Chapter 14 : Enteroviral Myocarditis and Dilated Cardiomyopathy: a Review of Clinical and Experimental Studies

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This chapter presents epidemiologic data on the incidence of myocarditis and dilated cardiomyopathy (DCM) and their associations with enteroviruses. The pathogenesis of enterovirus-induced heart disease is comprehensively reviewed, with particular attention given to experimental studies elucidating the viral and immunologic mechanisms of the disease process. The chapter gives an overview of pathology, and talks about viral replication in the heart, host defense mechanisms, cell-mediated destruction of myofibers, virus participation in chronic heart disease, autoimmunity, viral infection and cardiac dysfunction, and factors affecting disease severity. Next, it reviews the detection of enteroviral infection in patients with myocarditis and DCM. It also describes the clinical features of myocarditis and DCM, and discusses evidence that these diseases are two ends of the same disease spectrum. Finally, the chapter reviews conventional treatments for patients with myocarditis and DCM. In addition, the role of immunosuppression and future avenues of therapy are also examined.

Citation: Martino T, Liu P, Sole M, Petric M. 1995. Enteroviral Myocarditis and Dilated Cardiomyopathy: a Review of Clinical and Experimental Studies, p 291-351. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch14

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Coronary Artery Disease
Theiler's Murine Encephalomyelitis
Herpes simplex virus 1
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Image of FIGURE 1

Transverse cross-sectional slice of representative heart from virus-infected mice. Note the multifocal nature of the myocardial lesions, which consist of necrotic myocardial cells and an inflammatory cell infiltrate. Hematoxylin and eosin stain. Magnification, Xl5. Reproduced from the Journal of Clinical Investigation ( ), by copyright permission of the American Society for Clinical Investigation.

Citation: Martino T, Liu P, Sole M, Petric M. 1995. Enteroviral Myocarditis and Dilated Cardiomyopathy: a Review of Clinical and Experimental Studies, p 291-351. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch14
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Image of FIGURE 2

Light microscopic sections of representative murine hearts. (A) Pathologic changes in CVB3 murine myocarditis. Note the massive myocardial necrosis and inflammatory cell infiltrate in the ventricular myocardium of an A/J mouse at day 7 postinfection. (B) Control heart from an uninfected age-matched mouse. Hematoxylin and eosin stain. Magnification, X40.

Citation: Martino T, Liu P, Sole M, Petric M. 1995. Enteroviral Myocarditis and Dilated Cardiomyopathy: a Review of Clinical and Experimental Studies, p 291-351. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch14
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Image of FIGURE 3

Microvascular perfusion from thick sections. Microfil (liquid silicone rubber) was perfused to cast the coronary vessels. (A) Control (verapamil treated) on day 14, with many smooth vessels. (B) Virus-infected heart on day 14. Vessels show multiple focal areas of constriction and narrowing. Magnification, Xl00. The photograph was kindly contributed to our laboratory by Fayez Dawood and Wen-Hu Wen.

Citation: Martino T, Liu P, Sole M, Petric M. 1995. Enteroviral Myocarditis and Dilated Cardiomyopathy: a Review of Clinical and Experimental Studies, p 291-351. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch14
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Image of FIGURE 4

Proposed mechanisms involved in the pathogenesis of DCM following viral myocarditis. Reprinted with permission from the American College of Cardiology ( ).

Citation: Martino T, Liu P, Sole M, Petric M. 1995. Enteroviral Myocarditis and Dilated Cardiomyopathy: a Review of Clinical and Experimental Studies, p 291-351. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch14
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