Myocarditis classification: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Undo revision 1697383 by Homa Najafi (talk))
Tag: Undo
 
(44 intermediate revisions by 2 users not shown)
Line 4: Line 4:


==Overview==
==Overview==
Myocarditis can be [[Classification|classified]] based on the [[Causes|causative]], [[histological]], and clinicopathological [[criteria]]. [[Causes|Causative]] [[criteria]] include three main groups, as well as [[infectious]], [[Immune-mediated disease|immune-mediated,]] and [[toxic]] myocarditis. Based on the type of [[Infiltration (medical)|infiltrating]] [[Cells (biology)|cells]] myocarditis divided in [[lymphocytic]], [[eosinophilic]], [[polymorphic]], [[giant cell]] myocarditis, and [[cardiac sarcoidosis]]. [[Acute]], [[fulminant]], [[chronic]] active, and [[Chronic (medicine)|chronic]] persistent are subtypes of clinicopathopogical [[classification]].


Myocarditis can be classified based on the causative, histological, and clinicopathological criteria. Combination of the histologic data and clinical course of the disease resulted in clinicopathologic classification of myocarditis. Parameters such as onset of the disease, initial clinical and histological presentation, disease course and cardiac dysfunction define acute, fulminant, chronic active and chronic persistent subtypes of myocarditis. Acute myocarditis represents the most common type of myocarditis, in which symptoms last typically for days or weeks and the acute phase is followed by spontaneous improvement or development of stable DCM. In patients with fulminant myocarditis disease progresses rapidly resulting in severe heart failure and cardiogenic shock with mortality rate of 30–40% during the acute phase. Patients diagnosed with fulminant myocarditis surviving the acute phase have been instead suggested to have excellent long-term prognosis. In its chronic form, myocarditis is detected over a period of three or more months. Clinical and histologic relapses and development of ventricular dysfunction is characteristic for chronic active myocarditis, whereas chronic persistent myocarditis is characterized by persistent presence of inflammatory cells in the myocardium, but it is usually not associated with ventricular dysfunction.


