Myocarditis

This infographic provides an in-depth overview of myocarditis, including its causes, clinical presentation, diagnostics, and management principles.

• Causes
• Infectious: Viruses, bacteria, fungi, or parasites.
• Non-Infectious:
  • Immunologic: Includes systemic rheumatic diseases, eosinophilic syndromes, transplant rejection, or immune checkpoint inhibitor toxicity.
  • Toxic: Results from medications, illicit drugs, heavy metals, or endogenous molecules.
• Clinical Presentation
• Symptoms may range from fever, rash, myalgias, fatigue to respiratory or gastrointestinal issues.
• Fulminant myocarditis presents with acute heart failure, cardiogenic shock, arrhythmias, pericarditis, or tamponade.
• EKG Findings
• Common signs include AV block, aberrancy, ventricular tachycardia/fibrillation (VT/VF), ST-elevation, and low voltage.
• 5 Principles of Myocarditis Management

1. Build clinical suspicion: Through history, labs (inflammatory markers, troponin), imaging (echo/CMR), EKG, or cardiac catheterization.
2. Decide on Endomyocardial Biopsy (EMBx): EMBx is recommended for cases with hemodynamic compromise or refractory heart failure. Pathologic findings may include lymphocytic, eosinophilic, giant cell, or neutrophilic myocarditis.
3. Manage acute cardiac injury: Acute care may involve vasoactive agents, mechanical circulatory support (MCS), or temporary pacing.
4. Manage chronic cardiac sequelae: Includes GDMT for HFrEF, advanced therapies like LVAD, heart transplant, or hospice care.
5. Treat myocarditis:
   • Lymphocytic myocarditis: Steroids/azathioprine are under evaluation.
   • Giant cell myocarditis: Requires steroids and immunosuppressants.
   • Immune checkpoint inhibitor myocarditis: Treatment involves cessation of the offending agent and initiation of steroids and heart failure therapy.
   • Necrotizing eosinophilic myocarditis: Managed by identifying the underlying cause and using steroids.

Produced by Dr. Carine Hamo
“5 Principles of Myocarditis” by Dr. Amit Goyal

CardioNerds Infographics

Explore our comprehensive collection of infographics, categorized by cardiovascular topics such as heart failure and transplantation, arrhythmias and electrophysiology, cardio-obstetrics, cardiovascular imaging, congenital heart disease, prevention, coronary artery disease, critical care, hypertension, pericardial disease, pulmonary hypertension, valvular heart disease, vascular disease, women’s cardiovascular health, diversity, inclusion, and more!

Feel free to download and share these visuals in presentations or on social media. Please use the infographics as provided—without altering or cropping out the creators’ credit.

For even more learning, explore the CardioNerds Tweetorial Page, featuring a curated collection of educational tweetorials!