INFLAMMATORY CARDIOMYOPATHY: The Controversy of Diagnosis and Management
Section snippets
Etiology and Immunology
Lymphocytic myocarditis, histologically, is characterized by infiltration of the myocardium by lymphocytes and macrophages adjacent to myocyte injury or necrosis. It is intuitive that these inflammatory cells are the culprits in causing cardiac cell injury that leads to necrosis. Clinically, left ventricular systolic function may remain normal or, more frequently, may be subclinically impaired, with subsequent development of symptoms of heart failure or arrhythmias. In acute myocarditis,
Systemic Lupus Erythematosus
Cardiac involvement has been reported in 18% to 38% of cases of systemic lupus erythematosus (SLE).31 Cardiovascular involvement is the third leading cause of death in SLE.33 Pericarditis is the most common manifestation, found in 20% to 30% of patients with lupus.33 Coronary arteritis and occlusions are rare. Libman-Sacks endocarditis is reported in 13% to 74%.3 Myocarditis is also infrequent; it is reported in less than 10% of the cases.3 Domenech et al reported that cardiomyopathy is more
CONCLUSION
In the past decade, advances in immunology have greatly added to our understanding of myocarditis. Therapy with empiric steroids has been categorically futile. Hopefully, more selective immunosuppressive therapies will yield better outcomes. Further research in basic immunology and molecular biology will likely lead to exciting future therapies targeted at the cellular level.
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Cited by (8)
Alterations in cardiac function and gene expression during autoimmune myocarditis in mice
2000, Journal of Molecular and Cellular CardiologyRheumatologic disorders in the PICU
2014, Pediatric Critical Care MedicinemsRheumatologic disorders in the picu
2014, Pediatric Critical Care Medicine: Volume 3: Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune SystemsCardiac pathology of systemic lupus erythematosus
2009, Journal of Clinical PathologyTrue-true, unrelated: A case report
2005, Pediatric Emergency CareEtiology, evaluation, and management of acute myocarditis
2001, Cardiology in Review
Address reprint requests to Karen B. James, MD, Cleveland Clinic Foundation, 9500 Euclid Avenue, F25, Cleveland, OH 44195
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From the Department of Cardiology (KBJ, RS, JBY), and Department of Pathology (NR), Cleveland Clinic Foundation, Cleveland, Ohio