==Classification==
==Classification==


* Myocarditis can be classified based on the causative, histological, and clinicopathological criteria.  
*Myocarditis can be [[Classification|classified]] based on the [[Causes|causative]], [[histological]], and clinicopathological [[criteria]].
*The causative criteria define infectious agents (virus, protozoa, or bacteria) or non-infectious condition (autoimmune diseases, medications etc.) associated with myocarditis.
*Myocarditis may be [[Classification|classified]] according to [[Causes|causative]] [[criteria]] into three groups:<ref>{{cite journal|title=Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies|journal=Circulation|volume=93|issue=5|year=1996|pages=841–842|issn=0009-7322|doi=10.1161/01.CIR.93.5.841}}</ref><ref name="LeoneVeinot2012">{{cite journal|last1=Leone|first1=Ornella|last2=Veinot|first2=John P.|last3=Angelini|first3=Annalisa|last4=Baandrup|first4=Ulrik T.|last5=Basso|first5=Cristina|last6=Berry|first6=Gerald|last7=Bruneval|first7=Patrick|last8=Burke|first8=Margaret|last9=Butany|first9=Jagdish|last10=Calabrese|first10=Fiorella|last11=d'Amati|first11=Giulia|last12=Edwards|first12=William D.|last13=Fallon|first13=John T.|last14=Fishbein|first14=Michael C.|last15=Gallagher|first15=Patrick J.|last16=Halushka|first16=Marc K.|last17=McManus|first17=Bruce|last18=Pucci|first18=Angela|last19=Rodriguez|first19=E. René|last20=Saffitz|first20=Jeffrey E.|last21=Sheppard|first21=Mary N.|last22=Steenbergen|first22=Charles|last23=Stone|first23=James R.|last24=Tan|first24=Carmela|last25=Thiene|first25=Gaetano|last26=van der Wal|first26=Allard C.|last27=Winters|first27=Gayle L.|title=2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology|journal=Cardiovascular Pathology|volume=21|issue=4|year=2012|pages=245–274|issn=10548807|doi=10.1016/j.carpath.2011.10.001}}</ref><ref name="KindermannBarth2012">{{cite journal|last1=Kindermann|first1=Ingrid|last2=Barth|first2=Christine|last3=Mahfoud|first3=Felix|last4=Ukena|first4=Christian|last5=Lenski|first5=Matthias|last6=Yilmaz|first6=Ali|last7=Klingel|first7=Karin|last8=Kandolf|first8=Reinhard|last9=Sechtem|first9=Udo|last10=Cooper|first10=Leslie T.|last11=Böhm|first11=Michael|title=Update on Myocarditis|journal=Journal of the American College of Cardiology|volume=59|issue=9|year=2012|pages=779–792|issn=07351097|doi=10.1016/j.jacc.2011.09.074}}</ref><ref name="SagarLiu2012">{{cite journal|last1=Sagar|first1=Sandeep|last2=Liu|first2=Peter P|last3=Cooper|first3=Leslie T|title=Myocarditis|journal=The Lancet|volume=379|issue=9817|year=2012|pages=738–747|issn=01406736|doi=10.1016/S0140-6736(11)60648-X}}</ref><ref name="DennertCrijns2008">{{cite journal|last1=Dennert|first1=R.|last2=Crijns|first2=H. J.|last3=Heymans|first3=S.|title=Acute viral myocarditis|journal=European Heart Journal|volume=29|issue=17|year=2008|pages=2073–2082|issn=0195-668X|doi=10.1093/eurheartj/ehn296}}</ref><ref name="MaronTowbin2006">{{cite journal|last1=Maron|first1=Barry J.|last2=Towbin|first2=Jeffrey A.|last3=Thiene|first3=Gaetano|last4=Antzelevitch|first4=Charles|last5=Corrado|first5=Domenico|last6=Arnett|first6=Donna|last7=Moss|first7=Arthur J.|last8=Seidman|first8=Christine E.|last9=Young|first9=James B.|title=Contemporary Definitions and Classification of the Cardiomyopathies|journal=Circulation|volume=113|issue=14|year=2006|pages=1807–1816|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.174287}}</ref><ref name="BockKlingel2010">{{cite journal|last1=Bock|first1=Claus-Thomas|last2=Klingel|first2=Karin|last3=Kandolf|first3=Reinhard|title=Human Parvovirus B19–Associated Myocarditis|journal=New England Journal of Medicine|volume=362|issue=13|year=2010|pages=1248–1249|issn=0028-4793|doi=10.1056/NEJMc0911362}}</ref><ref>{{Cite journal
*Identification of the infectious agent or potential non-infectious trigger may be indicative not only for disease etiology.
| author = [[P. Liu]], [[T. Martino]], [[M. A. Opavsky]] & [[J. Penninger]]
*In addition to identification of the causative agent, histological and immunohistological analyses are performed to categorize myocarditis based on the presence, morphology and type of inflammatory infiltrates in the myocardium.  
| title = Viral myocarditis: balance between viral infection and immune response
*Lymphocytic myocarditis characterized by extensive infiltration of lymphocytes and monocytes with signs of cardiomyocyte necrosis (active lymphocytic myocarditis) represents the most frequent type of myocarditis.
| journal = [[The Canadian journal of cardiology]]
*Lymphocytic myocarditis is often observed in myocardium tested positive for viral persistence.  
| volume = 12
*Less common forms of myocarditis represent giant cell myocarditis and eosinophilic myocarditis.
| issue = 10
*Giant cell myocarditis is characterized by the presence of multinucleated giant cells and lymphocytes on heart biopsies.  
| pages = 935–943
*Presence of giant cells within non-caseating granulomas, usually associated with myocardial fibrosis is referred to as cardiac sarcoidosis.  
| year = 1996
*The characteristic feature of eosinophilic myocarditis is the presence of eosinophil-rich infiltrates in the myocardium and extensive myocyte necrosis, which is accompanied with elevated level of circulating eosinophils.
| month = October
*Giant cell myocarditis and eosinophilic myocarditis are associated with particularly poor prognosis.
| pmid = 9191484
}}</ref><ref name="CambridgeMacArthur1979">{{cite journal|last1=Cambridge|first1=G|last2=MacArthur|first2=C G|last3=Waterson|first3=A P|last4=Goodwin|first4=J F|last5=Oakley|first5=C M|title=Antibodies to Coxsackie B viruses in congestive cardiomyopathy.|journal=Heart|volume=41|issue=6|year=1979|pages=692–696|issn=1355-6037|doi=10.1136/hrt.41.6.692}}</ref>
**[[Infectious]] myocarditis
**[[Immune-mediated disease|Immune-mediated]] myocarditis
**[[Toxic]] myocarditis


