Review Article
Volume 16 Issue 07 - 2020
Death and Grief of Viral Myocarditis and Exciting Portrayal of Viruses
Raghavendra Rao MV1*, Abrar A Khan2, Dilip Mathai3, Vijay K Chennamchetty4, Tiara Calvo Leon5, Pamphil Igman6, Surekha Bhat7, Lakshmi Hitesh Billa8and Sanjay Kumar Agarwal9
1Scientist-Emeritus, and Director of Central research laboratory, Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad,Telangana, India,
2Professor, Dean, American University School of Medicine Aruba, Aruba, Central America
3Professor, Department of Medicine, Dean, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
4Senior consultant and HOD, Department of Pulmonology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
5Associate professor, Department of Pharmacology, American University School of Medicine Aruba, Central America
6Assistant Professor of Epidemiology and Biostatistics, American University School of Medicine Aruba, Central America
7Professor, Department of Biochemistry and genetics, American University School of Medicine Aruba, Central America
8Registrar, Department of Pulmonology, Apollo Hospitals, Hyderabad, Telangana, India
9Senior Consultant, Department of Cardiothoracic surgery, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
*Corresponding Author: Raghavendra Rao MV, Scientist-Emeritus, and Director of Central research laboratory, Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India.
Received: May 08, 2020; Published: June 04, 2020


Myocarditis is most often due to a viral infection. Viral myocarditis remains a prominent infectious-inflammatory disease for patients throughout the lifespan. Viral infections may cause inflammation of heart muscle (myocarditis) with temporary or potentially permanent damage to heart muscles cells Dealeading to a secondary cardiomyopathy occur when the heart muscle fibers are abnormally stretched when the heart chambers increase in size and volume. The stretched muscles lose their ability to contract strongly, similar to a slinky or an elastic band that has been overstretched and loses its shape and function. As the heart walls continue to stretch, they can also cause damage to the heart valves between the chambers of the heart causing blood to regurgitate or backwash, and as a result there is decreased cardiac output and heart failure. Viral (adenovirus, parvovirus B19, Coxsackievirus, HIV, Enterovirus, rubella virus, polio virus, cytomegalovirus, human herpes virus 6 and possibly hepatitis C.

Keywords: Adenovirus; Parvovirus B19; Coxsackievirus; HIV; Enterovirus; Rubella Virus; Polio Virus; Cytomegalovirus; Human Herpes Virus 6 Hepatitis C


  1. Raghavendra Rao MV., et al. “Is myocarditis like a hot knife through butter”. International Journal of Current Medical and Pharmaceutical Research 656 4.2 (2018): 2988-2992.
  2. “Infections of the heart with common viruses, Overview of the types of viruses causing heart disease”. Bentham Science Publishers (2016).
  3. Maekawa Y. et al. “Connecting the missing link between dilated cardiomyopathy and viral myocarditis: virus, cytoskeleton, and innate immunity”. Circulation1 (2007): 5-8.
  4. Roubille C. “Cytomegalovirus (CMV) and acute myocarditis in an immunocompetent patient”. Internal Medicine 2 (2010): 131-133.
  5. Erik D Heegaard and Kevin E Brown. “Human Parvovirus B19”. Clinical Microbiology Reviews 3 (2002): 485-505.
  6. Lorine E Aigner., et al. “Neonatal Rubella Myocarditis”. British Heart Journal 28 (1966): 691.
  7. Frustaci A., et al. “Fatal measles myocarditis”. Cardiologia 4 (1990): 347-349.
  8. “Practical Cardiovascular Pathology, 2nd edition”. CRC Press (2011): 197.
  9. Kolata Gina. "A Heart Attack? No, It Was the Coronavirus". New York Times (2020).
  10. Kuhl U., et al. “High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction”. Circulation 111 (2005): 887-893.
  11. Shi Y., et al. “Cardiac deletion of the Coxsackievirus-adenovirus receptor abolishes Coxsackievirus B3 infection and prevents myocarditis In vivo”. Journal of the American College of Cardiology 53 (2009): 1219-122.
  12. Kuhl U., et al. “Viral persistence in the myocardium is associated with progressive cardiac dysfunction”. Circulation 112 (2005): 1965-1970.
  13. Vanstechelman F and Vandekerckhove H. “Myocarditis in an immunocompetent patient”. Acta Cardiologica 2 (2012): 257-260.
  14. Hurt C and Tammaro D. “Diagnostic evaluation of mononucleosis-like illnesses”. The American Journal of Medicine 120 (2007): 911.
  15. Kenneson A and Cannon MJ. “Review and meta-analysis of the epidemiology of congenital cytomagalovirus (CMV) infection”. Reviews in Medical Virology 4 (2007): 253-276.
  16. Matos SB., et al. “Seroprevalence and serum profile of cytomegalovirus infection among patients with hematologic disorders in Bahia State, Brazil”. Journal of Medical Virology 2 (2011): 298-304.
