Abstract
Inflammatory dilated cardiomyopathy (DCMi) is a syndrome, not an etiological disease entity. The infective etiology and the immunopathology can be best determined through endomyocardial biopsy with a complete work-up by light microscopy, immunohistology, and polymerase chain reaction for microbial agents. This review focuses on the methodological advances in diagnosis in the past few years and exemplifies the importance of an etiology-orientated treatment in different case scenarios. In fulminant nonviral myocarditis, immunosuppressive treatment together with hemodynamic stabilization of the patient via mechanical circulatory support (e.g., microaxial pumps, extracorporeal membrane oxygenation, left ventricular assist device) can be life-saving. For viral inflammatory cardiomyopathy, intravenous immunoglobulin treatment can resolve inflammation and often eradicate the virus.
Highlights
In immunocompetent patients, herpesviruses including EBV and human herpesvirus 6 (HHV6) infections rarely induce cardiac symptoms
The infective etiology and the immunopathology can be best determined through endomyocardial biopsy with a complete work-up by light microscopy, immunohistology, and polymerase chain reaction for microbial agents
Prevalence rates for HHV6 genomes detected in patients with myocarditis or DCM ranged from 8 to 20% and for EBV genomes from 0 to 8%
Summary
Herpesviruses including EBV and HHV6 infections rarely induce cardiac symptoms. Intravenous immunoglobulin treatment can resolve inflammation and often eradicate the virus. Keywords Myocarditis · Endomyocardial biopsy · Immunohistology · Intravenous immunoglobulins · Immunosuppressive therapy In the larger series of patients with inflammatory heart diseases, analyses for HHV6 and EBV were always included.
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