Myocarditis
Open accessAbstract
Myocarditis is an underdiagnosed cause of acute heart failure, sudden death, and chronic dilated cardiomyopathy. In developed countries, viral infections commonly cause myocarditis; however, in the developing world, rheumatic carditis, Trypanosoma cruzi, and bacterial infections such as diphtheria still contribute to the global burden of the disease. The short-term prognosis of acute myocarditis is usually good, but varies widely by cause. Those patients who initially recover might develop recurrent dilated cardiomyopathy and heart failure, sometimes years later. Because myocarditis presents with non-specific symptoms including chest pain, dyspnoea, and palpitations, it often mimics more common disorders such as coronary artery disease. In some patients, cardiac MRI and endomyocardial biopsy can help identify myocarditis, predict risk of cardiovascular events, and guide treatment. Finding effective therapies has been challenging because the pathogenesis of chronic dilated cardiomyopathy after viral myocarditis is complex and determined by host and viral genetics as well as environmental factors. Findings from recent clinical trials suggest that some patients with chronic inflammatory cardiomyopathy have a progressive clinical course despite standard medical care and might improve with a short course of immunosuppression.
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Giant cell myocarditis is a rare but rapidly progressing condition associated with a high risk of death or the necessity for heart transplantation.
“Giant cell myocarditis is a rare but rapidly progressing condition associated with a high risk of death or the necessity for heart transplantation.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [186]
The Cause section describes giant-cell myocarditis as rare and says it presents with fulminant or acute heart failure, supporting the rapid-progression characterization. The Classification section calls it a more serious form to consider when prognosis is worse. The copy does not establish a high risk of death or need for transplantation specifically for giant-cell myocarditis; its death-or-transplantation discussion concerns myocarditis more broadly. (LLM, conf=0.82)
Experimental — accuracy not yet measuredEosinophilic myocarditis is characterized by predominant infiltration of eosinophils in the myocardium.
“Eosinophilic myocarditis is characterized by a predominant infiltration of eosinophils in the myocardium”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [186]
The Cause section describes an eosinophil-rich infiltrate in acute necrotising eosinophilic myocarditis. It does not explicitly say that eosinophils predominate in the myocardium across all forms of eosinophilic myocarditis; the Classification section also notes that an eosinophil-rich infiltrate can occur in giant-cell myocarditis. Page numbers are unavailable in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredEosinophilic myocarditis leads to advanced heart disorders such as heart failure, fibrosis, and thrombosis.
“leading to advanced heart disorders such as heart failure, fibrosis, and thrombosis.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [186]
The Cause section says acute necrotising eosinophilic myocarditis can present with fulminant or acute heart failure. It describes little fibrosis in the acute setting, rather than identifying fibrosis as a consequence of that condition, and the passages found do not link eosinophilic myocarditis to thrombosis. The claim’s list of three outcomes is therefore only partly supported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredECG in myocarditis can show either diffuse ST-segment elevations or ST-segment elevation in a coronary distribution.
“can show either diffuse STsegment elevations or ST-segment elevation in a coronary distribution.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [186]
The Diagnosis section says pericarditis accompanying epicardial inflammation can produce diffuse ST-segment elevation in myocarditis. It also mentions other ST-wave abnormalities, but does not say that ST-segment elevation can follow a coronary distribution; its reference to coronary distribution concerns wall-motion abnormalities, not ECG findings. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredVarious conditions including infections, drugs, hypersensitivity, and autoimmune factors may be associated with the onset and progress of eosinophilic myocarditis.
“various conditions including infections, drugs, hypersensitivity, and autoimmune factors may be associated with the onset and progress of this disease.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [186]
The ECG is abnormal in the majority of patients with myocarditis.
“The ECG is abnormal in the majority of patients with myocarditis”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [186]
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- Authors
- Sagar, S., Liu, P. P., & Cooper, L. T.
- Affiliations
- Mayo Clinic (US)
- University Health Network (CA)
- Corresponding author
- Cooper, Leslie T
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 379
- Issue
- 9817
- Pages
- 738-747
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC5814111
- OpenAlex
- W4240413437
- Cited by
- 743
- References
- 104
- Citations by year
- 2026: 41 · 2025: 83 · 2024: 89 · 2023: 81 · 2022: 79 · 2021: 60 · 2020: 44 · 2019: 58 · 2018: 34 · 2017: 42 · 2016: 38 · 2015: 34 · 2014: 24 · 2013: 25 · 2012: 11
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R56HL056267, R01HL056267)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Pericarditis and Cardiac Tamponade
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- myocarditis, viral myocarditis, dilated cardiomyopathy, acute heart failure, sudden cardiac death, rheumatic carditis, Trypanosoma cruzi, diphtheria, cardiac MRI, endomyocardial biopsy, immunosuppression, prognosis, pathogenesis
- MeSH terms
- Acute Disease, Bacterial Infections, Humans, Myocarditis, Prognosis, Virus Diseases
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