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

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.