==Clinicopathological criteria==
*Myocarditis may be [[Classification|classified]] according to [[histological]] [[criteria]] into five groups:<ref>{{Cite journal
| author = [[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]]
| title = Myocarditis. A histopathologic definition and classification
| journal = [[The American journal of cardiovascular pathology]]
| volume = 1
| issue = 1
| pages = 3–14
| year = 1987
| month = January
| pmid = 3455232
}}</ref><ref name="GoreSaphir1947">{{cite journal|last1=Gore|first1=Ira|last2=Saphir|first2=Otto|title=Myocarditis|journal=American Heart Journal|volume=34|issue=6|year=1947|pages=827–830|issn=00028703|doi=10.1016/0002-8703(47)90147-6}}</ref><ref name="LeoneVeinot2012">{{cite journal|last1=Leone|first1=Ornella|last2=Veinot|first2=John P.|last3=Angelini|first3=Annalisa|last4=Baandrup|first4=Ulrik T.|last5=Basso|first5=Cristina|last6=Berry|first6=Gerald|last7=Bruneval|first7=Patrick|last8=Burke|first8=Margaret|last9=Butany|first9=Jagdish|last10=Calabrese|first10=Fiorella|last11=d'Amati|first11=Giulia|last12=Edwards|first12=William D.|last13=Fallon|first13=John T.|last14=Fishbein|first14=Michael C.|last15=Gallagher|first15=Patrick J.|last16=Halushka|first16=Marc K.|last17=McManus|first17=Bruce|last18=Pucci|first18=Angela|last19=Rodriguez|first19=E. René|last20=Saffitz|first20=Jeffrey E.|last21=Sheppard|first21=Mary N.|last22=Steenbergen|first22=Charles|last23=Stone|first23=James R.|last24=Tan|first24=Carmela|last25=Thiene|first25=Gaetano|last26=van der Wal|first26=Allard C.|last27=Winters|first27=Gayle L.|title=2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology|journal=Cardiovascular Pathology|volume=21|issue=4|year=2012|pages=245–274|issn=10548807|doi=10.1016/j.carpath.2011.10.001}}</ref>
**[[Lymphatic]] myocarditis
**[[Eosinophilic]] myocarditis
**[[Polymorphic]] myocarditis
**[[Giant cell]] myocarditis
**[[Cardiac sarcoidosis]]
 
