From the Guidelines
The treatment of myopericarditis focuses on managing symptoms, reducing inflammation, and preventing complications, with NSAIDs as the first-line medication, and colchicine added to reduce recurrence, as recommended by the 2015 ESC guidelines 1. The initial management includes rest and restriction of physical activity for 3-6 months, particularly avoiding competitive sports and strenuous exercise to reduce the risk of sudden cardiac death.
- NSAIDs, such as ibuprofen (600-800mg three times daily) or aspirin (650-975mg every 4-6 hours), are recommended for 1-2 weeks, then tapered based on symptom resolution and normalization of inflammatory markers, as outlined in the guidelines 1.
- Colchicine (0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg) for 3 months can be added to reduce recurrence, as supported by the evidence 1.
- For severe cases or those unresponsive to NSAIDs, corticosteroids like prednisone (0.25-0.5mg/kg/day) may be used, with gradual tapering over weeks to months, as suggested by the guidelines 1. The workup should include:
- ECG
- Cardiac biomarkers (troponin, CK-MB)
- Inflammatory markers (ESR, CRP)
- Echocardiography to assess cardiac function and pericardial effusion
- Cardiac MRI is valuable for confirming the diagnosis and assessing myocardial involvement, as recommended by the guidelines 1. Follow-up should include regular cardiac evaluations with ECG, echocardiography, and exercise testing before clearing patients to return to physical activity, typically after 3-6 months of normal findings and complete symptom resolution, as outlined in the guidelines 1.
From the Research
Diagnosis of Myopericarditis
- Myopericarditis is a condition characterized by inflammation of both the pericardium and the myocardium, and its diagnosis can be challenging due to its similar presentation to acute myocardial infarction (AMI) 2, 3.
- The use of biomarkers such as troponin and C-reactive protein (CRP) can help differentiate between myopericarditis and AMI, with myopericarditis typically showing higher CRP levels and lower troponin elevations 4.
- Electrocardiogram (ECG) findings, such as ST-segment elevation, can also be present in myopericarditis, but may not always be distinguishable from those seen in AMI 3.
Treatment and Management of Myopericarditis
- The treatment of myopericarditis is generally similar to that of pericarditis, with a focus on reducing inflammation and controlling symptoms 5.
- Non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are commonly used in the treatment of myopericarditis, with corticosteroids also being considered in some cases 6.
- Rest and avoidance of physical activity are also recommended, particularly in the acute phase of the illness 5.
- In cases of COVID-19-related myopericarditis, management with colchicine, NSAIDs, and corticosteroids has been reported to be effective, with interventional therapy only needed in cases of cardiac tamponade 6.
Clinical Features and Prognosis of Myopericarditis
- Myopericarditis can present with a range of symptoms, including chest pain, fever, and shortness of breath, and can affect patients of any age 2, 6.
- The prognosis of myopericarditis is generally good, with most patients experiencing complete remission within 3-6 months 5.
- However, cardiac mortality has been reported to be higher in patients with myopericarditis compared to those with pericarditis alone 2.
- The use of cardiac MRI can help identify myocardial sequelae in patients with myopericarditis, although these findings may not always have clinical significance 2.