig Alfred Fiedler first reported the history of a sudden cardiac heart failure, in the absence of coronary, valve, pericardial disease or classical specific infections with multiorgan involvement. He postulated a peculiar isolated acute inflammation of the myocardium with poor prognosis due to invisible microorganisms, which years later would have been identified as viruses. Subsequent revision of Fiedler original histologic slides by Schmorl showed cases with either lymphocytic or giant cell infiltrates.

The in vivo diagnosis became possible with the right heart catheterism and endomyocardial biopsy. Employment of immunohistochemistry and molecular techniques improved the diagnosis and etiology identification. The mechanism of myocyte injury by coxsackie virus was identified in protease 2A coded by the virus and disrupting the dystrophin in the cytoskeleton. Both RNA and DNA viruses may be cardiotropic, and coxsackie and adenovirus share a common receptor (CAR). Unfortunately, vaccination is not yet available.

Cardiac Magnetic Resonance is a revolutionary diagnostic tool by detecting edema, of myocardial inflammation. However endomyocardial biopsy remains the gold standard for etiological and histotype diagnosis, with limited sensitivity due to sampling error.

Viral lymphocytic fulminant myocarditis may not be fatal and the employment of mechanical assistant device – ECMO in acute phase for temporary support may be lifesaving with good prognosis.

Section snippets

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Acknowledgment

This study is supported by the Registry for Cardio-cerebro-vascular Pathology, Veneto Region, Venice, Italy.

References (37)

  • S.S. Abramov

    On the casuistry of the primary myocarditidis

    Medisinskoe Obozrenie, Moscow

    (1897)
  • S. Saltykow

    Uber diffuse Myokarditis

    Virchows Archiv fur Patholologische Anatomie

    (1905)
  • K.A.L. Aschoff

    Zur Myocardiitisfrage

    Verhandlungen der deutschen pathologischen Gesellschaft, Stuttgart

    (1904)
  • G. Dalldorf et al.

    An unidentified, Filtrable agent isolated from the feces of children with paralysis

    Science.

    (1948)
  • C. Chagas

    Sur les alteration du Coeur dans la trypanosomiases américaine (maladie de Chagas)

    Arch Mal Coeur

    (1928)
  • M. Bernstein et al.

    Boeck's sarcoid: report of a case with visceral involvement

    Ann Int Med

    (1929)
  • W. Forssmann

    Die Sondierung des rechten Herzens [Probing of the right heart]

    Klin. Wochenschr.

    (1929)
  • S. Sakakibara et al.

    Endomyocardial biopsy

    Jpn. Heart J.

    (1962)
  • Cited by (13)

    • The heart and SARS-CoV-2

      2022, Medicina Clinica
    • Acute myocarditis revealing autoimmune and inflammatory disorders: Clinical presentation and outcome

      2022, International Journal of Cardiology
      Citation Excerpt :

      Fourth, diagnostic gold standard for myocarditis is endomyocardial biopsy (EMB) and EMB was performed in only 5 patients in our series. Although EMB has a low sensitivity and its diagnostic yield has been challenged in real-world practice [23], the diagnostic contribution of EMB is enhanced by molecular analysis of viral genome in the heart [6]. Fifth, extensive screening for a viral infection was performed only in a limited number of cases, knowing that is usually has a limited impact on treatment.

    View all citing articles on Scopus
    View full text