In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

Infectious myocarditis and pericarditis

ESC Congress 2010

Myocardial Disease

Alida Caforio (Padua, IT) gave an overview of the pathogenesis of viral myo- and pericardits. She emphasized the polymorphic presentation and also underlined the complex polygenic control of susceptibility and that environmental factors are required to cause disease. The pathogenesis of dilated cardiomyopathy is still incompletely understood though many (most) cases are thought to be caused by virus. Viral infection triggers the immune system and accelerates autoimmune reactions. Infection and autoreactivity=Two faces of the same coin!

Sabine Pankuweit (Marburg, DE) took up the challenge of how viral infection of the heart and pericardium can be diagnosed. Since the 1980s when available molecular techniques came around, it has become increasingly clear that understanding the results of the refined and detailing techniques is very complicated indeed. The best way is to quantify the mean load of viral copies (Bock & al, NEJM 2010). However, there are still open ends to the interpretation and there are quite a few gaps in understanding the pathogenesis. Dr. Pankuweit rightly stressed the importance of making the diagnostic effort. Myocarditis is not rare and can be harmful.

Uwe Kuehl (Berlin, DE) gave us the Berlin group’s view and experience of treating patients diagnosed with viral myocarditis. The antiviral response depends on the virus type/subtype and the type of infected cell (myocyte, fibroblast, endothelial cell etc.) Interferon-beta clears entero- and adenovirus with a clinical improvement of 67%. Erythrovirus (parvoB19) affects first endothelial cells. With interferon-beta there is a poor virus clearance and virus load reduction, however, 50% of patients experience clinical improvement.

P. Seferovic (Belgrade, SE) gave an overview of bacterial/non-viral peri- and myocarditis. Special attention was bestowed on Lyme disease, AIDS (and concomitant infections) and TB. It is mandatory to remember that many infectious disorders, other than viral ones, are of major importance in large parts of the world (Chagas and TB just to mention a few). They are serious and they affect a lot of people.

It was concluded that endomyocardial and pericardial biopsying must be accompanied by a thorough work-up of the patient: in-depth clinical examination, imaging and often auxiliary molecular investigations of blood or tissue. Only then can one aspire to get benefit from the pouring in of new knowledge and how it can help in the clinical setting. The meeting was very well attended (full house) and the time kept.




Infectious myocarditis and pericarditis
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.