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Myocarditis
Elaine Winkel1, Joseph Parrillo
1Mainline Heart Failure and Transplant Program, 556 Lankenau Medical Building East, 100 Lancaster Drive, Wynnewood, PA 19096, USA. winkele@casep.com
Insights
Myocarditis, a heart inflammation, and its consequence, 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
Background:
- Myocarditis and dilated cardiomyopathy (DCM) are significant causes of illness and death, particularly in pediatric and young adult populations.
- These conditions present diagnostic challenges, often mimicking other cardiac ailments.
Purpose of the Study:
- To outline diagnostic and management strategies for myocarditis.
- To emphasize the importance of early recognition and intervention in improving patient outcomes.
Main Methods:
- Differential diagnosis considerations for heart failure, arrhythmias, and chest pain.
- Recommendations for endomyocardial biopsy (EMB) for diagnosis, including considerations for multiple or serial biopsies.
- Guidance on hospitalization, conventional heart failure therapies (ACE inhibitors, digitalis, diuretics, beta-blockers), and electrophysiologic evaluation.
Main Results:
- Myocarditis requires a high index of suspicion in patients with unexplained cardiac symptoms.
- Endomyocardial biopsy (EMB) is a key diagnostic tool, though sensitivity may necessitate multiple samples.
- Standard heart failure treatments are recommended for left ventricular dysfunction, with potential benefit from immunosuppressive therapy in select cases.
Conclusions:
- Prompt diagnosis and management of myocarditis are essential to prevent progression to dilated cardiomyopathy (DCM) and reduce mortality.
- Close monitoring of clinical course, treatment response, and left ventricular function is critical.
- Advanced heart failure management, including mechanical support and transplantation, should be considered for severe cases.
Abstract:
Myocarditis and its sequela, dilated cardiomyopathy (DCM), cause substantial morbidity and mortality, especially in children and young adults. Physicians should include myocarditis in the differential diagnosis of all patients who have new symptoms of heart failure, arrhythmia, or chest pain syndromes of unclear cause, and should strongly consider performing endomyocardial biopsy (EMB) to establish the diagnosis. It may be necessary to perform multiple or serial biopsies to increase sensitivity. Patients with myocarditis and symptomatic heart failure, chest pain, or arrhythmias need hospitalization for evaluation and treatment. Patients with symptomatic left ventricular dysfunction should be treated with conventional heart failure therapy, including angiotensin-converting enzyme (ACE) inhibitors, digitalis, diuretics, and beta-blockers. Patients with arrhythmias or syncope may require electrophysiologic evaluation. In addition to conventional therapy, physicians should consider a course of immunosuppressive therapy in selected patients. The clinical course, response to therapy, and left ventricular function need close monitoring. Patients with myocarditis and rapidly progressive heart failure or cardiogenic shock should be referred early to an advanced heart failure center for implantation of a ventricular assist device and consideration for cardiac transplantation.