Myocarditis classification

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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. Maliha Shakil, M.D. [2] Homa Najafi, M.D.[3]


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.


Causative criteria

Immune-mediated myocarditis
•Tetanus toxoid


•Serum sickness












•Thiazide diuretics

Heart transplant rejection
•Infection-negative lymphocytic

Infection-negative giant cell
Autoimmune disorders:


•Rheumatoid arthritis

•Churg-Strauss syndrome

•Kawasaki's disease




•Myasthenia gravis

•DM type1



•Wegener's granulomatosis

•Rheumatic heart disease

Toxic myocarditis
Heavy metals
Physical agents















•Electric shock
•Scorpion sting

•Snake, and spider bites

•Bee and wasp stings

•Carbon monoxide




•Sodium azide

Infectious myocarditis






•Corynebacterium diphtheriae

•Haemophilus influenzae

•Mycobacterium tuberculosis

•Mycoplasma pneumonia

•Borrelia •Leptospira









•Trypanosoma cruzi

•Toxoplasma gondii


•Trichinella spiralis

•Echinococcus granulosus

•Taenia solium
•Coxiella burnetii





•Influenza A & B viruses


•Mumps virus

•Measles virus

•Rubella virus

•Hepatitis C virus

•Dengue virus

•Yellow fever virus



•Paravirus B19






Histological criteria

Classification based on histological criteria
Giant cell
Cardiac sarcoidosis

Clinicopathological criteria

Classification based on clinicopathological criteria
Fulminant myocarditis
Acute myocarditis
Chronic active myocarditis
Chronic persistent myocarditis


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