Myocarditis classification

Myocarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Adrenergic Myocarditis
Giant Cell Myocarditis

Causes

Differentiating Myocarditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Myocarditis classification On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Google Images

American Roentgen Ray Society Images of Myocarditis classification

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Myocarditis classification

CDC on Myocarditis classification

Myocarditis classification in the news

Blogs on Myocarditis classification

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Myocarditis classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Varun Kumar, M.B.B.S. Maliha Shakil, M.D. [2] Homa Najafi, M.D.[3]

## Overview[edit | edit source]

Myocarditis can be classified based on the causative, histological, and clinicopathological criteria. Causative criteria include three main groups, as well as infectious, immune-mediated, and toxic myocarditis. Based on the type of infiltrating cells myocarditis divided in lymphocytic, eosinophilic, polymorphic, giant cell myocarditis, and cardiac sarcoidosis. Acute, fulminant, chronic active, and chronic persistent are subtypes of clinicopathopogical classification.

## Classification[edit | edit source]

* Myocarditis can be classified based on the causative, histological, and clinicopathological criteria.
* Myocarditis may be classified according to causative criteria into three groups:[1][2][3][4][5][6][7][8][9]
* Infectious myocarditis
* Immune-mediated myocarditis
* Toxic myocarditis

* Myocarditis may be classified according to histological criteria into five groups:[10][11][2]
* Lymphatic myocarditis
* Eosinophilic myocarditis
* Polymorphic myocarditis
* Giant cell myocarditis
* Cardiac sarcoidosis

* Myocarditis may be classified according to clinicopathological four criteria into three groups:[12][13][14]
* Fulminant myocarditis
* Acute myocarditis
* Chronic active myocarditis
* Chronic persistent myocarditis

## Causative criteria[edit | edit source]

* Myocarditis can be classified based on the causative criteria into immune-mediated myocarditis, infectious myocarditis and toxic myocarditis. bkjvskaljbkjbkjbakj

| Immune-mediated myocarditis|

|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|

| Allergens|

| Alloantigens|

| Autoantigens

| •Tetanus toxoid

•Vaccines

•Serum sickness|

| Drugs:

•Penicillin

•Cefaclor

•Colchicine

•Furosemide

•Isoniazid

•Lidocaine

•Tetracycline

•Sulfonamides

•Phenytoin

•Phenylbutazone

•Methyldopa

•Thiazide diuretics

•Amitriptyline|

| Heart transplant rejection|

| •Infection-negative lymphocytic

Infection-negative giant cell|

| Autoimmune disorders:

