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Key Features

  • Causes include

    • Autoimmune diseases

      • Dermatomyositis

      • Inflammatory bowel disease

      • Rheumatoid arthritis

      • Sjögren syndrome

      • Systemic lupus erythematosus

      • Granulomatosis with polyangiitis

      • Giant cell myocarditis

    • Drugs

      • Aminophylline

      • Amphetamine

      • Anthracycline

      • Catecholamines

      • Chloramphenicol

      • Cocaine

      • Cyclophosphamide

      • Doxorubicin

      • 5-FU

      • Mesylate

      • Methysergide

      • Phenytoin

      • Trastuzumab

      • Zidovudine

    • Hypersensitivity reactions due to drugs

      • Azithromycin

      • Benzodiazepines

      • Clozapine

      • Cephalosporins

      • Dapsone

      • Dobutamine

      • Lithium

      • Diuretics

      • Thiazide

      • Methyldopa

      • Mexiletine

      • Streptomycin

      • Sulfonamides

      • Nonsteroidal anti-inflammatory drugs

      • Tetanus toxoid

      • Tetracycline

      • Tricyclic antidepressants

    • Hypersensitivity reactions due to venoms

      • Bee, wasp

      • Black widow spider

      • Scorpion

      • Snake

    • Systemic diseases

      • Eosinophilic granulomatosis with polyangiitis

      • Collagen diseases

      • Sarcoidosis

      • Kawasaki disease

      • Scleroderma

    • Other

      • Heat stroke

      • Hypothermia

      • Transplant rejection

      • Radiation injury

Clinical Findings

  • Clinical presentation varies widely

Diagnosis

  • In patients receiving chemotherapy, it is important to look for subtle signs of cardiovascular compromise

  • Echocardiography, cardiac MRI, and serial MUGA studies can provide concrete data regarding LV function

  • Biomarkers such as B-type natriuretic peptide (BNP or NT-prBNP) may be valuable when serial measures are obtained

  • Other biomarkers may appear early in the course of myocardial injury (especially troponin and myeloperoxidase) and may allow for early detection of cardiotoxicity before other signs become evident

Treatment

  • High-dose corticosteroids and removal of the offending medication or underlying trigger is used to treat eosinophilic myocarditis

  • Calcium channel blockers and nitrates may be effective in documented coronary spasm

  • Usual therapy for heart failure or conduction system disease is warranted when symptoms occur

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