Myocarditis, Noninfectious

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-Fluorouracil

  • 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 presentation varies widely

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

Serial echocardiography or cardiac MRI or both can provide concrete data regarding LV function

Echocardiography/Doppler myocardial strain patterns may be the first abnormality observed and assessment of the T2 signal from cardiac MRI may provide early detection of cardiotoxicity

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

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