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
- Build clinical suspicion: Through history, labs (inflammatory markers, troponin), imaging (echo/CMR), EKG, or cardiac catheterization.
- 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.
- Manage acute cardiac injury: Acute care may involve vasoactive agents, mechanical circulatory support (MCS), or temporary pacing.
- Manage chronic cardiac sequelae: Includes GDMT for HFrEF, advanced therapies like LVAD, heart transplant, or hospice care.
- 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
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