31. Fulminant Myocarditis with Cardiogenic Shock: Case Discussion

The CardioNerds discuss a case of fulminant myocarditis, teaching a comprehensive approach to myocarditis with just 5 foundational principles. Review the myocarditis infographic on the myocarditis topic page. The episode ends with a special message from the true heroes of this episode, Chas and Julie Miller. 

This marks our first episode after 100,000 downloads of the show – and this is a benchmark that we are celebrating together with all of you. Since launch, we have had 82 voices on the show and youtube channel. Our website which collates all the podcast episodes, youtube videos, tweetorials, and more has been accessed in 120 countries. We just cannot thank you enough! 

On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more.

5 points of maximal impulse in approaching myocarditis

  1. Build the clinical suspicion for myocarditis: You need a high index of suspicion given the variable presentation, and definitely need to keep a differential so you don’t miss things like acute coronary syndromes.
  2. Decide if EMBx is necessary: Most often obtained in fulminant presentations to look for pathologic findings of giant cell myocarditis or eosinophilic myocarditis, because these findings will change management.
  3. Manage the acute cardiac injury, which can range from supportive care to treatment of shock, arrhythmias, and even tamponade.
  4. Manage the chronic cardiac sequelae: Recovering from the acute phase of myocarditis doesn’t necessarily mean smooth sailing — some develop chronic heart failure, warranting GDMT — or guideline directed management and therapy, as defined by Dr. Randall Starling in Ep 13.
  5. Treat the myocarditis: Immunosuppression is often started empirically in fulminant disease, but continuation depends on what you find on pathology.