•SLE

•Rheumatoid arthritis

•Churg-Strauss syndrome

•Kawasaki's disease

•IBD

•Scleroderma

•Polymyositis

•Myasthenia gravis

•DM type1

•Thyrotoxicosis

•Sarcoidosis

•Wegener's granulomatosis

•Rheumatic heart disease|

| Toxic myocarditis|

|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|

| Drugs|

| Heavy metals|

| Hormones|

| Physical agents|

| Miscellaneous|

| •Amphetamines

•Anthracyclines

•Cocaine

•Cyclophosphamide

•Ethanol

•Fluorouracil

•Lithium

•Catecholamines

•Hematine

•Interleukin-2

•Trastuzumab

•Clozapine|

| •Copper

•Iron

•Lead|

| •Phaeochromocytoma

•Beriberi|

| •Radiation

•Electric shock|

| •Scorpion sting

•Snake, and spider bites

•Bee and wasp stings

•Carbon monoxide

•Inhalant

•Phosphorus

•Arsenic

•Sodium azide|

| Infectious myocarditis|

|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|

| Bacterial|

| Spirochaetal|

| Fungal|

| Protozoal|

| Parasitic|

| Rickettsial|

| Viral|

| •Staphylococcus

•Streptococcus

•Pneumococcus

•Meningococcus

•Gonococcus

•Salmonella

•Corynebacterium diphtheriae

•Haemophilus influenzae

•Mycobacterium tuberculosis

•Mycoplasma pneumonia

•Brucella|

| •Borrelia •Leptospira|

| •Aspergillus

•Actinomyces

•Blastomyces

•Candida

•Coccidioides

•Cryptococcus

•Histoplasma

•Mucormycosis

•Nocardia

•Sporothrix|

| •Trypanosoma cruzi

•Toxoplasma gondii

•Entamoeba

•Leishmania|

| •Trichinella spiralis

•Echinococcus granulosus

•Taenia solium|

| •Coxiella burnetii

•R.rickettsii

•R.tsutsugamushi|

| •Coxsackievirus

•Echoviruses

•Polioviruses

•Influenza A & B viruses

•RSV

•Mumps virus

•Measles virus

•Rubella virus

•Hepatitis C virus

•Dengue virus

•Yellow fever virus

•HIV-1

•Adenoviruses

•Paravirus B19

•Cytomegalovirus

•HSV-6

•EBV

•VZV

•HSV|

## Histological criteria[edit | edit source]

* Myocarditis can be classified based on the type of infiltrating cells in lymphocytic, eosinophilic, polymorphic, giant cell myocarditis, and cardiac sarcoidosis.

| Classification based on histological criteria|

|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|

| Lymphocytic|

| Eosinophilic|

| Polymorphic|

| Giant cell|

| Cardiac sarcoidosis|

## Clinicopathological criteria[edit | edit source]

* Fulminant myocarditis: Fulminant myocarditis occurs following a viral prodrome. Fulminant myocarditis presents as acute severe cardiovascular compromise with ventricular dysfunction. On endomyocardial biopsy, there are multiple foci of inflammation.[15][16]

* Acute myocarditis: Acute myocarditis presents with a less distinct onset of the illness. When the patient does present, there is already a decline in left ventricular dysfunction. Acute myocarditis may progress to dilated cardiomyopathy.

* Chronic active myocarditis: Chronic active myocarditis has a less distinct onset of the illness. There are clinical and histologic relapses and the development of ventricular dysfunction. Histologically, chronic inflammatory changes with mild to moderate fibrosis may be develop after 2 to 4 years.

* Chronic persistent myocarditis: Chronic persistent myocarditis has a less distinct onset of the illness. Histologically it is characterized by persistent infiltration and myocyte necrosis. Despite the presence of symptoms, ventricular dysfunction is absent.[14]

