Endomyokardiet

Endomyokardiet is a medical condition characterized by inflammation of the inner heart layers, primarily the endocardium and the myocardium. The term is used to describe inflammatory processes that affect the inner lining of the heart muscle and can be part of broader forms of myocarditis or endocardial disease. The condition can be acute or chronic and may lead to structural changes such as scarring or fibrosis of the endocardium.

Causes and pathophysiology vary and include infectious agents (viruses, bacteria, and, less commonly, fungi), immune-mediated or autoimmune reactions, and toxic or drug-related factors. Eosinophilic disorders, such as Löffler endomyocarditis, are notable subtypes where eosinophilic infiltration causes tissue damage and subsequent fibrosis. Over time, chronic inflammation can promote endomyocardial fibrosis, restricting ventricular filling and potentially leading to a restrictive cardiomyopathy or valvular dysfunction.

Clinical features depend on the extent and location of inflammation and fibrosis. Patients may experience chest pain, shortness of breath, fatigue, palpitations, or signs of heart failure. Some cases are asymptomatic or present with arrhythmias or embolic events. Diagnosis relies on a combination of clinical assessment, electrocardiography, measurements of cardiac biomarkers, and imaging. Echocardiography is commonly used to assess heart structure and function; cardiac magnetic resonance imaging can detect inflammation and fibrosis. In uncertain cases, endomyocardial biopsy may be performed to confirm the diagnosis.

Treatment focuses on addressing the underlying cause and managing symptoms. This may include antiviral or antibacterial therapy when infection is identified, anti-inflammatory or immunosuppressive treatment for immune-mediated forms, and management of heart failure. Anticoagulation may be indicated if thrombus formation is present. The prognosis varies with the etiology, extent of inflammation, and degree of fibrosis, with some patients experiencing recovery and others progressing to chronic cardiomyopathy.