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endomyocardial biopsy
Indications:
1) unexplained, new-onset heart failure (class B)
a) of <2 weeks' duration associated hemodynamic compromise, regardless of ventricular size
b) 2 weeks' to 3 months' duration associated with:
- dilated left ventricle &
a] *new ventricular arrhythmias, Mobitz type II 2nd-degree AV block or 3rd-degree AV block, or
b] *failure to respond to usual care within 1 to 2 weeks
2) unexplained heart failure with other characteristics (class C)
3) unexplained cardiomyopathy (class C)
- myocarditis
4) unexplained ventricular arrhythmias (class C)
5) unexplained atrial fibrillation (class C)
6) suspected cardiac tumor (class C) excepting typical myxomas
7) suspected hemochromatosis, cardiac sarcoidosis, amyloidosis [1]
Contraindications:
- prior to cardiac magnetic resonance imaging* if cardiac sarcoidosis suspected
* 18F-fluorodeoxyglucose (FDG) PET scan if CMRi is negative prior to biopsy
General
myocardial biopsy
References
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006