Chapter 7 : Viral Heart Disease

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Viral Heart Disease, Page 1 of 2

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Viral pathogens are well known to cause injury, inflammation, tissue destruction, and remodeling of heart muscle. Indeed, viruses are among the most common inciting agents to cause a condition termed acute myocarditis. This condition may also be provoked by bacteria, other pathogens, as well as toxins and autoimmune diseases, each of which could mimic the appearance of viral myocarditis. The reason for this phenotypic mimicry is that myocarditis is a process characterized pathologically by an inflammatory infiltrate of the myocardium with death or degeneration of adjacent myocytes, not typical of the ischemic damage associated with atherosclerotic coronary artery disease. The inflammation and damage may involve myocytes, interstitium, vascular elements, and pericardium. The inflammatory process affects cardiac function adversely, causing either ventricular dysfunction, arrhythmias, or both. The acute process may persist and manifest as chronic low-grade tissue inflammation and fibrosis associated with cardiomyopathy and frank heart failure.

Citation: McManus B, Seidman M, Klingel K, Luo H. 2017. Viral Heart Disease, p 99-113. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch7
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Image of FIGURE 1

Endomyocardial biopsy specimen from a 19-year-old man with heart failure. Histopathology includes multifocal mononuclear cell infiltrates, areas of myocardial cell death, and apparent edema. Hematoxylin and eosin (H & E) stain; scale bar, 200 μm.

Citation: McManus B, Seidman M, Klingel K, Luo H. 2017. Viral Heart Disease, p 99-113. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch7
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Image of FIGURE 2

PCR analysis of fixed heart samples obtained from infants with endocardial fibroelastosis (EFE). Note the PCR-positive bands at 223 bp indicative of mumps virus. Sequence analysis confirmed the viral genome as that consistent with mumps.

Citation: McManus B, Seidman M, Klingel K, Luo H. 2017. Viral Heart Disease, p 99-113. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch7
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Image of FIGURE 3

Electrocardiogram from a 67-year-old man with no prior history of heart disease, normal coronary arteries, and now severe acute heart failure and viral myocarditis. Sinus tachycardia and low-voltage QRS complexes with inverted myocardial injury pattern, particularly in the inferior ventricular wall, as well as left axis deviation and right bundle branch block are present.

Citation: McManus B, Seidman M, Klingel K, Luo H. 2017. Viral Heart Disease, p 99-113. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch7
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Image of FIGURE 4

hybridization for coxsackievirus B3 genome in myocardium of a newborn with lethal enteroviral myocarditis. Note replication of the virus in myocytes as visualized by radioactive RNA/RNA hybridization (black dots) in close association with mononuclear inflammatory cells. Magnification, 400×.

Citation: McManus B, Seidman M, Klingel K, Luo H. 2017. Viral Heart Disease, p 99-113. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch7
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Image of FIGURE 5

(A) hybridization of acute parvovirus B19 infection of the heart is restricted to endothelial cells of small vessels as demonstrated by radioactive RNA/DNA hybridization. Cardiac inflammation is less prominent as compared to enteroviral myocarditis. Magnification, 400×. (B) PCR detection of enteroviral RNA (left panel) and parvovirus B19 DNA (right panel) by nested PCR in the myocardium of different patients with histologically proven myocarditis. Automatic DNA sequencing of viral amplification products confirms specificity of the PCR and allows the analysis of virus genotypes.

Citation: McManus B, Seidman M, Klingel K, Luo H. 2017. Viral Heart Disease, p 99-113. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch7
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Image of FIGURE 6

Nested PCR for the adenovirus genome. The agarose gel demonstrates a 308-bp PCR-positive band in the adenovirus-positive control lane, as well as in lanes designated MP, AD, BS, and JW, in which DNA was extracted from myocardial tissue samples obtained from patients with myocarditis. Patients designated LS and JH are PCR negative, as is the negative (–) control lane. MW, molecular weight.

Citation: McManus B, Seidman M, Klingel K, Luo H. 2017. Viral Heart Disease, p 99-113. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch7
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