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]

Overview

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

Causative criteria




 
 
 
 
 
 
 
 
 
 
 
 
 
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


 
 
 
 
 
 
 
 
 
 
 
 
 
Classification based on histological criteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lymphocytic
 
 
 
Eosinophilic
 
 
 
Polymorphic
 
 
 
Giant cell
 
 
 
Cardiac sarcoidosis
 
 


Clinicopathological criteria


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

References

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  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.
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  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.
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  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)
  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.
  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.

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