The role of autoimmunity in cardiovascular disease has long been a topic of investigation in the clinic and the laboratory. Years of research effort were devoted to establishing a link between streptococcal infection and rheumatic heart disease based on an autoimmune response (see Chapter 63). Chagas disease is still believed to be based on a cross-reaction of antibodies to Trypanosoma cruzi with myocardial or cardiac conductive tissue. Finally, postpericardiotomy syndrome and postmyocardial infarction syndrome are sometimes cited as instances of an autoimmune response instigated by damaged or necrotic tissue. This chapter reviews the evidence linking autoimmunity with two important forms of heart disease, myocarditis and dilated cardiomyopathy. It must be stated, ab initio, that immunologic testing has so far not been effective in allowing a clear distinction between autoimmune and other etiologies of these diseases.
