Endomyocardial Biopsy Diagnosis of Myocarditis and Changes Following Immunsuppressive Treatment
This paper will deal only with idiopathic myocarditis and will not attempt to include myocarditis of other origin, e.g., rheumatic myocarditis, Chaga’s myocarditis, Whipple’s disease, rickettsia, and protozoal myocarditis or myocarditis from opportunistic organisms. Over 4000 endomyocardial biopsies have been performed at Stanford over the last 10 years. Excluding those biopsies performed for the detection of cardiac rejection in cardiac recipients and those to assess anthracycline car-diotoxicity, 850 biopsies have been performed for the diagnosis of apparent cardiac disease. Of this last group 163 (19%) were performed in cases of clinically suspected myocarditis. Because of the similarity of the inflammatory infiltrate seen in endomyocardial biopsies from patients with myocarditis to that seen in acute cardiac rejection, we attempted to use immunosuppressive therapy similar to that used to prevent cardiac rejection. This treatment for myocarditis is controversial. There have been sporadic reports in the literature suggesting improvement of myocarditis with steroid therapy [1–4], whereas other reports have suggested that steroid treatment may increase the adverse effects of myocarditis or even enhance its course [5–7]. The purpose of this paper is to present our current experience in the treatment of myocarditis with immunosuppressive agents and to state our position in this controversy.
KeywordsPneumonia Serotonin Interferon Caffeine Cyclophosphamide
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