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Etiology and pathogenesis of myocarditis

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


Myocarditis is an inflammatory disease of cardiac muscle, diagnosed on endomyocardial biopsy (EMB) by established histologic, immunologic, and immunohistochemical criteria [1]. It can be acute, subacute, or chronic, and there may be either focal or diffuse involvement of the myocardium. In symptomatic patients, the cardiac presentation is frequently one of acute heart failure (HF), although a syndrome mimicking acute myocardial infarction or a tachyarrhythmia, including sudden death, or high-grade heart block may occur. If the epicardium is involved, pericarditis may be associated with pleuritic chest pain and pericardial effusion. Isolated endomyocardial inflammation and fibrosis is seen in Löffler's cardiomyopathy, tropical endomyocarditis, hypereosinophilic syndrome, and some adverse drug reactions.

The etiology and pathogenesis of myocarditis will be reviewed here. Issues related to the clinical manifestations, diagnosis, natural history, and treatment of myocarditis are discussed separately. (See "Clinical manifestations and diagnosis of myocarditis in adults" and "Treatment and prognosis of myocarditis in adults".)


The incidence of myocarditis according to International Classification of Diseases diagnosis codes was 22/100,000 or approximately 1.5 million cases in the 2013 world population [2].

Myocarditis can be caused by a variety of infectious and noninfectious illnesses (table 1). Among the infectious etiologies, viruses are the presumed most frequent pathogens, but bacteria, fungi, protozoa, and helminths have also been implicated [3,4]. In North America and Western Europe, the most frequently identified viruses were enteroviruses (including coxsackievirus) until the 1990s. Parvovirus B-19 and human herpes virus 6 are the viruses most frequently found. This topic review will focus on viral and hypersensitivity myocarditis. Many of the other causes of myocarditis are discussed in detail elsewhere in UpToDate. These include:

Infections such as acute rheumatic fever due to group A streptococci and Chagas disease. (See "Acute rheumatic fever: Epidemiology and pathogenesis" and "Chagas heart disease: Clinical manifestations and diagnosis".)

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Literature review current through: Nov 2017. | This topic last updated: Jul 28, 2017.
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