  17. Tomohiro Harada., et al. “Rubella-Associated Perimyocarditis: A Case Report”. Angiology6 (2002): 727-732.
  18. Verdonschot J., et al. “Relevance of cardiac parvovirus B19 in myocarditis and dilated cardiomyopathy: review of the literature”. European Journal of Heart Failure 12 (2016): 1430-1441.
  19. Molina KM., et al. “Parvovirus B19 myocarditis causes significant morbidity and mortality in children”. Pediatric Cardiology 2 (2013): 390-397.
  20. Ben-Haim S., et al. “Cardiovascular infection and inflammation”. Seminars in Nuclear Medicine 39 (2009): 103-114.
  21. Vincent Racaniello. “Coxsackie NY and the virus named after it”. Virology Blog (2009).
  22. Ackerknecht Erwin Heinz. “A short history of medicine”. Baltimore: Johns Hopkins University Press (1982).
  23. Best JM., et al. “Rubella". Topley and Wilson's Microbiology and Microbial Infections”. 2 Virology (2005): 960-992.
  24. Lee JY and Bowden DS. "Rubella virus replication and links to teratogenicity". Clinical Microbiology Reviews 4 (2000): 571-587.
  25. Atkinson W., et al. “Rubella Epidemiology and Prevention of Vaccine-Preventable Diseases (10th edition.)”. Centers for Disease Control and Prevention (2007).
  26. Reagan Leslie J. “Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America (2010).
  27. Riley HD Jr. “History of the cytomegalovirus”. Southern Medical Journal 2 (1997): 184-190.
  28. Shanes JG., et al. “Interobserver variability in the pathologic interpretation of endomyocardial biopsy results”. Circulation 75 (1987): 401-405.
  29. Hauck AJ., et al. “Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error”. Mayo Clinic Proceedings 64 (1989): 1235-1245.
  30. Baughman KL. “Diagnosis of myocarditis: death of Dallas criteria”. Circulation 113 (2006): 593-595.
  31. Hari Tunuguntla., et al. “Acute Myocarditis and Pericarditis in Children”. Pediatrics in Review1 (2019): 14-25.
  32. Leslie T Cooper. “Myocarditis Around the World”. World heart federation.
  33. P P Liu and J W Mason. “Advances in the Understanding of Myocarditis”. Circulation 9 (2020): 1076-1082.
  34. Alberto Zanatta., et al. “Story telling myocarditis”. International Journal of Cardiology 294 (2019): 61-64.
  35. Fleisher LA., et al. “ACCF/AHA update on perioperative cardiovascular evaluation and care for Non-cardiac surgery”. Journal of the American College of Cardiology 54 (2009).
  36. Barbandi M., et al. “A case series of reversible acute cardiomyopathy associated with H1N1 influenza infection". Methodist DeBakey Cardiovascular Journal1 (2012): 42-45.
  37. Badorff C., et al. “Enteroviral cardiomyopathy: bad news for the dystrophin-glycoprotein complex". Herz 3 (2000): 227-232.
  38. Kuhl U., et al. “Viral persistence in the myocardium is associated with progressive cardiac dysfunction”. Circulation 112 (2005): 1965-1970.
  39. Felker GM., et al. “Echocardiographic findings in fulminant and acute myocarditis”. Journal of the American College of Cardiology 1 (2000): 227-232.
  40. Mendes LA., et al. “Ventricular remodeling in active myocarditis: Myocarditis Treatment Trial”. American Heart Journal 2-1 (1999): 303-308.
  41. Fuse K., et al. “Predictors of disease course in patients with acute myocarditis”. Circulation 102 (2000): 2829-2835.
  42. Nishii M., et al. “Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis”. Journal of the American College of Cardiology 44 (2004): 1292-1297.
  43. Smith SC., et al. “Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates”. Circulation 95 (1997): 163-168.
  44. Friedrich MG., et al. “Cardiovascular magnetic resonance in myocarditis: A JACC White Paper”. Journal of the American College of Cardiology 53 (2009): 1475-1487.
  45. Cooper LT., et al. “The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology”. Circulation 116 (2007): 2216-2233.
  46. ALP Caforio., et al. “Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases”. European Heart Journal33 (2013): 2636-2648.
  47. Mason JW. “Myocarditis and dilated cardiomyopathy: an inflammatory link”. Cardiovascular Research 60 (2003): 5-10.
  48. Maekawa Y., et al. “Connecting the missing link between dilated cardiomyopathy and viral myocarditis: virus, cytoskeleton, and innate immunity”. Circulation 115 (2007): 5-8.
  49. Boehmer JP., et al. “Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis”. The New England Journal of Medicine 342 (2000): 690-695.
  50. Lawson CM. “Evidence for mimicry by viral antigens in animal models of autoimmune disease including myocarditis”. Cellular and Molecular Life Sciences 57 (2000): 552-560.
  51. Badorff C and Knowlton KU. “Dystrophin disruption in enterovirus-induced myocarditis and dilated cardiomyopathy: from bench to bedside”. Medical Microbiology and Immunology 193 (2004): 121-126.
  52. Caforio AL, et al. “Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance”. European Journal of Heart Failure 4 (2002): 411-417.
