DIAGNOSTIC STRATEGY IN ACUTE MYOCARDITIS

Myocarditis is a focalised or diffuse disease of the myocardium. The p rincipal causal agents are viruses in Europe and North America and a p arasite in South America (Chagas' disease). The prevalence of acute my ocarditis is variable, related to the periodic cycle of viral epidemic s. The diagnosis is difficult to establish because the clinical presen tation is variable, ranging from asymptomatic forms to rapidly fatal a cute congestive heart failure. The diagnostic tools suffer from lack o f sensitivity or specificity. Endomyocardial biopsy, despite its low s ensitivity, remains the reference investigation as it provides histolo gical proof of the myocarditis. Myocardial scintigraphy with antimyosi n antibodies has the advantage of very good sensitivity but with less specificity. The authors discuss the critical indications and limitati ons of each investigation.