*Myocarditis may be [[Classification|classified]] according to clinicopathological four [[criteria]] into three groups:<ref name="FelkerBoehmer2000">{{cite journal|last1=Felker|first1=G.Michael|last2=Boehmer|first2=John P|last3=Hruban|first3=Ralph H|last4=Hutchins|first4=Grover M|last5=Kasper|first5=Edward K|last6=Baughman|first6=Kenneth L|last7=Hare|first7=Joshua M|title=Echocardiographic findings in fulminant and acute myocarditis|journal=Journal of the American College of Cardiology|volume=36|issue=1|year=2000|pages=227–232|issn=07351097|doi=10.1016/S0735-1097(00)00690-2}}</ref><ref name="PinamontiAlberti1988">{{cite journal|last1=Pinamonti|first1=Bruno|last2=Alberti|first2=Ezip|last3=Cigalotto|first3=Alessandro|last4=Dreas|first4=Lorella|last5=Salvi|first5=Alessandro|last6=Silvestri|first6=Furio|last7=Camerini|first7=Fulvio|title=Echocardiographic findings in myocarditis|journal=The American Journal of Cardiology|volume=62|issue=4|year=1988|pages=285–291|issn=00029149|doi=10.1016/0002-9149(88)90226-3}}</ref><ref name="LiebermanHutchins1991">{{cite journal|last1=Lieberman|first1=Eric B.|last2=Hutchins|first2=Grover M.|last3=Herskowitz|first3=Ahvie|last4=Rose|first4=Noel R.|last5=Baughman|first5=Kenneth L.|title=Clinicopathoiogic description of myocarditis|journal=Journal of the American College of Cardiology|volume=18|issue=7|year=1991|pages=1617–1626|issn=07351097|doi=10.1016/0735-1097(91)90493-S}}</ref>
**[[Fulminant]] myocarditis
**[[Acute (medicine)|Acute]] myocarditis
**[[Chronic (medical)|Chronic]] active myocarditis
**[[Chronic]] persistent myocarditis
 
==Causative criteria==
 
*Myocarditis can be [[Classification|classified]] based on the [[Causes|causative]] [[criteria]] into [[Immune-mediated disease|immune-mediated]] myocarditis, [[infectious]] myocarditis and [[toxic]] myocarditis. bkjvskaljbkjbkjbakj
 
 
 
 
 
<br />{{familytree/start}}
{{familytree | | | | | | | | | | | | | | B01 | | | | | |B01=Immune-mediated myocarditis}}
{{familytree | | | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|.| }}
{{familytree | | | | | |!| | | | | | | | |!| | | | | | | | |!| }}
{{familytree | | | | | C01 | | | | | | | C02 | | | | | | | C03 |C01=Allergens|C02=Alloantigens|C03=Autoantigens}}
{{familytree | | | | | |!| | | | | | | | |!| | | | | | | | |!| | | | | |}}
{{familytree | | |,|-|-|^|-|-|.| | | | | |!| | | | | |,|-|-|^|-|-|.| | |}}
{{familytree | | D01 | | | | D02 | | | | D03 | | | | D04 | | | | D05 | |D01=•Tetanus toxoid
 
•Vaccines
 
•Serum sickness|D02='''Drugs:'''
 
•Penicillin
 
•Cefaclor
 
•Colchicine


*'''Fulminant myocarditis:''' Fulminant myocarditis occurs following a viral prodrome.  Fulminant myocarditis presents as acute severe cardiovascular compromise with ventricular dysfunction.<ref name="pmid1960305">{{cite journal| author=Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL| title=Clinicopathologic description of myocarditis. | journal=J Am Coll Cardiol | year= 1991 | volume= 18 | issue= 7 | pages= 1617-26 | pmid=1960305 | doi= | pmc= | url= }} </ref><ref name="pmid10706898">{{cite journal| author=McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM et al.| title=Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 10 | pages= 690-5 | pmid=10706898 | doi=10.1056/NEJM200003093421003 | pmc= | url= }} </ref>  On [[endomyocardial biopsy]], there are multiple foci of inflammation.
•Furosemide


*'''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]].
•Isoniazid


*'''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 present.
•Lidocaine


*'''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.
•Tetracycline


==Causative criteria==
•Sulfonamides
*'''Virus:''' coxsackievirus B3, adenoviruses or herpesviruses and other
*'''Protozoa:''' Trypanosoma cruzi (Chagas disease)
*'''Bacteria:''' Borrelia burgdorferi (Lyme disease) and other
*'''Immune checkpoint inhibitors:''' anti-CTLA-4, anti-PD-1 or anti-PD-L1 therapy
*'''Systemic autoimmune diseases:''' Systemic lupus erythematosus, myasthenia gravis and other


