The Myth of Colchicine in Treating Myopericarditis: Case Report and Literature Review

Abstract

Myopericarditis is inflammation of the pericardium with concurrent myocardial involvement. The clinical presentation of myopericarditis is often with varying degrees of cardiac symptomatology. Its etiology is often idiopathic, but it may also be related to infectious and inflammatory prodrome. Symptoms are proportional to the extent and pattern of myocardial involvement. Many are diagnosed sub-clinically during the management of other systemic illnesses. Echocardiography and cardiac magnetic resonance imaging are important tools in the evaluation of myopericarditis, as the diagnosis of left ventricular dysfunction greatly affects the management, follow-up, and prognosis of these patients. The acute management of myopericarditis remains without clear direction and focuses on symptom control. The use of NSAIDs is often cautioned, as it has been described to actually accelerate the myocarditic process in animal models, possibly increasing mortality. Colchicine, a well-established anti-inflammatory agent, may have a role in the management of acute myopericarditis. We present two cases, each involving a young male, without underlying medical conditions, who presented to the emergency room with acute onset chest pain. Both were found to have elevated cardiac biomarkers and electrocardiographic (EKG) changes, admitted as in-patients and eventually diagnosed with acute myopericarditis. They made full recoveries and were eventually discharged home. Both were started on colchicine during hospitalization, which were continued for several months upon discharge. Overall, there is limited published data regarding the medical management of myopericarditis. There need to be prospective studies and registries to further our knowledge in the management of this illness.

Acute Perimyocarditis – an ST-Elevation Myocardial Infarction Mimicker: A Case Report

“…Myopericarditis is inflammatory pericarditis and myocardium culminating in myocardial cellular damage [ 2 , 8 ]. This condition is generally evaluated and treated as pericarditis, but when severe/prolonged ventricular dysfunction is found, it is called perimyocarditis [ 2 ]. Perimyocarditis must be evaluated and treated as myocarditis [ 9 ].…”

“…Myocarditis can cause ST-elevation on ECG; the more specific ECG changes for myocarditis include localized ST-elevation in inferolateral and anterolateral leads with concordant reciprocal depression, convex ST-segment, new Q wave, and prolonged QT interval [ 2 ]. A study showed that patients with acute myocarditis might also have AV block [ 11 ].…”

“…Cardiac output can depend on increased heart rate in patients with systolic dys-function. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) need to be avoided because they can cause myocardial damage and sodium retention, exacerbate renal hypoperfusion, and increase the risk of mortality [ 2 , 5 , 9 ]. The use of NSAIDs on humans with myocarditis still lacks supporting evidence.…”

“…The use of NSAIDs on humans with myocarditis still lacks supporting evidence. Animal studies show they aggravate myocardial inflammation and necrosis, elevate viral titers, and reduce interferon [ 2 , 17 ]. About 50% patients made a full recovery, some developed heart failure (30%), and about 20% required heart transplantation [ 5 ].…”

“…Therefore, the investigation of alternative diagnoses and appropriate treatment was delayed. Perimyocarditis is characterized by chest pain, as well as high cardiac troponin levels and ST-elevation [ 2 , 3 ]. This makes the disease a great STEMI mimicker.…”