Treatment for Myopericarditis
The treatment for myopericarditis consists of NSAIDs at reduced dosages compared to pure pericarditis, colchicine as adjunctive therapy, and mandatory rest with avoidance of physical activity for at least 6 months. 1
Diagnosis and Initial Management
Myopericarditis is diagnosed when patients with definite criteria for acute pericarditis show elevated cardiac biomarkers (troponin I or T, CK-MB) without newly developed impairment of left ventricular function. 2
- Hospitalization: All patients with myopericarditis should be hospitalized for diagnosis, monitoring, and to rule out acute coronary syndromes 2, 1
- Diagnostic workup:
- Coronary angiography (based on clinical presentation and risk factors) to rule out acute coronary syndromes
- Cardiac magnetic resonance (CMR) to confirm myocardial involvement
- Serial CRP measurements to guide treatment duration
Medication Therapy
First-line Treatment
NSAIDs: Recommended at potentially reduced dosages compared to pure pericarditis 2, 1
- Aspirin: 1500-3000 mg/day
- Ibuprofen: 1200-2400 mg/day
- Indomethacin: 75-150 mg/day
Colchicine: Added as adjunctive therapy 2, 1
- 0.5 mg twice daily for patients ≥70 kg
- 0.5 mg once daily for patients <70 kg
- Duration: 3 months for first episode, at least 6 months for recurrent cases
Second-line Treatment
- Corticosteroids: Only if NSAIDs are contraindicated, not tolerated, or ineffective 2, 1
- Low to moderate doses (prednisone 0.2-0.5 mg/kg/day)
- Maintain initial dose until symptoms resolve and CRP normalizes
- Taper slowly afterward
Note: Corticosteroids are not recommended as first-line therapy as they are associated with higher recurrence rates 2, 3
Physical Activity Restrictions
Physical activity restrictions are more stringent for myopericarditis than for isolated pericarditis:
- Mandatory rest and avoidance of physical activity beyond normal sedentary activities for at least 6 months 2, 1
- This is critical to prevent complications including sudden cardiac death, which has been reported in military personnel and athletes after strenuous exertion 2
Monitoring and Follow-up
- Regular assessment of:
- Symptoms
- CRP levels to guide treatment duration
- ECG changes
- Echocardiogram findings
- Monitor for potential complications:
- Cardiac tamponade (rare)
- Constrictive pericarditis (very rare in myopericarditis)
Prognosis
Myopericardial involvement generally has a good prognosis with:
- No evolution to heart failure in most patients
- Complete remission typically seen in 3-6 months 4
- Low mortality rates
Special Considerations
- For specific causes like bacterial or tuberculous pericarditis, targeted antimicrobial therapy is essential 5
- In cases of recurrent episodes, extended colchicine therapy (>6 months) may be considered 1
- For multiple recurrences that are resistant to conventional therapy, interleukin-1 blockers have shown efficacy 3, 6
The treatment approach to myopericarditis balances the need to control inflammation while avoiding potential harm from excessive anti-inflammatory therapy, with mandatory physical activity restriction being a crucial component of management.