Myocarditis

This page is for adult patients. For pediatric patients, see: myocarditis (peds)

Background

  • Inflammatory (dilated) cardiomyopathy caused by necrosis of myocytes

Causes

Phases

  • Acute
    • Viral cytotoxicity and focal necrosis
  • Subacute
    • Host's humoral/immune response leading to further cell injury
  • Chronic
    • Diffuse myocardial fibrosis and cardiac dysfunction

Clinical Features

  • Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids

Differential Diagnosis

Consider other causes of CHF

Chest pain

Critical

Emergent

Nonemergent

Evaluation

Management

  • Acute phase
    • Antiviral agents (Pleconaril/Ribavirin) may be effective
  • Subacute phase
    • Studies have not shown efficacy of immunosupressants
    • Pediatric patients may receive high-dose IVIG
  • Chronic phase
    • Treatment for CHF symptoms
    • Ventricular Assist Devices (VAD)
    • Cardiac transplant

Disposition

  • If CHF is present, admit to monitored bed
  • If hemodynamically unstable, admit to ICU

Prognosis

  • Fulminant myocarditis has best prognosis
  • Mortality: 20% 1 yr/ 50% 5 yr
  • Children with 70% survival rate at 5 yrs

Complications

See Also

References