Acute and Fulminant Myocarditis: a Pragmatic Clinical Approach to Diagnosis and Treatment

Ammirati, Enrico; Veronese, Giacomo; Cipriani, Manlio; Moroni, Francesco; Garascia, Andrea; Brambatti, Michela; Adler, Eric; Frigerio, Maria

doi:10.1007/s11886-018-1054-z

Cited by 82 publications

(78 citation statements)

References 82 publications

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“…In patients with preserved LVEF, assessment of late gadolinium enhancement (LGE) distribution patterns on cardiac MRI can improve patient risk stratification 156,157 . Among patients with fulminant myocarditis (patients who present with cardiogenic shock needing inotropes and/or mechanical circulatory support (MCS)), the histological subtype subtending the myocarditis, including giant-cell and eosinophilic myocarditis, is independently associated with increased mortality 158 . Finally, inflammatory cardiomyopathy can be the first presentation in patients with HF symptoms and can be the result of a delayed diagnosis of acute myocarditis.…”

Section: Clinical Scenariosmentioning

confidence: 99%

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Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

et al. 2020

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Inflammatory cardiomyopathy is defined as myocarditis in association with cardiac dysfunction and ventricular remodelling 1,2. Despite extensive research and improved diagnosis and understanding of the pathogenesis of inflammatory cardiomyopathy, this disorder is still associated with a poor prognosis when complicated by left ventricular (LV) dysfunction, heart failure (HF) or arrhythmia 3. Furthermore, fulminant myocarditis, a rare, sudden and severe cardiac inflammation, is one of the main causes of cardiogenic shock in young adults 4,5. Prompt diagnosis and specific treatment strategies are needed to reduce mortality and the need for heart transplantation in these patients 4,5. Many questions remain unanswered regarding the pathogenesis of inflammatory cardiomyopathy and the role of the viral infection, the immune system, the host genetic background and the environment in disease progression and prognosis. These gaps in knowledge highlight the need for advanced experimental systems that can better model the human immune system and the need to improve the characterization and classification of the patients, for example, with the use of phenomapping and phenomics, which involve detailed evaluation of immune status, viral presence and/or other biomarkers. In this Review, we discuss the available evidence and identify the gaps in our understanding of the pathogenesis, diagnosis, treatment and prognosis of myocarditis and inflammatory cardiomyopathy, appraise the available animal and cell models of these conditions and propose future directions for the field. We discuss the role

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Section: Clinical Scenariosmentioning

confidence: 99%

“…Therefore, defining the time of cardiac symptom onset is crucial. A mild elevation of troponin levels in plasma that is disproportionate to the severity of the LVEF impairment and associated with a dilated left ventricle at presentation is suggestive of inflammatory cardiomyopathy rather than acute myocarditis 158 .…”

Section: Clinical Scenariosmentioning

confidence: 99%

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

et al. 2020

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“…Alternatively, chest pain may be more typical for pericarditis, thus suggesting pericardial involvement. 2,21,22,31,[64][65][66][67] Approximately 60% of patients may have antecedent arthralgias, malaise, fever, sweats or chills consistent with viral infections (e.g. pharyngitis, tonsillitis and upper respiratory tract infection) 1-2 weeks before onset.…”

Section: Clinical Presentation and Diagnosis Of Myocarditismentioning

confidence: 99%

“…Inflammatory markers of myocarditis [21][22][23]26,34,35,64,66 eosinophilia may suggest hypersensitivity (eosinophilic) myocarditis. 1-3,11-15 2.…”

Section: Laboratory Evaluationmentioning

confidence: 99%

Update on myocarditis – what we know so far and where we may be heading

Rroku

Kottwitz

Heidecker

2020

European Heart Journal. Acute Cardiovascular Care

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“…It is a "diagnosis in search of its aetiology but with therapeutic options" [63]. A new American Heart Association statement in 2020 [64], recent European publications [2,63,65], and a Chinese expert consensus statement [66] underline the importance of symptomatic and supportive treatment including mechanical circulatory support (Impella microaxial pump and/or extracorporeal membrane oxygenation [ECMO]) as well as treatment of heart failure and cardiogenic shock but also of antiviral or intravenous immunoglobulin (IVIg) therapy whenever appropriate. Dose rec-ommendations for IVIgG range between 20-40 g/day for 2 days and 10-20 g daily for 5-7 days [66], for IVIgM (Pentaglobin) 15-20 g on day 1 and day 3 [2,[67][68][69].…”

Section: Fulminant Myocarditismentioning

confidence: 99%

Inflammatory dilated cardiomyopathy

Maisch

Pankuweit

2020

Herz

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Inflammatory dilated cardiomyopathy (DCMi) is a syndrome, not an etiological disease entity. The infective etiology and the immunopathology can be best determined through endomyocardial biopsy with a complete work-up by light microscopy, immunohistology, and polymerase chain reaction for microbial agents. This review focuses on the methodological advances in diagnosis in the past few years and exemplifies the importance of an etiology-orientated treatment in different case scenarios. In fulminant nonviral myocarditis, immunosuppressive treatment together with hemodynamic stabilization of the patient via mechanical circulatory support (e.g., microaxial pumps, extracorporeal membrane oxygenation, left ventricular assist device) can be life-saving. For viral inflammatory cardiomyopathy, intravenous immunoglobulin treatment can resolve inflammation and often eradicate the virus.

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Acute and Fulminant Myocarditis: a Pragmatic Clinical Approach to Diagnosis and Treatment

Cited by 82 publications

References 82 publications

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

Update on myocarditis – what we know so far and where we may be heading

Inflammatory dilated cardiomyopathy

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