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CARDIOvASCuLAR ``CARdIOvASCulAR—PATHOlOGY CARDIOvASCuLAR ``CARdIOvASCulAR—PATHOlOGY SECTION III 313

Acute pericarditis Inflammation of the pericardium [ A , red arrows]. Commonly presents with sharp pain, aggravated
by inspiration, and relieved by sitting up and leaning forward. Often complicated by pericardial
A
effusion [between yellow arrows in A ]. Presents with friction rub. ECG changes include
widespread ST-segment elevation and/or PR depression.
Causes include idiopathic (most common; presumed viral), confirmed infection (eg,
coxsackievirus B), neoplasia, autoimmune (eg, SLE, rheumatoid arthritis), uremia, cardiovascular
(acute STEMI or Dressler syndrome), radiation therapy.
Treatment: NSAIDs, colchicine, glucocorticoids, dialysis (uremia).

Myocarditis Inflammation of myocardium Ž global enlargement of heart and dilation of all chambers. Major
cause of SCD in adults < 40 years old.
Presentation highly variable, can include dyspnea, chest pain, fever, arrhythmias (persistent
tachycardia out of proportion to fever is characteristic).
Multiple causes:
ƒ Viral (eg, adenovirus, coxsackie B, parvovirus B19, HIV, HHV-6); lymphocytic infiltrate with
focal necrosis highly indicative of viral myocarditis.
ƒ Parasitic (eg, Trypanosoma cruzi, Toxoplasma gondii)
ƒ Bacterial (eg, Borrelia burgdorferi, Mycoplasma pneumoniae, Corynebacterium diphtheriae)
ƒ Toxins (eg, carbon monoxide, black widow venom)
ƒ Rheumatic fever
ƒ Drugs (eg, doxorubicin, cocaine)
ƒ Autoimmune (eg, Kawasaki disease, sarcoidosis, SLE, polymyositis/dermatomyositis)
Complications include sudden death, arrhythmias, heart block, dilated cardiomyopathy, HF, mural
thrombus with systemic emboli.

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