From the Guidelines
Myocarditis symptoms include chest pain, dyspnea, palpitations, and syncope, and treatment options depend on the severity of the condition, with hospitalization recommended for patients with definite myocarditis that is either mild or moderate in severity. The diagnosis of myocarditis is defined by cardiac symptoms, an elevated cTn, and abnormal electrocardiographic, echocardiographic, CMR, and/or histopathologic findings on biopsy or postmortem evaluation in the absence of flow-limiting coronary artery disease 1. Some key symptoms and signs of myocarditis include:
- Chest pain
- Dyspnea
- Palpitations
- Syncope Treatment options for myocarditis may include:
- Rest and over-the-counter pain medications
- Hospitalization for monitoring and supportive care
- Corticosteroids, such as prednisone, for patients with myocarditis and COVID-19 pneumonia
- NSAIDs, colchicine, and/or prednisone for patients with suspected pericardial involvement
- Guideline-directed medical therapy for heart failure, such as ACE inhibitors and beta-blockers, as appropriate 1. It is essential to note that myocarditis following COVID-19 mRNA vaccination is rare, and COVID-19 vaccination is associated with a very favorable benefit-to-risk ratio for all age and sex groups evaluated thus far 1. In terms of management, cardiology consultation is recommended for those with a rising cTn and/or ECG or echocardiographic abnormalities concerning for myocarditis, and CMR is recommended in hemodynamically stable patients with suspected myocarditis 1. Patients with fulminant myocarditis should be managed at centers with an expertise in advanced heart failure, mechanical circulatory support, and other advanced therapies 1.
From the Research
Myocarditis Symptoms
- Myocarditis is a disease with a complex pathogenesis that is not completely understood, and its prevalence is likely underestimated 2
- The clinical presentation of acute myocarditis is heterogeneous, ranging from subtle symptoms like mild chest pain to life-threatening fulminant heart failure requiring urgent advanced hemodynamic support 3
- Symptoms of myocarditis can include:
- Mild chest pain
- Shortness of breath
- Fatigue
- Palpitations
- Fever
Treatment Options
- Treatment of myocarditis relies on supportive care, while disease-specific therapies are limited 3
- Angiotensin converting enzyme inhibitors, such as captopril, enalapril, and lisinopril, and angiotensin II receptor antagonists, such as L-158,809 and losartan, may be used to relieve symptoms arising from inflammation and concurrent cellular damage 2
- Immunosuppression is beneficial in certain histological subtypes of myocarditis, but clear evidence supporting antiviral or immunomodulatory therapies for the majority of acute viral myocarditis cases remains insufficient 3
- In severe or fulminant myocarditis, aggressive interventions such as mechanical circulatory support devices and transplantation may be necessary 3
- Angiotensin II receptor blockers may be an alternative to angiotensin-converting enzyme inhibitors in patients with myocardial infarction without heart failure 4
- Statins may be prescribed to reduce LDL-cholesterol levels and prevent further cardiac damage 5