==Histological criteria==
•Phenytoin
*'''Active myocarditis:''' cardiac inflammation with apparent cardiomyocyte necrosis
*'''Borderline myocarditis:''' cardiac inflammation without evident cardiomyocyte necrosis
*'''Lymphocytic myocarditis:''' extensive infiltration of lymphocytes and monocytes
*'''Giant cell myocarditis:''' multinucleated giant cells and lymphocytes on heart biopsies
*'''Eosinophilic myocarditis:''' eosinophil-rich infiltrates with extensive myocyte necrosis


•Phenylbutazone


==Overview==
•Methyldopa
There is no established system for the classification of [disease name].


OR
•Thiazide diuretics


[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
•Amitriptyline|D03=Heart transplant rejection|D04=•Infection-negative lymphocytic


OR


[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
Infection-negative giant cell|D05='''Autoimmune disorders:'''
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].


OR
•SLE


Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
•Rheumatoid arthritis


OR
•Churg-Strauss syndrome


If the staging system involves specific and characteristic findings and features:
•Kawasaki's disease
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].


OR
•IBD


The staging of [malignancy name] is based on the [staging system].
•Scleroderma 


OR
•Polymyositis


There is no established system for the staging of [malignancy name].
•Myasthenia gravis


==Classification==
•DM type1


* Myocarditis can be classified based on the causative, histological, and clinicopathological criteria.
•Thyrotoxicosis
* Myocarditis may be classified according to causative criteria into three groups:
**Infectious myocarditis
**Immune-mediated myocarditis
**Toxic myocarditis


* Myocarditis may be classified according to histological criteria into five groups:
•Sarcoidosis
**Lymphatic myocarditis
**Eosinophilic myocarditis
**Polymorphic myocarditis
**Giant cell myocarditis
**Cardiac sarcoidosis


* Myocarditis may be classified according to clinicopathological four criteria into three groups:
•Wegener's granulomatosis
**Fulminant myocarditis
**Acute myocarditis
**Chronic active myocarditis
**Chronic persistent myocarditis


===Causative criteria===
•Rheumatic heart disease|}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | B01 | | | | | |B01=B01}}
{{familytree | | | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|.| }}
{{familytree | | | | | |!| | | | | | | | |!| | | | | | | | |!| }}
{{familytree | | | | | C01 | | | | | | | C02 | | | | | | | C03 |C01=C01|C02=C02|C03=C03}}
{{familytree | | | | | |!| | | | | | | | |!| | | | | | | | |!| | | | | |}}
{{familytree | | |,|-|-|^|-|-|.| | | | | |!| | | | | |,|-|-|^|-|-|.| | |}}
{{familytree | | D01 | | | | D02 | | | | D03 | | | | D04 | | | | D05 | |D01=D01|D02=D02|D03=D03|D04=D04|D05=D05|}}
{{familytree/end}}
{{familytree/end}}




Line 113: Line 129:


{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | A01=A01}}
{{familytree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | A01=Toxic myocarditis}}
{{familytree | | |,|-|-|-|-|-|v|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|-|.| | | | }}
{{familytree | | |,|-|-|-|-|-|v|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|-|.| | | | }}
{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | | | B14 | | |B10=B10|B11=B11|B12=B12|B13=B13|B14=B14}}  
{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | | | B14 | | |B10=Drugs|B11=Heavy metals|B12=Hormones|B13=Physical agents|B14=Miscellaneous}}
{{familytree | | |!| | | | | |!| | | | | |!| | | | | |!| | | | | |!| | | | }}
{{familytree | | C10 | | | | C11 | | | | C12 | | | | C13 | | | | C14 | | |C10=•Amphetamines
 
