In this position statement of the ESC Working Group on Myocardial and Pericardial Diseases an expert consensus group reviews the current knowledge on clinical presentation, diagnosis and treatment of myocarditis, and proposes new diagnostic criteria for clinically suspected myocarditis and its distinct biopsy-proven pathogenetic forms. The aims are to bridge the gap between clinical and tissue-based diagnosis, to improve management and provide a common reference point for future registries and multicentre randomised controlled trials of aetiology-driven treatment in inflammatory heart muscle disease.

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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.

Cardiovascular Magnetic Resonance in Myocarditis: A JACC White Paper

The full text of this document is available on the Website of the European Society of Cardiology: www.escardio.org in the section ‘Scientific Information’, Guidelines. Introduction 1809 Pathophysiology 1810 Plaque rupture and erosion 1810 Inflammation 1812 Thrombosis 1812 Vasoconstriction 1812 Myocardium 1813 Diagnosis 1813 Clinical presentation 1813 Physical examination 1813 Electrocardiogram 1813 Biochemical markers of myocardial damage 1814 Recommendations 1815 Risk assessment 1815 Risk factors 1815 Clinical presentation 1815 Electrocardiogram 1816 Markers of myocardial damage 1816 Markers of inflammatory activity 1816 Markers of thrombosis 1817 Echocardiography 1817 Predischarge stress testing 1817 Coronary angiography 1817 Recommendations for risk stratification 1818 Treatment options 1818 Anti-ischaemic agents 1818 Beta-blockers 1818 Nitrates 1818

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Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Update on myocarditis.

Recently, the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) convened a conference to discuss refinements in the diagnosis of acute myocardial infarction. The panel on biochemistry considered issues related to the use of marker proteins. We were guided predominantly by the science of the area. We were also cognizant of the impact that changes in the standards would have on epidemiology, clinical trials, education of physicians, and patient care. Our recommendations will be incorporated, with the recommendations of the other panels, into a position paper for the ESC and the ACC. However, the members of the biochemistry group decided to express the opinions we felt were important in this area independently. Our thinking does not represent the position of the ESC, the ACC, or of the conjoint task force.

Many modifications of the original World Health Organization criteria for acute myocardial infarction1 have been accepted and incorporated into the ESC/ACC criteria; some deletions have also occurred. Until recently, most markers were detected using enzymatic activity; detection of the protein concentration now is preferred. Thus, it is more appropriate to refer to molecules released into the circulation as a consequence of cardiac injury as biochemical diagnostic markers or biomarkers. In this editorial, we emphasize issues related to the biochemical diagnosis of acute myocardial infarction. New and improved plasma biomarkers (troponins) with better sensitivity and specificity will be emphasized in preference to markers such as total creatine kinase (CK), CK-MB, lactate dehydrogenase, and aspartate aminotransferase. Rapid assays for the early detection of infarction that may be helpful will be delineated, and the use of the troponin markers to aid in the risk stratification of patients with acute coronary syndromes will be recommended.

### Biomarker Increases

Detectable increases in the biomarkers of cardiac injury are indicative of injury to the …

It’s Time for a Change to a Troponin Standard

Cardiac Troponin T in Patients With Clinically Suspected Myocarditis

Einleitung. Bradykarde Rhythmusstorungen entstehen infolge einer Verzogerung oder eines Ausfalls der Erregungsentstehung und der Erregungsleitung. Therapeutische Konsequenzen ergeben sich nur, wenn in Folge der Rhythmusstorung Symptome auftreten.

Bodo Eckhard Strauer

Papers

Cardiac Troponin T in Patients With Clinically Suspected Myocarditis

Erkrankungen von Herz und Gefäßen