Viral Myocarditis-Diagnostic and Therapeutic Challenge for Physicians

Myocarditis is defined as inflammation of the heart muscle according to clinical, immunohistological and pathological criteria. Myocarditis can manifest a wide spectrum of symptoms ranging from mild dyspnea or chest pain, and sometimes without a specific therapy it can lead to cardiogenic shock and death, too. According to the evidence, the incidence of myocarditis is 8-10 cases per 100.000 humans, and the prevalence of non-selected autopsies is 1-5 per 100 cases. The most common possible triggers for myocarditis are: coxsackie virus B3, parvovirus B19, adenovirus, and human herpesvirus 6. Viral myocarditis appears in three stages: acute viral infection, inflammatory cell infiltration, and myocardial remodeling. The initial patient evaluation includes a detailed history and a careful physical examination which should include an electrocardiogram, chest X-ray, blood studies, non-invasive imaging techniques. The diagnosis of myocarditis can only be obtained by investigations of endomyocardial biopsy, including: histology, immunohistology and molecular biology or virology. Therapy can be divided into supportive and specific therapy (immunosuppressive therapy, interferon, immunoglobulin, immune-adsorptive therapy, immune-modulation, vaccination).