Myokarditis und entzündliche Kardiomyopathie

Zusammenfassung

Die Behandlung einer Herzinsuffizienz oder von Rhythmusstörungen im Rahmen einer akuten oder chronischen Myokarditis erfolgt, unabhängig von der auslösenden Ursache, symptomatisch nach allgemeinen Evidenz-basierten Leitlinien. Akute stabile Myokarditiden benötigen meist zunächst keinen spezifischen Therapieansatz. Akut sich rasch verschlechternde Patienten müssen jedoch schnell myokardbioptisch differenzialdiagnostisch analysiert werden, um ggf. immunsuppressive Therapieansätze z. B. bei der Riesenzellmyokarditis, eosinophilen oder granulomatösen Myokarditiden sofort initiieren zu können. Bei chronischen Verläufen ist nach myokardbioptischem Ausschluss einer Viruspersistenz eine Immunsuppression sinnvoll. Bei Nachweis einer Viruspersistenz (Adeno/Enteroviren) stellt Interferon-Beta die Therapieoption dar. Symptomatische Patienten mit Nachweis vaskulotroper Erythro- und/oder Herpesviren können von den oben beschriebenen Therapieversuchen unter Umständen profitieren [16], [46].

Abstract

Myocarditis is a cardiac inflammatory disease mainly caused by autoimmune processes and/or viral infections. Despite the advances of non-invasive diagnostic tests, endomyocardial biopsies (EMBs) remains the gold standard diagnostic technique for myocarditis and inflammatory cardiomyopathy. If the immune response fails to eliminate the infectious agent or inflammatory process does not resolve, only EMB can elucidate the cause and the status of the disease. Such tissue analyses are the prerequisite for an initiation of a specific antiviral or an anti-inflammatory treatment in addition to basic heart failure therapy. Other conditions such as giant cell myocarditis or cardiac sarcoidosis benefit from an anti-inflammatory treatment during the acute phase, so EMB has an important role both in acute and chronic settings. Despite the promising results with immunosuppressive or antiviral therapy in specific clinical scenarios according to published data, larger randomized studies are warranted in order to detect the effect of these treatments in strong clinical endpoints.

Schlüsselwörter

Myokarditis - Virusinfektion - Behandlung - Herzversagen

Keywords

myocarditis - viral infection - treatment - heart failure

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