  53. Horwitz MS., et al. “Pancreatic expression of interferon-gamma protects mice from lethal coxsackievirus B3 infection and subsequent myocarditis”. Nature Medicine 6 (2000): 693-697.
  54. Pauschinger M., et al. “Myocardial remodeling in viral heart disease: possible interactions between inflammatory mediators and MMP-TIMP system”. Heart Failure Reviews 9 (2004): 21-31.
  55. Heymans S., et al. “Inhibition of urokinase type plasminogen activator or matrix metalloproteinases prevents cardiac injury and dysfunction during viral myocarditis”. Circulation 114 (2006): 565-573.
  56. Coker ML., et al. “Left ventricular remodeling in transgenic mice with cardiac restricted overexpression of tumor necrosis factor”. Circulation 104 (2001): 826-831.
  57. Heymans S. “Inflammation and cardiac remodeling during viral myocarditis”. Ernst Schering Res Found Workshop (2006): 197-218.
  58. Mason JW., et al. “A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators”. The New England Journal of Medicine 5 (1995): 269-275.
  59. Hufnagel G., et al. “The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID): first epidemiological results”. Herz3 (2000): 279-285.
  60. Liu W., et al. “Nifedipine inhibits the activation of inflammatory and immune reactions in viral myocarditis”. Life Sciences 85 (2009): 235-240.
  61. Khatib R., et al. “Enhancement of Coxsackievirus B3 replication in Vero cells by indomethacin”. The Journal of Infectious Diseases 162 (1990): 997-998.
  62. David J Cennimo. “Parvovirus B19 Infection Workup, Drugs and diseases”. Pediatrics: General Medicine (2019).
  63. Martha L Muller and Michael Stuart Bronze. “Coxsackieviruses Workup, drugs, diseases” (2018).
  64. Flor M Munoz and Phyllis Flomenber. “Diagnosis, treatment, and prevention of adenovirus infection” (2020).
  65. De Paschale M and Clerici. “Serological diagnosis of Epstein-Barr virus infection: Problems and solutions”. World Journal Virology (2012):
  66. DeLisa Fairweather., et al. “Prevention of myocarditis using regenerative medicine therapy”. The Journal of Immunology 166 (2018): 2.
  67. A Pages ON., et al. “Paracorporeal pulsatile biventricular assist device versus extracorporal membrane oxygenation-extracorporal life support in adult fulminant myocarditis”. The Journal of Thoracic and Cardiovascular Surgery 137 (2009): 194-197.
  68. B Duncan BW., et al. “Mechanical circulatory support for the treatment of children with acute fulminant myocarditis”. The Journal of Thoracic and Cardiovascular Surgery 122 (2001): 440-448.
  69. C Reinhartz O., et al. “Thoratec ventricular assist devices in pediatric patients: update on clinical results”. ASAIO Journal 51 (2005): 501-503.
  70. D Topkara VK., et al. “Ventricular assist device use for the treatment of acute viral myocarditis”. The Journal of Thoracic and Cardiovascular Surgery 131 (2006): 1190-1191.
  71. Wang YX., et al. “Antiviral and myocyte protective effects of murine interferon-beta and -{alpha}2 in coxsackievirus B3-induced myocarditis and epicarditis in Balb/c mice”. American Journal of Physiology 293 (2007): H69-H76.
  72. Okada I., et al. “Combination treatment with ribavirin and interferon for coxsackievirus B3 replication”. Journal of Laboratory and Clinical Medicine 120 (1992): 569-573.
  73. Matsumori A., et al. “Prevention of viral myocarditis with recombinant human leukocyte interferon alpha A/D in a murine model”. Journal of the American College of Cardiology 9 (1987): 1320-1325.
  74. Ray CG., et al. “The use of intravenous ribavirin to treat influenza virus-associated acute myocarditis”. The Journal of Infectious Diseases 159 (1989): 829-836.
  75. Frustaci A., et al. “Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunologic profile of responders versus nonresponders”. Circulation 107 (2003): 857-863.
  76. Frustaci A., et al. “Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study”. European Heart Journal (2009).
  77. Frustaci A., et al. “Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study”. European Heart Journal 30 (2009): 1995-2002.
  78. Gullestad L., et al. “Immunomodulating therapy with intravenous immunoglobulin in patients with chronic heart failure”. Circulation 103 (2001): 220-225.
  79. Mason JW., et al. “A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators”. The New England Journal of Medicine 333 (1995): 269-275.
  80. McNamara DM., et al. “Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy”. Circulation 103 (2001): 2254-2259.
  81. Parrillo JE., et al. “A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy”. The New England Journal of Medicine 321 (1989): 1061-1068.
  82. Wojnicz R., et al. “Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results”. Circulation 104 (2001): 39-45.
Citation: Raghavendra Rao MV., et al. “Death and Grief of Viral Myocarditis and Exciting Portrayal of Viruses”. EC Microbiology 16.7 (2020): 32-46.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for September Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the September issue of respective journals. Submissions are accepted on/before August 15, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to