Diagnosis of myocarditis as one of the actual problems in cardiology

Abstract

Nowadays the diagnosis and prognosis of myocarditis is one of the most pressing, complex and incompletely solved problems in modern cardiology, that exist due to the large polymorphism of clinical manifestations of this disease and because of the lack of specific symptoms and diagnostic criteria. In most cases, the occurrence of heart failure, pain, heart rhythm and conduction disorders or other clinical manifestations are observed on the 2nd week after the onset of infectious disease, but inflammatory heart disease may not have a clear connection with the infection. Among the main methods used to diagnose myocarditis in clinical practice are electrocardiography (ECG), Holter monitoring (HM) ECG, echocardiography (echocardiography) and speckle-tracking (ST) echocardiography, cardiac magnetic resonance (CMR) imaging and endomyocardial biopsy. ECG and HMECG are highly informative methods for detection, prediction and dynamic monitoring of frequent complications of myocarditis – arrhythmias and conduction disorders. Two-dimensional echocardiography is a mandatory technique for assessing myocardial contractility that allows to assess the size of the heart chambers, systolic and diastolic function, global and regional contractility, the presence of thrombosis in the cavities, pericardial effusion and, most importantly. In recent years, there has been increasing data on the use of CT echocardiography for the diagnosis of myocarditis, based on the assessment of myocardial deformation and its rate in the longitudinal, radial and circular directions. Contrast-enhanced magnetic resonance imaging of the heart is non-invasive and one of the most informative methods for detecting signs of inflammatory myocardial damage. CMR allows to visualize the anatomy, study the structure and characterize the tissue of the heart, determine the functional features of the atria and ventricles. However, the gold standard for verifying the diagnosis of myocarditis to this day remains endomyocardial biopsy. Laboratory methods of diagnosis are additional researches, that in a complex with instrumental methods allow to estimate changes of myocardial inflammatory process at long supervision.