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Clinical manifestations and diagnosis of myocarditis in adults

Leslie T Cooper, Jr, MD
Section Editors
William J McKenna, MD
Sharon A Hunt, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Myocarditis can be produced by a variety of different causes, many of which are infectious (table 1) [1]. In developed countries, viral infection is the most frequently presumed cause of myocarditis. In the 1980s and 1990s, enteroviruses (coxsackie B and others) were frequently associated with myocarditis and dilated cardiomyopathy. In the past 10 years, however, other viruses, including adenovirus, parvovirus B19, hepatitis C, and herpes virus 6, have emerged as significant pathogens [2]. In many developing countries, rheumatic carditis, Chagas disease, and disorders associated with advanced HIV are important causes of myocarditis.

Although histology remains the gold standard for establishing the diagnosis of myocarditis, low-risk patients are often presumed to have myocarditis on the basis of a compatible clinical scenario, suggesting new onset inflammatory cardiomyopathy and cardiovascular magnetic resonance (CMR) features without an endomyocardial biopsy (EMB). However, clinical features at presentation in myocarditis are polymorphic and there is no sign, symptom, or constellation of clinical features that is diagnostic of acute or subacute/chronic myocarditis.

The clinical manifestations and diagnosis of myocarditis will be reviewed here. The etiology, pathogenesis, treatment, and prognosis of this disorder are discussed separately. (See "Etiology and pathogenesis of myocarditis" and "Treatment and prognosis of myocarditis in adults".)


Myocarditis is an inflammatory disease of the myocardium. As discussed below, the World Health Organization/International Society and Federation of Cardiology (WHO/ISFC) definition specifies diagnosis by established histological (Dallas criteria), immunological, and immunohistochemical criteria [3], though many patients with clinical manifestations of myocarditis do not undergo endomyocardial biopsy so a definitive diagnosis is not established. (See 'Dallas criteria' below and 'WHO/ISFC definition' below and 'Endomyocardial biopsy' below.)

Inflammatory cardiomyopathy is defined as myocarditis accompanied by cardiac dysfunction [3]. Inflammatory cardiomyopathy can lead to dilated cardiomyopathy or other cardiomyopathies. (See "Definition and classification of the cardiomyopathies".)

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Literature review current through: Nov 2017. | This topic last updated: May 20, 2016.
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