Acute myocarditis

Abstract

Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis should be considered in patients who present with a recent onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by the sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness. Parvovirus B19, human herpesvirus 6, coxsackievirus, and adenovirus are most frequently the viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical and surgical center which is experienced in mechanical circulatory support is warranted. In this setting, extracorporeal membrane oxygenation (ECMO) should be the first-line mechanical assistance. For highly unstable patients, the preferred option is a Mobile Cardiac Assistance Unit, that rapidly moves to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure occurs.