Abstract
The diagnosis of acute and chronic myocarditis remains a challenge for clinicians. Characterization of this disease has been hampered by its diverse etiologies and heterogeneous clinical presentations. Most cases of myocarditis are caused by infectious agents. Despite successful research in the last few years, the pathophysiology of viral myocarditis and its sequelae leading to severe heart failure with a poor prognosis is not fully understood and represents a significant public health issue globally. Most likely, at a certain point, besides viral persistence, several etiological types merge into a common pathogenic autoimmune process leading to chronic inflammation and tissue remodeling, ultimately resulting in the clinical phenotype of dilated cardiomyopathy. Understanding the underlying molecular mechanisms is necessary to assess the prognosis of patients and is fundamental to appropriate specific and personalized therapeutic strategies. To reach this clinical prerequisite, there is the need for advanced diagnostic tools, including an endomyocardial biopsy and guidelines to optimize the management of this disease. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has currently led to the worst pandemic in a century and has awakened a special sensitivity throughout the world to viral infections. This work aims to summarize the pathophysiology of viral myocarditis, advanced diagnostic methods and the current state of treatment options.
Highlights
The term “myocarditis” was introduced by Jean-Nicolas Corvisart in the early 19th century
Viral persistence in the myocardium is associated with progressive deterioration of left ventricular ejection fraction (LVEF), whereas elimination of the viral genomes led to a marked improvement in left ventricular (LV) function [43,44]
With the intention of summarizing the currently available knowledge on the pathophysiological mechanisms of viral cardiomyopathy, this review aims to shed light on viral etiology, advanced diagnostics and the current state of treatment options
Summary
The term “myocarditis” was introduced by Jean-Nicolas Corvisart in the early 19th century. If the infectious agent is rapidly eliminated and the inflammatory process is finalized, the disease will heal with only minor changes in the myocardium At this stage, the true causes of the disease can no longer be determined. When the viral infection has been overcome, and the antiviral immune response has subsided, but irreversible myocardial damage has already developed, the clinical picture evolves into DCM In this situation, diagnostics have started too late, and they cannot elucidate the original causes of the disease. The aim of any diagnostics is to enable a precise diagnosis that can differentiate between virus positivity or virus exclusion, proof of inflammation, characterization and intensity This is possible by the use of the EMB to enable a specific, personalized and causal treatment option
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