Vnitr Lek 2000, 46(11):801-807

[Myocarditis].

P Gregor: Kardiocentrum-II.interní klinika Fakultní nemocnice Královské Vinohrady a 3. Lékarské fakulty Univerzity Karlovy, Praha.

In the submitted paper the author summarizes findings concerning the controversial disease of contemporary cardiology--myocarditis. The prevalence of myocarditis in post-mortem material is about 1%. It is usually of viral origin (in particular Coxsackie viruses group B). The origin can be however also bacterial, spirochetal, mycoplasmatic, mycotic, protozoan and helminthic. Clinically it is manifested by a wide spectrum of manifestations from subclinical forms to fatal conditions (cardiac failure to cardiogenic shock, arrhythmia). On the ECG it is usually manifested by changes of the repolarization stage ST-T, by impaired conduction, possibly by pathological Q waves. Echocardiography can reveal localized (rarely diffuse) kinetic disorders which frequently do not correspond to classical areas supplied by a certain coronary artery, reversible myocardial hypertrophy is frequent. As to biochemical markers, sometimes a prolonged elevation of cardiospecific enzymes can be recorded. The most accurate evidence is that obtained by endomyocardial biopsy (but low activity). As to treatment, we start in the acute stage with bed rest and antibiotics, administration of angiotensin converting enzyme inhibitors is also recommended. In exceptional cases (in particular progressing acute conditions) administration of corticosteroids and/or immunosuppressives can be tried. Non-steroid anti-rheumatic preparations are not administered with the exception of symptomatic indication, (except in the acute stage of the disease).