•Anthracyclines
 
•Cocaine
 
•Cyclophosphamide
 
•Ethanol
 
•Fluorouracil
 
•Lithium
 
•Catecholamines
 
•Hematine
 
•Interleukin-2
 
•Trastuzumab
 
•Clozapine|C11=•Copper
 
•Iron
 
•Lead|C12=•Phaeochromocytoma
 
 
•Beriberi|C13=•Radiation
 
 
•Electric shock|C14=•Scorpion sting
 
•Snake, and spider bites
 
•Bee and wasp stings
 
•Carbon monoxide
 
•Inhalant
 
•Phosphorus
 
•Arsenic
 
•Sodium azide}}  
{{familytree/end}}
{{familytree/end}}


Line 123: Line 187:
{{familytree | | C01 | | | C02 | | | C03 | | | C04 | | | C05 | | | C06 | | | C07 | | |C01=Bacterial|C02=Spirochaetal|C03=Fungal|C04=Protozoal|C05=Parasitic|C06=Rickettsial|C07=Viral}}
{{familytree | | C01 | | | C02 | | | C03 | | | C04 | | | C05 | | | C06 | | | C07 | | |C01=Bacterial|C02=Spirochaetal|C03=Fungal|C04=Protozoal|C05=Parasitic|C06=Rickettsial|C07=Viral}}
{{familytree | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | }}
{{familytree | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | }}
{{familytree | | D01 | | | D02 | | | D03 | | | D04 | | | D05 | | | D06 | | | D07 | ||D01=-Staphylococcus
{{familytree | | D01 | | | D02 | | | D03 | | | D04 | | | D05 | | | D06 | | | D07 | ||D01=•Staphylococcus


-Streptococcus
•Streptococcus


-Pneumococcus
•Pneumococcus


-Meningococcus
•Meningococcus


-Gonococcus
•Gonococcus


-Salmonella
•Salmonella


-Corynebacterium diphtheriae
•Corynebacterium diphtheriae


-Haemophilus influenzae
•Haemophilus influenzae


-Mycobacterium tuberculosis
•Mycobacterium tuberculosis


-Mycoplasma pneumonia
•Mycoplasma pneumonia


-Brucella|D02=-Borrelia
•Brucella|D02=•Borrelia


-Leptospira|D03=- Aspergillus
•Leptospira|D03=•Aspergillus


-Actinomyces
•Actinomyces


-Blastomyces
•Blastomyces


-Candida
•Candida


-Coccidioides
•Coccidioides


-Cryptococcus
•Cryptococcus


-Histoplasma
•Histoplasma


-Mucormycosis
•Mucormycosis


-Nocardia
•Nocardia


-Sporothrix|D04=-Trypanosoma cruzi
•Sporothrix|D04=•Trypanosoma cruzi


-Toxoplasma gondii
•Toxoplasma gondii


-Entamoeba
•Entamoeba


-Leishmania|D05=-Trichinella spiralis
•Leishmania|D05=•Trichinella spiralis


-Echinococcus granulosus
•Echinococcus granulosus


-Taenia solium|D06=-Coxiella burnetii
•Taenia solium|D06=•Coxiella burnetii


-R.rickettsii
•R.rickettsii


-R.tsutsugamushi|D07=-Coxsackievirus
•R.tsutsugamushi|D07=•Coxsackievirus


-Echoviruses
•Echoviruses


-Polioviruses
•Polioviruses


-Influenza A & B viruses
•Influenza A & B viruses


-RSV
•RSV


-Mumps virus
•Mumps virus


-Measles virus
•Measles virus


-Rubella virus
•Rubella virus


-Hepatitis C virus
•Hepatitis C virus


-Dengue virus
•Dengue virus


-Yellow fever virus
•Yellow fever virus


-HIV-1
•HIV-1


-Adenoviruses
•Adenoviruses


-Paravirus B19
•Paravirus B19


-Cytomegalovirus
•Cytomegalovirus


-HSV-6
•HSV-6


-EBV
•EBV


-VZV
•VZV


-HSV}}
•HSV}}
{{familytree/end}}
{{familytree/end}}


===Histological criteria===
==Histological criteria==


*Myocarditis can be [[Classification|classified]] based on the type of [[Infiltration (medical)|infiltrating]] [[Cells (biology)|cells]] in [[lymphocytic]], [[eosinophilic]], [[polymorphic]], [[giant cell]] myocarditis, and [[cardiac sarcoidosis]].




