Myokarditis: Diagnostik und Verlauf

Abstract

Summary The term “myocarditis” is applied to a variety of inflammatory disorders affecting the myocardium. Because of a wide spectrum of clinical manifestations ranging from asymptomatic to frank circulatory failure little is known about the epidemiological aspects of the disease. Based on the initial presentation four typical clinical syndromes can be distinguished: 10–30% of patients experience acute chest pain indistinguishable from an acute coronary syndrome, 60–70% present with congestive heart failure, in 5–15% arrhythmias might be among the first complaints and 5–10% present with fulminant cardiogenic shock. Thus it is important to rule out other confounding cardiac disorders during the initial diagnostic work-up. In the following review we propose a pragmatic approach to the diagnostic work-up of myocarditis according to the presenting manifestations. The range of the clinical course is also highly variable, notably up to 60% of cases of myocarditis undergo a full recovery, whereas on the other hand progressive pump failure might require a rapid intervention including mechanical circulatory assistance. Interestingly the clinical presentation and symptoms at onset are predictive for the further course and outcome. Further research in basic and clinical science is warranted in the search for an effective treatment and understanding of this challenging disorder.