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Related Concept Videos

Myocarditis II: Clinical Features and Diagnostic Tests01:27

Myocarditis II: Clinical Features and Diagnostic Tests

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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
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Myocarditis III: Medical Management01:14

Myocarditis III: Medical Management

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Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
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Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
739
Myocarditis I: Introduction01:21

Myocarditis I: Introduction

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Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

25
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Myocarditis IV: Nursing Management01:22

Myocarditis IV: Nursing Management

36
Myocarditis is an inflammatory condition of the myocardium requiring meticulous nursing management for optimal patient outcomes. Effective management begins with a thorough assessment of the patient's medical history, paying close attention to past infections, autoimmune disorders, travel history, and exposure to toxins or drugs. Recent viral infections and systemic diseases are particularly relevant due to their potential role in triggering myocarditis.Physical Examination and MonitoringThe...
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Related Experiment Video

Updated: Sep 16, 2025

Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
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Association Between Vasoactive Inotropic Score and Clinical Outcomes in Patients With Fulminant Myocarditis.

David Hong1, Minjung Bak2, Hyukjin Park3

  • 1Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Korean Circulation Journal
|July 8, 2025
PubMed
Summary

The vasoactive inotropic score (VIS) is less effective for predicting outcomes in fulminant myocarditis patients treated with venoarterial-extracorporeal membrane oxygenation (VA-ECMO). Its prognostic value is significantly diminished when VA-ECMO is applied.

Keywords:
Cardiotonic agentsExtracorporeal membrane oxygenationMyocarditisPrognosis

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Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Clinical Research

Background:

  • Fulminant myocarditis is a severe cardiac condition requiring intensive management.
  • The vasoactive inotropic score (VIS) is used to assess hemodynamic support needs.
  • The impact of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) on VIS prognostic value is not well-defined.

Purpose of the Study:

  • To evaluate the prognostic significance of the vasoactive inotropic score (VIS) in patients diagnosed with fulminant myocarditis.
  • To compare the prognostic performance of VIS in patients with and without venoarterial-extracorporeal membrane oxygenation (VA-ECMO) support.

Main Methods:

  • Retrospective analysis of 417 patients with fulminant myocarditis from seven Korean hospitals.
  • Primary outcome: composite of all-cause death, heart transplantation, or left ventricular assist device (LVAD) implantation within one year.
  • Statistical analysis included hazard ratios and C-index for predictive performance evaluation.

Main Results:

  • The median VIS was 19.9; 52.0% of patients received VA-ECMO.
  • VIS was associated with the primary outcome in both VA-ECMO and non-VA-ECMO groups.
  • Prognostic value and predictive performance of VIS were significantly reduced in patients treated with VA-ECMO compared to those without.

Conclusions:

  • The prognostic value of the vasoactive inotropic score (VIS) is significantly diminished in patients with fulminant myocarditis who are treated with venoarterial-extracorporeal membrane oxygenation (VA-ECMO).
  • Clinical decision-making regarding prognostic assessment in fulminant myocarditis may need to consider the influence of VA-ECMO on VIS interpretation.