| Classification based on clinicopathological criteria|

|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|

| Fulminant myocarditis|

| Acute myocarditis|

| Chronic active myocarditis|

| Chronic persistent myocarditis|

## References[edit | edit source]

1. ↑ "Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies". Circulation. 93 (5): 841–842. 1996. doi:10.1161/01.CIR.93.5.841. ISSN 0009-7322.
2. ↑ 2.0 2.1 Leone, Ornella; Veinot, John P.; Angelini, Annalisa; Baandrup, Ulrik T.; Basso, Cristina; Berry, Gerald; Bruneval, Patrick; Burke, Margaret; Butany, Jagdish; Calabrese, Fiorella; d'Amati, Giulia; Edwards, William D.; Fallon, John T.; Fishbein, Michael C.; Gallagher, Patrick J.; Halushka, Marc K.; McManus, Bruce; Pucci, Angela; Rodriguez, E. René; Saffitz, Jeffrey E.; Sheppard, Mary N.; Steenbergen, Charles; Stone, James R.; Tan, Carmela; Thiene, Gaetano; van der Wal, Allard C.; Winters, Gayle L. (2012). "2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology". Cardiovascular Pathology. 21 (4): 245–274. doi:10.1016/j.carpath.2011.10.001. ISSN 1054-8807.
3. ↑ Kindermann, Ingrid; Barth, Christine; Mahfoud, Felix; Ukena, Christian; Lenski, Matthias; Yilmaz, Ali; Klingel, Karin; Kandolf, Reinhard; Sechtem, Udo; Cooper, Leslie T.; Böhm, Michael (2012). "Update on Myocarditis". Journal of the American College of Cardiology. 59 (9): 779–792. doi:10.1016/j.jacc.2011.09.074. ISSN 0735-1097.
4. ↑ Sagar, Sandeep; Liu, Peter P; Cooper, Leslie T (2012). "Myocarditis". The Lancet. 379 (9817): 738–747. doi:10.1016/S0140-6736(11)60648-X. ISSN 0140-6736.
5. ↑ Dennert, R.; Crijns, H. J.; Heymans, S. (2008). "Acute viral myocarditis". European Heart Journal. 29 (17): 2073–2082. doi:10.1093/eurheartj/ehn296. ISSN 0195-668X.
6. ↑ Maron, Barry J.; Towbin, Jeffrey A.; Thiene, Gaetano; Antzelevitch, Charles; Corrado, Domenico; Arnett, Donna; Moss, Arthur J.; Seidman, Christine E.; Young, James B. (2006). "Contemporary Definitions and Classification of the Cardiomyopathies". Circulation. 113 (14): 1807–1816. doi:10.1161/CIRCULATIONAHA.106.174287. ISSN 0009-7322.
7. ↑ Bock, Claus-Thomas; Klingel, Karin; Kandolf, Reinhard (2010). "Human Parvovirus B19–Associated Myocarditis". New England Journal of Medicine. 362 (13): 1248–1249. doi:10.1056/NEJMc0911362. ISSN 0028-4793.
8. ↑ P. Liu, T. Martino, M. A. Opavsky & J. Penninger (1996). "Viral myocarditis: balance between viral infection and immune response". The Canadian journal of cardiology. 12 (10): 935–943. PMID 9191484. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
9. ↑ Cambridge, G; MacArthur, C G; Waterson, A P; Goodwin, J F; Oakley, C M (1979). "Antibodies to Coxsackie B viruses in congestive cardiomyopathy". Heart. 41 (6): 692–696. doi:10.1136/hrt.41.6.692. ISSN 1355-6037.
10. ↑ H. T. Aretz, M. E. Billingham, W. D. Edwards, S. M. Factor, J. T. Fallon, J. J. Jr Fenoglio, E. G. Olsen & F. J. Schoen (1987). "Myocarditis. A histopathologic definition and classification". The American journal of cardiovascular pathology. 1 (1): 3–14. PMID 3455232. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
11. ↑ Gore, Ira; Saphir, Otto (1947). "Myocarditis". American Heart Journal. 34 (6): 827–830. doi:10.1016/0002-8703(47)90147-6. ISSN 0002-8703.
12. ↑ Felker, G.Michael; Boehmer, John P; Hruban, Ralph H; Hutchins, Grover M; Kasper, Edward K; Baughman, Kenneth L; Hare, Joshua M (2000). "Echocardiographic findings in fulminant and acute myocarditis". Journal of the American College of Cardiology. 36 (1): 227–232. doi:10.1016/S0735-1097(00)00690-2. ISSN 0735-1097.
13. ↑ Pinamonti, Bruno; Alberti, Ezip; Cigalotto, Alessandro; Dreas, Lorella; Salvi, Alessandro; Silvestri, Furio; Camerini, Fulvio (1988). "Echocardiographic findings in myocarditis". The American Journal of Cardiology. 62 (4): 285–291. doi:10.1016/0002-9149(88)90226-3. ISSN 0002-9149.
14. ↑ 14.0 14.1 Lieberman, Eric B.; Hutchins, Grover M.; Herskowitz, Ahvie; Rose, Noel R.; Baughman, Kenneth L. (1991). "Clinicopathoiogic description of myocarditis". Journal of the American College of Cardiology. 18 (7): 1617–1626. doi:10.1016/0735-1097(91)90493-S. ISSN 0735-1097.
15. ↑ Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL (1991). "Clinicopathologic description of myocarditis". J Am Coll Cardiol. 18 (7): 1617–26. PMID 1960305.CS1 maint: Multiple names: authors list (link)
16. ↑ McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM; et al. (2000). "Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis". N Engl J Med. 342 (10): 690–5. doi:10.1056/NEJM200003093421003. PMID 10706898.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

Template:WS Template:WH