1. Myocarditis n Inflammation of myocardium caused by specific pathogen

2. Etiology

3. Prevalency n 1% of necropsies (Gravanis,1992) n 10% of pts with new CHF (Mason, 1995) n 20% of children and young adult with sudden death (Taylor,1995) n Maximum : XII.-IV., male (2,5times), young

4. Etiopatogenesis n Parvovirus B19 (> 50%), Coxsackie, Adenovirus, CMV, EBV… n Viral multiplication in myocardium with infiltration by mononuclears, then autoimmunne reaction with necrosis

5. Clinical picture n Subclinical…fulminant (shock, immitation of MI) n Symptoms of virosis (57%) : fatigue cough, fever, arthralgia, myalgia… (Herskowitz,1993)

6. Clinical picture n Chest pain (pleural, AP, non-typical), dyspnoe n Tachycardia, arhythmias, systolic murmurs (MI, TI), LV failure, shock n Sudden death n Picture of MI (incl.ECG, enzymes) – echo, coronary arteriography

7. Electrocardiography n ST-T changes n Arhythmias (sv., ventricular, conduction abnormalities (A-V blockade I –III°, LBBB) n Patological Q (QS) - reversible n Q-T Prolongation

8. Laboratory n Elevation of troponins (> 48-72 h) n Inflammatory signs (CRP…) n Serology n EMB

9. Echocardiography n Disturbances of kinetics (other than MI) n LV Dilatation n Reversible myocardial hypertrophy n Pericardial effusion

10. Myokarditidy - therapy n Limitation of physical activity n ACE inhibitors n Symptomatic therapy

11. Presence of viral genome in myocardium n Imunnomodulation th - Interferon beta: n Antivirotics (ganciclovir, telbivudin) (Weinkauf 2005) n Absence of viral genome: immunosuppressive th - Prednisone, azathioprin 6 m (Frustaci, TIMIC study, 2009) n In bacterial : ATB