===Clinicopathological criteria===
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | A01=Classification based on histological criteria}}
{{familytree | | |,|-|-|-|-|-|v|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|-|.| | | | }}
{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | | | B14 | | |B10=Lymphocytic|B11=Eosinophilic|B12=Polymorphic|B13=Giant cell|B14=Cardiac sarcoidosis}}
{{familytree/end}}<br />


<br />
==Clinicopathological criteria==
 
*'''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]].<ref name="pmid1960305">{{cite journal| author=Lieberman EB, Hutchins GM, Herskowitz A, Rose NR, Baughman KL| title=Clinicopathologic description of myocarditis. | journal=J Am Coll Cardiol | year= 1991 | volume= 18 | issue= 7 | pages= 1617-26 | pmid=1960305 | doi= | pmc= | url= }} </ref><ref name="pmid10706898">{{cite journal| author=McCarthy RE, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM et al.| title=Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 10 | pages= 690-5 | pmid=10706898 | doi=10.1056/NEJM200003093421003 | pmc= | url= }} </ref>
 
*'''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 (medicine)|Acute]] myocarditis may progress to [[dilated cardiomyopathy]].
 
*'''Chronic active myocarditis:''' [[Chronic (medical)|Chronic]] active myocarditis has a less distinct onset of the [[illness]].  There are [[clinical]] and [[Histological|histologic]] [[Relapse|relapses]] and the [[development]] of [[ventricular dysfunction]].  [[Histologically]], [[Chronic (medicine)|chronic]] [[inflammatory]] changes with mild to moderate [[fibrosis]] may be [[Development (biology)|develop]] after 2 to 4 years.
 
*'''Chronic persistent myocarditis:''' [[Chronic (medical)|Chronic]] persistent myocarditis has a less distinct onset of the illness. [[Histologically]] it is [[Characterization (mathematics)|characterized]] by persistent [[Infiltration (medical)|infiltration]] and [[myocyte]] [[necrosis]].  Despite the presence of [[symptoms]], [[ventricular dysfunction]] is absent.<ref name="LiebermanHutchins1991">{{cite journal|last1=Lieberman|first1=Eric B.|last2=Hutchins|first2=Grover M.|last3=Herskowitz|first3=Ahvie|last4=Rose|first4=Noel R.|last5=Baughman|first5=Kenneth L.|title=Clinicopathoiogic description of myocarditis|journal=Journal of the American College of Cardiology|volume=18|issue=7|year=1991|pages=1617–1626|issn=07351097|doi=10.1016/0735-1097(91)90493-S}}</ref>
 
 
{{familytree/start}}
{{familytree | | | | | | | | | | | A01 | | | | | | | | | | | | | | | A01=Classification based on clinicopathological criteria}}
{{familytree | | |,|-|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|.| | | | }}
{{familytree | | B10 | | | | B11 | | | | B12 | | | | B13 | | |B10=Fulminant myocarditis|B11=Acute myocarditis|B12=Chronic active myocarditis|B13=Chronic persistent myocarditis}}
{{familytree/end}}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WS}}
{{WH}}


[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
{{WS}}
{{WH}}

Latest revision as of 13:33, 15 April 2021

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

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

  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)
  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.

Template:WS Template:WH

Retrieved from "https://www.wikidoc.org/index.php?title=Myocarditis_classification&oldid=1697384"