Myocardial inflammation,necrosis and
Cardiomegaly and diminished systolic
function occur due to myocardial damage.
Typical signs of CHF occur which may
progress to shock,arrythmias and sudden
Virus act on myocardium in three phases.
1) Virus Replication Or Acute Phase
2) Autoimmune Injury Phase
3) Dilated Cardiomyopathy Phase Or Chronic
Sign And Symptoms
Manifestations of myocarditis range from asymptomatic or
nonspecific generalized illness to acute cardiogenic shock and
Infants and young children more often have a fulminant
Tachycardia, hypotension, gallop rhythm, and cardiac
Associated findings may include a rash or evidence of end
organ involvement such as hepatitis or aseptic meningitis.
Patients with acute or chronic myocarditis may also
present with :
Palpitations, easy fatigability, or syncope.
Cardiac findings include, gallop rhythm, and an apical
systolic murmur of mitral insufficiency.
In patients with associated pericardial disease, a rub
may be noted.
Hepatic enlargement, peripheral edema, and
pulmonary findings such as wheezes or rales may be
present in patients with decompensated congestive
Nonspecific and may include sinus tachycardia, atrial
or ventricular arrhythmias, heart block.
Reveal cardiomegaly, pulmonary vascular prominence,
pulmonary edema, or pleural effusions.
Often shows diminished ventricular systolic function,
cardiac chamber enlargement, mitral insufficiency, and
occasionally, evidence of pericardial effusion.
May be useful in identifying inflammatory cell
infiltrates or myocyte damage.
5)-OTHER SUPPORTIVE BUT NONSPECIFIC
Wbc’s often elevated.
Troponins elevated in 1/3rd cases.
CK-MB may be elevated.
AST may be elevated.
• Primary therapy for acute myocarditis is supportive
• Management is done according to clinical signs and
Conventional heart failure therapy is currently the
only accepted therapy for myocarditis including:
1. ACE inhibitors.
2. Angiotensin receptor blocking agents.
5. In patients manifesting with significant atrial or
ventricular arrhythmias, specific antiarrhythmic
agents (for example, amiodarone) should be given.
ROLE OF IMMUNOMODULATION
Immunomodulation of patients with myocarditis is
Intravenous immune globulin may have a role in
the treatment of acute or fulminant myocarditis.
Corticosteroids have been reported to improve
cardiac function, but the data are not convincing
Relapse has been noted in patients receiving
There are no studies to recommend specific
antiviral therapies for myocarditis.
The prognosis of symptomatic myocarditis:
in newborns is poor and 75% mortality has been
The prognosis is better for children and adolescents.
Recovery of ventricular function has been reported
in 10-50% of patients.