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Clinical Scenario
Duration of Illness
Pathological Correlates
Acute myocardial infarc-tion-like syndromewith normal coro-nary arteries
Heart failure with normal-sized or dilated leftventricle and hemody-namic compromise
Heart failure with dilated left ventricle and new ventricular arrhyth-mias, high-degreeheart block, or lackof response to usualcare within 1 to 2 wk
Heart failure witheosinophilia
Heart failure with dilated left ventricle and newventricular arrhyth-mias, high-degreeheart block, or lackof response to usualcare in 1 to 2 wk
Heart failure with dilatedleft ventricle withoutnew ventricular ar-rhythymias or high-degree heart block
More than several months
Heart failure with dilatedleft ventricle withoutnew ventricular ar-rhythmias or high-degree heart block
More than several months
Any duration
A few weeks or months
A few weeks or months
Less than 2wk
Several hours or days
Active lymphocyctic myo-carditis or, rarely, necro-tizing eosinophilic myo-carditis or giant-cellmyocarditis
Active lymphocyctic myo-carditis or, less com-monly, necrotizing eo-sinophilic myocarditisor giant-cell myocarditis
Giant-cell myocarditis,eosinophilic myocar-ditis, or lymphocyticmyocarditis
Nonspecific changes mostlikely, with the presenceof viral genomes in 25to 35% of patients andof lymphocyctic myocar-ditis (Dallas criteria) inabout 10%
Eosinophilic or hypersensi-tivity myocarditis, eo-sinophilic endromyo-carditis
Depends on functional class ejection fractionand the presence or ab-sence of inflammationand viral genomes onbiopsy
Cardiac sarcoidosis (idio-pathic granulomatousmyocarditis) or specific infection (e.g., Trypano-soma cruzi and Borrelia burgdorferi); nonspecificchanges most likely
Prognosis
Treatment
Nonspecific changes mostlikely; increased number ofinflammatory cells shown by sensitive immunostain-ing in up to 40% of patients and the presence of viral genomes in 25 to 35%
Good in fulminant lympho-cytic myocarditis, butacute care often requiresinotropic or mechanicalcirculatory support
Good if lymphocytic myo-carditis is present onbiopsy
Poor; high likelihood ofdeath or need for car-diac transplantation ifgiant-cell myocarditisis found on biopsy
Good in the first severalyears, but a risk of latedisease progressionwith heart failure and cardiomyopathy
Increased risk of need forpacemaker or implant-able cardioverter-defi-brillator if sarcoidosisis confirmed on biopsy
Poor
Supportive; antiviral treat-ment and immunosup-pression under investi-gation
Supportive; corticosteroidsfor biopsy-proven car-diac sarcoidosis
Supportive, including iden-tification and treatmentof underlying cause;possible use of corti-costeroids for hyper-sensitivity myocarditis
Supportive; definition of genomic predictors ofrisk under investigation
Variable therapy accordingto histopathologicalresults
Supportive; possible use of corticosteroids or IVIGin children
Supportive