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Myocarditis.

Winkel1, Costanzo, Parrillo

  • 1Rush Heart Institute, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Street, Suite 439, Chicago, IL 60612, USA. ewinkel@rush.edu

Current Treatment Options in Cardiovascular Medicine
|November 30, 2000
PubMed
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Myocarditis, a heart inflammation, and its complication, dilated cardiomyopathy (DCM), significantly impact young patients. Early diagnosis via endomyocardial biopsy and prompt treatment are crucial for managing heart failure and arrhythmias.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Pediatrics

Background:

  • Myocarditis and dilated cardiomyopathy (DCM) are significant causes of illness and death, particularly in pediatric and young adult populations.
  • These conditions present with diverse symptoms, including heart failure, arrhythmias, and chest pain, often necessitating a broad differential diagnosis.

Purpose of the Study:

  • To emphasize the importance of considering myocarditis in patients presenting with unexplained cardiac symptoms.
  • To outline diagnostic strategies, including endomyocardial biopsy (EMB), and therapeutic approaches for myocarditis and DCM.
  • To guide management decisions for patients with varying disease severity and clinical presentations.

Main Methods:

  • Clinical assessment for symptoms of heart failure, arrhythmia, or chest pain.

Related Experiment Videos

  • Consideration of endomyocardial biopsy (EMB), potentially requiring multiple or serial procedures for diagnostic sensitivity.
  • Hospitalization for evaluation and treatment of symptomatic patients.
  • Application of conventional heart failure therapies (ACE inhibitors, digitalis, diuretics, beta-blockers).
  • Electrophysiologic evaluation for patients with arrhythmias or syncope.
  • Consideration of immunosuppressive therapy in select cases.
  • Close monitoring of clinical course, treatment response, and left ventricular function.
  • Early referral for advanced heart failure management, including ventricular assist devices and cardiac transplantation, for severe cases.

    • Main Results:

    • Diagnosis of myocarditis may require multiple or serial endomyocardial biopsies to achieve sufficient sensitivity.
    • Conventional heart failure therapies are recommended for patients with symptomatic left ventricular dysfunction.
    • Immunosuppressive therapy may be beneficial in specific patient cohorts.
    • Patients with rapidly progressive heart failure or cardiogenic shock require advanced interventions such as ventricular assist devices or cardiac transplantation.

    Conclusions:

    • Myocarditis should be a key consideration in the differential diagnosis of acute cardiac syndromes in all age groups.
    • Timely diagnosis, including EMB, and tailored treatment, encompassing conventional and potentially immunosuppressive therapies, are essential for improving outcomes.
    • Aggressive management, including advanced heart failure support, is critical for patients with severe or progressive disease.