Histopathological Diagnosis of Acute Myocarditis and Dilated Cardiomyopathy
The histopathological diagnosis of acute fulminant myocarditis or endstage idiopathic cardiomyopathy at autopsy does not usually present a diagnostic problem. Clinically, however, it is difficult, if not impossible, to diagnose acute myocarditis because the presenting history and clinical features, as well as hemodynamic and electrophysiologic changes, are often similar to those of idiopathic dilated cardiomyopathy for which it is often mistaken and vice versa. The widespread use of the endomyocardial biopsy raised hopes that it would be possible to diagnose acute myocarditis more accurately by demonstrating a definite inflammatory infiltrate in the myocardium. It has been well documented in the literature that the presence of inflammatory infiltrates, including lymphocytes, in the myocardium are not always due to acute myocarditis and it has also been shown that lymphocytes themselves may be present in idiopathic dilated cardiomyopathy [1, 2]. This has led to confusion and, in some cases, over-diagnosis of acute myocarditis with a resulting diagnostic dilemma . The purpose of this paper, therefore, is to attempt to define the histopathological changes of acute myocarditis in such a way that will allow, or at least help, to differentiate acute myocarditis from idiopathic dilated cardiomyopathy particularly on endomyocardial biopsy.
KeywordsDilate Cardiomyopathy Endomyocardial Biopsy Idiopathic Dilate Cardiomyopathy Acute Myocarditis Fulminant Myocarditis
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