When is an endomyocardial biopsy most likely indicated?

An endomyocardial biopsy is a procedure conducted to obtain a small sample of heart muscle tissue for diagnostic purposes. This procedure is particularly important when there is a suspicion of inflammation or infiltrative diseases affecting the myocardium, such as myocarditis or cardiomyopathies associated with systemic diseases. In these cases, the biopsy allows for a direct examination of the myocardial tissue, enabling clinicians to identify pathological changes, differentiate between various types of heart conditions, and guide treatment decisions.

Other situations, such as evaluating heart size or routine heart monitoring, do not typically require a biopsy. Measurements of heart size can be adequately assessed through non-invasive imaging techniques such as echocardiography. Moreover, while biopsies could provide insights in cases of infection, they are specifically most indicated when there is a clear need to investigate for inflammation or infiltrative processes, which could significantly alter management and prognosis for the patient.