Virale Myokarditis im Kindesalter

[Lethal lymphocytic myocarditis-an underestimated diagnosis in infancy and childhood?]

In the past, histological diagnosis of (post-)viral myocarditis was based on the so-called Dallas criteria, which have been criticized because of high interobserver variability and sampling error. Immunohistochemical qualification and quantification of interstitial intramyocardial leucocytes was established and standard values concerning adults were published. Fatal casualties due to a viral myocarditis are rare as far as babies and children are concerned (sudden unexpected death in infancy; SUDI). Cases of sudden unexpected death in the first year of life are frequently regarded as sudden infant death syndrome (SIDS). To diagnose myocarditis when there are only single focal lymphocytic infiltrates in the myocardium, the number of samples taken by autopsy is relevant. But even in babies, immunohistochemical qualification and quantification of interstitial lymphocytes and macrophages can lead to standard values allowing diagnosis of myocarditis. Depending on the course of a viral infection, molecular pathological detection of viral genome in the myocardium is possible to support the diagnosis. Using the mentioned methods gradually, there are more cases of suspected SIDS, which are in fact cases of virus-induced myocarditis as cause of death. Primary enteroviruses (coxsackie viruses) and adenoviruses were found but also Epstein-Barr virus and PVB-19.

Sudden cardiac death-update

Sudden cardiac death (SCD) is one of the most common causes of death worldwide with a higher frequency especially in the young. Therefore, SCD is represented frequently in forensic autopsy practice, whereupon pathological findings in the heart can explain acute death. These pathological changes may not only include myocardial infarction, coronary thrombosis, or all forms of myocarditis/endocarditis but also rare diseases such as hereditary structural or arrythmogenic anomalies, lesions of the cardiac conduction system, or primary cardiac tumours.

[Sudden cardiac death. Selected forensic aspects]

Sudden cardiac death is one of the most common causes of death and a significant number of sudden deaths occurs especially in young people. Sudden cardiac death is also frequently represented in forensic autopsy practice. In such cases pathological findings in the heart can often explain the reason for the acute death. These pathological changes include not only myocardial infarction, coronary thrombosis and all forms of myocarditis/endocarditis but also rare diseases, such as hereditary structural or arrythmogenic anomalies, lesions of the cardiac conduction system or primary cardiac tumors.