Lieberman et al developed a clinicopathologic classification for patients with myocarditis. The authors are from the Johns Hopkins University in Baltimore.
Categories of myocarditis:
(1) fulminant
(2) acute
(3) chronic active
(4) chronic persistent
|
Parameter |
Fulminant |
Acute |
|
onset of cardiac symptoms |
distinct onset |
indistinct onset |
|
clinical presentation |
severe left ventricular dysfunction; cardiogenic shock |
left ventricular dysfunction with congestive heart failure |
|
clinical course |
death or complete recovery |
incomplete recovery or dilated cardiomyopathy |
|
initial histology |
multifocal acute myocardial inflammation |
active or borderline myocarditis |
|
histologic course |
complete resolution |
complete resolution |
|
Parameter |
Chronic Active |
Chronic Persistent |
|
onset of cardiac symptoms |
indistinct onset |
indistinct onset |
|
clinical presentation |
left ventricular dysfunction with congestive heart failure |
normal left ventricular function; chest pain or palpitations |
|
clinical course |
dilated cardiomyopathy |
symptoms other than heart failure |
|
initial histology |
active or borderline myocarditis |
active or borderline myocarditis |
|
histologic course |
ongoing or resolving myocarditis; fibrosis with giant cells |
ongoing or resolving myocarditis |
where:
• The inflammatory cell infiltrate in active myocarditis usually consists mostly of lymphocytes.
• The extent of myocyte necrosis correlates with myocardial function.
Immunosuppressive therapy is sometimes helpful in acute myocarditis, but not in the other types.
NOTE: The categories resemble the categories previously used for viral hepatitis.
Purpose: To classify a patient with myocarditis using the clinicopathologic scheme of Lieberman et al.
Specialty: Cardiology, Infectious Diseases, Immunology/Rheumatology
Objective: laboratory tests, severity, prognosis, stage
ICD-10: I09.0, I51.4,
