Autoimmunity in myocarditis and dilated cardiomyopathy

Autoimmune Diseases: "Myocarditis is an acquired inflammatory condition involving the myocardial tissue. Although myocarditis is largely associated with viral infections, some cases remain idiopathic, while in others there is convincing evidence of autoimmune pathophysiology. Autoimmunity is influenced by genetic, immune, hormonal and environmental factors. Myocardial injury (due to infection, ischaemia, inflammation, toxins or other cardiotoxic factors) may trigger exposure to autoantigens, subsequently, initiating an autoimmune response, causing myocarditis and dilated cardiomyopathy. Nevertheless, in some cases no specific trigger is found," Dres. Udi Nussinovitch and Yehuda Shoenfeld (Israel) report in their new textbook "The General Practice Guide to Autoimmune Diseases".

Signs and symptoms of myocarditis and dilated cardiomyopathy (DCM) are:

- History of an upper respiratory illness or recent viral infection in some patients (myocarditis)
- A number of myocarditis cases are subclinical
- Asymptomatic cardiomegaly
- Symptomatic left- and right- heart failure
- Physical examination findings consistent with heart failure
- Chest pain on exertion or at rest
- Dyspnoea on exertion or at rest
- Fatigue
- Palpitations and arrhythmias (both ventricular and supra-ventricular)
- Peripheral pitting oedema
- Systemic and pulmonary embolisms
- Syncope
- Elevated serum levels of myocardial enzymes (in myocarditis)
- Electrocardiographic changes
- Sudden death

"Clinically, myocarditis may be asymptomatic or present with chest pain, palpitations, ECG changes, syncope, arrhythmias. Early diagnosis may be extremely challenging since signs and symptoms may be unspecific. Clinically, DCM is most commonly characterized as symptomatic heart failure. Prior to confirmation of a diagnosis of autoimmune myocarditis/DCM, proof of autoimmunity may be required. Evidence of autoimmune myocarditis/DCM may be found in a mononuclear cell infiltrate presenting with an abnormal human leukocyte antigen (HLA), presence of circulating anti-heart autoantibodies (AHA) or autoreactive lymphocytes in patients, and in unaffected family members, and in in-situ evidence of autoreactive lymphocytes and/or autoantibodies in cardiac tissue..."

>> Y. Shoenfeld, P.L. Meroni (Eds.) The General Practice Guide to Autoimmune Diseases. Pabst, 332 pages, ISBN 978-3-89967-770-6

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