From the Guidelines
Management of myopericarditis should prioritize hospitalization for diagnosis and monitoring, especially in cases with myocardial involvement, and empirical anti-inflammatory therapies such as aspirin or NSAIDs should be prescribed to control chest pain. The treatment approach for myopericarditis involves a combination of supportive care, anti-inflammatory medications, and activity restriction. Patients with significant symptoms, arrhythmias, or heart failure should be admitted to the hospital for monitoring 1.
Key Considerations
- The cornerstone of treatment is non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin 1500 – 3000 mg/day or ibuprofen 1200 – 2400 mg/day, which are usually prescribed to control chest pain 1.
- Corticosteroids are prescribed as a second choice in cases of contraindication, intolerance, or failure of aspirin/NSAIDs 1.
- In the setting of myopericarditis, some authors recommend reducing dosages of NSAIDs, as compared with pure pericarditis, because in animal models of myocarditis, NSAIDs have been shown to be non-efficacious and may enhance inflammation, increasing mortality 1.
- Rest and avoidance of physical activity beyond normal sedentary activities is recommended in all patients with myopericarditis, with return to exercise permissible after at least 6 months from the onset of the illness in cases with myocardial involvement 1.
Treatment Approach
- Patients should restrict physical activity, particularly competitive sports and strenuous exercise, for at least 6 months, with return to activity guided by normalization of cardiac biomarkers, inflammatory markers, and cardiac imaging.
- Regular follow-up with serial echocardiograms and cardiac MRI is important to monitor for development of dilated cardiomyopathy or other complications.
- This approach targets the underlying inflammatory process while preventing complications and supporting cardiac recovery.
From the Research
Management of Myopericarditis
- Myopericarditis is a primarily pericardial inflammatory syndrome that occurs when clinical diagnostic criteria for pericarditis are satisfied and concurrent mild myocardial involvement is documented by elevation of biomarkers of myocardial damage 2.
- The management of myopericarditis is similar to that of pericarditis, generally with a reduction of empiric anti-inflammatory doses mainly aimed at the control of symptoms 2, 3.
- Rest and avoidance of physical activity beyond normal sedentary activities for 6 months is recommended, as for myocarditis 2.
Pharmacological Treatment
- Available treatments for acute and recurrent pericarditis include aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, immunosuppressive agents, immunoglobulins, and anti-interleukin-1 (IL-1) agents 4.
- Colchicine is the mainstay of treatment in acute and recurrent pericarditis, while anti-IL1 agents are a valuable option in case of recurrent pericarditis refractory to conventional drugs 4.
- The use of NSAID should be cautious in myopericarditis, as they may not be effective and may actually enhance the myocarditic process and increase mortality in animal models of myocarditis 3.
- However, a recent study found that treatment with NSAIDs was not associated with adverse outcomes in patients with acute myocarditis or myopericarditis 5.
Prognosis
- The natural history of myopericarditis in large populations is not known with accuracy, but the majority of cases have objective normalization of echocardiography, electrocardiography, laboratory testing, and functional status on follow-up 3.
- Up to 14% of patients with myopericarditis may report atypical, non-limiting chest discomfort on follow-up 3.
- There is no evidence that troponin elevation confers worse prognosis in patients with preserved left ventricular function 2.