From the Guidelines
Myocarditis does not "wake up" as it is not a condition that becomes dormant and then reactivates, and any recurrence of symptoms should be evaluated as a new inflammatory process. Myocarditis is an inflammation of the heart muscle (myocardium) that can be caused by viral infections, autoimmune conditions, or reactions to medications 1. Once a person has recovered from myocarditis, the condition is considered resolved, though there may be residual damage to the heart muscle in some cases. If symptoms similar to a previous episode of myocarditis return, this would represent a new inflammatory process rather than a "waking up" of the old condition.
Key Considerations
- Anyone experiencing symptoms such as chest pain, shortness of breath, fatigue, or irregular heartbeat after previously having myocarditis should seek immediate medical attention for proper evaluation 1.
- These symptoms could indicate a recurrence of inflammation or other cardiac issues that require prompt assessment.
- Treatment would depend on the specific cause and severity of the new inflammatory process and might include anti-inflammatory medications, heart medications, or supportive care while the heart heals 1.
- The diagnosis of myocarditis should be based on the criteria summarized by recent guidelines, including cardiac symptoms, elevated cardiac biomarkers, and abnormal electrocardiographic, echocardiographic, CMR, and/or histopathologic findings 1.
Diagnostic Approach
- Initial testing should consist of an ECG, measurement of cardiac biomarkers, and an echocardiogram 1.
- CMR is recommended in hemodynamically stable patients with suspected myocarditis, as it can detect inflammation or necrosis, early fibrosis, and a potential arrhythmia substrate promoting adverse LV remodeling 1.
- Cardiology consultation is recommended for those with a rising cardiac biomarker and/or ECG or echocardiographic abnormalities concerning for myocarditis 1.
From the Research
Myocarditis Symptoms and Diagnosis
- Myocarditis is a potentially fatal condition that can be misdiagnosed in the emergency department (ED) setting 2
- Symptoms may range from mild to severe and are often preceded by a viral prodrome 2
- Laboratory assessment and an electrocardiogram can be helpful for the diagnosis, but echocardiography is the ideal test in the ED setting 2
- Approximately 82% to 95% of adult patients with acute myocarditis present with chest pain, while 19% to 49% present with dyspnea, and 5% to 7% with syncope 3
Myocarditis Treatment and Management
- Treatment is primarily focused on respiratory and hemodynamic support 2
- Initial hemodynamic management includes vasopressors and inotropes, whereas more severe cases may require an intra-aortic balloon pump, extracorporeal membrane oxygenation, or a ventricular assist device 2
- Nonsteroidal anti-inflammatory drugs should be avoided while intravenous immunoglobulin is controversial 2
- Immunosuppression (eg, corticosteroids) is appropriate for patients who have myocarditis characterized by eosinophilic or giant cell myocardial infiltrations or due to systemic autoimmune disorders 3
Myocarditis Prognosis and Complications
- Myocarditis is a serious condition with the potential for significant morbidity and mortality 2
- Dilated cardiomyopathy with chronic heart failure is the major long-term sequela of myocarditis 4
- Approximately 75% of patients admitted with myocarditis have an uncomplicated course, with a mortality rate of approximately 0% 3
- Acute myocarditis that is complicated by acute heart failure or ventricular arrhythmias is associated with a 12% rate of either in-hospital mortality or need for heart transplant 3