Treatment with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Does Not Affect Outcome in Patients with Acute Myocarditis or Myopericarditis

Mirna, Moritz; Schmutzler, Lukas; Topf, Albert; Boxhammer, Elke; Sipos, Brigitte; Hoppe, Uta C.; Lichtenauer, Michael

doi:10.3390/jcdd9020032

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in myopericarditis is another unsolved problem. There are studies supporting the hypothesis that it can be potentially harmful and should be avoided in myocarditis [ 102 ], as well as studies where NSAIDs neither affected all-cause mortality rate nor left ventricle function [ 103 ]. Nevertheless, none of the studies showed the benefit of NSAIDs in myocarditis treatment, and generally, they should not be widely implemented [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Related Myocarditis in Adults: A Systematic Review of Case Reports

Urban

Fułek

Błaziak

et al. 2022

JCM

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Despite the progress of its management, COVID-19 maintains an ominous condition which constitutes a threat, especially for the susceptible population. The cardiac injury occurs in approximately 30% of COVID-19 infections and is associated with a worse prognosis. The clinical presentation of cardiac involvement can be COVID-19-related myocarditis. Our review aims to summarise current evidence about that complication. The research was registered at PROSPERO (CRD42022338397). We performed a systematic analysis using five different databases, including i.a. MEDLINE. Further, the backward snowballing technique was applied to identify additional papers. Inclusion criteria were: full-text articles in English presenting cases of COVID-19-related myocarditis diagnosed by the ESC criteria and patients over 18 years old. The myocarditis had to occur after the COVID-19 infection, not vaccination. Initially, 1588 papers were screened from the database search, and 1037 papers were revealed in the backward snowballing process. Eventually, 59 articles were included. Data about patients’ sex, age, ethnicity, COVID-19 confirmation technique and vaccination status, reported symptoms, physical condition, laboratory and radiological findings, applied treatment and patient outcome were investigated and summarised. COVID-19-related myocarditis is associated with the risk of sudden worsening of patients’ clinical status, thus, knowledge about its clinical presentation is essential for healthcare workers.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Related Myocarditis in Adults: A Systematic Review of Case Reports

Urban

Fułek

Błaziak

et al. 2022

JCM

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“…Our patient was initially treated with a high dose of MP: 2 mg/kg/day (with the possible implication of early-started low-dose corticosteroids due to rash and concern of an allergic reaction), and the high dose was reduced to a moderate dose (0.3 mg/kg/day) after TTE and laboratory confirmation of myocardial recovery with further gradual dose reduction. Ibuprofen was stopped since non-steroidal anti-inflammatory drugs (NSAIDs) could enhance inflammation and increase mortality, which has been shown in animal models of myocarditis, although recent findings suggest that treatment with NSAIDs does not affect outcome in patients with acute myocarditis or myopericarditis [10,11,16]. In our opinion, patients with HF due to SLE should be treated in parallel with HF guidelinedirected therapy to reduce the risk of further myocardial damage and potential complications, although the optimal duration of the treatment is not yet well-established.…”

Section: Discussionmentioning

confidence: 99%

Perimyocarditis as First Manifestation of Systemic Lupus Erythematosus Successfully Treated With Heart Failure and Immunosuppressive Therapy

Matijašević¹,

Rotkvić²,

Planinić³

et al. 2023

Preprint

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Systemic lupus erythematosus (SLE) myocarditis is presumed to be rare but associated with ad-verse outcomes. If SLE diagnosis has not previously been established, its clinical presentation is often unspecific and difficult to recognize. Furthermore, there is a lack of data in the scientific literature regarding myocarditis and its treatment in systemic immune-mediated diseases, leading to its late recognition and undertreatment. We present the case of a young woman whose first lupus manifestations included acute perimyocarditis, among other symptoms and signs that provided clues to the diagnosis of SLE. Transthoracic and speckle tracking echocardiography were helpful in detecting early abnormalities in myocardial wall thickness and contractility while waiting for cardiac magnetic resonance (CMR). Since the patient presented with acute decompensated heart failure (HF), HF treatment was promptly started in parallel with immunosuppressive therapy, with a good response. In the treatment of myocarditis with heart failure, we were guided by the echocardiographic findings, biomarkers for myocardial injury N-terminal pro b-type natriuretic peptide (NT-proBNP) and hs-troponin I, biomarkers for systemic inflammation erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and biomarkers for SLE disease activity (Complement C)3, C4, and anti-dsDNA levels.

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Ardiana

Aditya

2022

Am J Case Rep

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Patient: Male, 40-year-old Final Diagnosis: Probable acute perimyocarditis Symptoms: Chest pain • shortness of breath • tachycardia Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Challenging differential diagnosis Background: A normal coronary angiogram in ST-elevation myocardial infarction (STEMI) can be considered a myocardial infarction with non-obstructive coronary arteries (MINOCA) until an alternative diagnosis is obtained. However, the COVID-19 pandemic might delay urgent coronary angiography in a resource-limited setting. Perimyocarditis often causes symptoms, such as chest pain, as well as ST-elevation and high cardiac troponin levels. This STEMI mimicker can also cause cardiogenic shock and death when not treated properly. Case Report: A 40-year-old man reported having acute onset of substernal chest pain, which was suspected to be STEMI. The patient was an active smoker without any risk factors or a history of cardiovascular disease. The examination showed elevated cardiac troponin I, ST-elevation in high lateral leads, and regional wall motion abnormality (RWMA) by echocardiogram. Furthermore, thrombolytic therapy had failed, and rescue percutaneous coronary intervention was not performed due to the catheterization laboratory limitation during the COVID-19 pandemic. Before coronary angiography, the patient was scheduled for 2 consecutive days of COVID-19 polymerase chain reaction (PCR) swabs. On the second day of hospitalization, the patient experienced a cardiogenic shock. The COVID-19 PCR results were negative, while coronary angiography revealed normal coronary arteries. The patient was eventually diagnosed with probable acute perimyocarditis. Conclusions: Myocarditis is implicated in young patients without typical cardiovascular risk factors or in those with recent infection and cardiovascular symptoms mimicking acute coronary syndrome. It might also be present in situations where ST-elevation distribution on the electrocardiogram is discordant with the RWMA observed on the echocardiogram.

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Treatment with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Does Not Affect Outcome in Patients with Acute Myocarditis or Myopericarditis

Cited by 11 publications

References 27 publications

COVID-19 Related Myocarditis in Adults: A Systematic Review of Case Reports

COVID-19 Related Myocarditis in Adults: A Systematic Review of Case Reports

Perimyocarditis as First Manifestation of Systemic Lupus Erythematosus Successfully Treated With Heart Failure and Immunosuppressive Therapy

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

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