Myocarditis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.
Natural history
Myocarditis with myocardial infarction like ECG changes are usually self limiting with no overt sequelae[1]. Patients with ECG changes suggestive of bundle branch block, old infarct or high degree AV block are associated with poor long term prognosis and may progress to develop cardiac failure. Viral myocarditis are usually benign and majority of cases of Coxsackie B virus infection are subclinical.
Patients presenting with mild ventricular dysfunction secondary to viral myocarditis typically improve within weeks to months and rarely, may progress to severe ventricular dysfunction and may lead to arrhythmias or even death[2]. Though only a small fraction of patients with lymphocytic myocarditis develop ventricular arrhythmias, idiopathic ventricular tachycardia is seen in upto 33% of these patients[3].
Complications
As mentioned above, myocarditis may present with ventricular dysfunction and may progress to cardiac failure due to presence of scar tissue. This can further lead to development of pulmonary edema, arrhythmias or cardiogenic shock.
Other complications include recurrent myositis, cardiac conduction abnormalities and may even lead to sudden death[3].
Prognosis
Endomyocardial biopsy which is the primary diagnostic tool is used usually in patients presenting with advanced heart failure or arrhythmias and thus long term prognosis in mild cases is not known. Prognosis in myocarditis varies with the cause and the severity of the disease.
Development of syncope, bundle branch block, ejection fraction <40% and pulmonary hypertension are known to be poor predictors of myocarditis and can lead to subsequent death or transplantation[4].
In a series, among 15 patients who met the criteria for fulminant myocarditis, 14(93%) patients survived for 11 years without the need for heart transplant. This suggests that patients with fulminant myocarditis have a good long term prognosis if they survive the acute phase of the disease[5]. In the same series, 132 patients met the criteria for acute myocarditis and 60(45%) of these patients were alive at the end of 11 years without having received a transplant.
References
- ↑ Dec GW, Waldman H, Southern J, Fallon JT, Hutter AM, Palacios I (1992). "Viral myocarditis mimicking acute myocardial infarction". J Am Coll Cardiol. 20 (1): 85–9. PMID 1607543.
- ↑ Wentworth P, Jentz LA, Croal AE (1979). "Analysis of sudden unexpected death in southern Ontario, with emphasis on myocarditis". Can Med Assoc J. 120 (6): 676–80, 706. PMC 1819176. PMID 436050.
- ↑ 3.0 3.1 Hosenpud JD, McAnulty JH, Niles NR (1986). "Unexpected myocardial disease in patients with life threatening arrhythmias". Br Heart J. 56 (1): 55–61. PMC 1277385. PMID 3730208.
- ↑ Scartazzini R, Schneider P, Bickel H (1975). "[New beta-lactam antibiotics. Functionalisation of the cephem 3-position with sulfur or nitrogen bearing substituents (author's transl)]". Helv Chim Acta. 58 (8): 2437–50. doi:10.1002/hlca.19750580824. PMID 1194054.
- ↑ 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.