Immunosuppressive therapy in the management of biopsy proven acute myocarditis.

The effectiveness of immunosuppressive treatment in impeding rejection reactions after cardiac transplantation provided the impetus for the introduction of this form of therapy for myocarditis, a disease in which nearly-identical histologic findings are observed. The histologic findings of myocarditis may be present in a variety of disease entities. The clinical features of myocarditis range from an asymptomatic course to severe congestive heart failure and sudden cardiac death. Clinically, the disease may be suspected but establishment of the diagnosis with certainty is enabled only on the basis of histologic confirmation by means of endomyocardial biopsy, a safe and easily-performed procedure. The histologic criteria of myocarditis have been defined by international agreement. From serial biopsies, the initial findings can be differentiated as those of acute and borderline as well as healed myocarditis and those of follow-up biopsies as persistent, healing or healed forms. The basis for the use of immunosuppressive treatment in myocarditis was derived from laboratory studies demonstrating that, after a short initial phase, immunological pathomechanisms assume an essential role. Two clinical studies have indicated that immunosuppressive treatment may be of benefit in patients with myocarditis. The regimen employed is generally a combination of prednisolone and azathioprine for a period of six months. The initial dosage is 1.25 mg/kg prednisolone daily with reduction to 0.3 mg/kg and 2 mg/kg azathioprine daily modified, as necessary, according to the leukocyte count.(ABSTRACT TRUNCATED AT 250 WORDS)