Infographics: Myocarditis

CardioNerds Myocarditis

Myocarditis

This infographic provides an in-depth overview of myocarditis, including its causes, clinical presentation, diagnostics, and management principles.

  • Causes
  • Infectious: Viruses, bacteria, fungi, or parasites.
  • Non-Infectious:
    • Immunologic: Includes systemic rheumatic diseases, eosinophilic syndromes, transplant rejection, or immune checkpoint inhibitor toxicity.
    • Toxic: Results from medications, illicit drugs, heavy metals, or endogenous molecules.
  • Clinical Presentation
  • Symptoms may range from fever, rash, myalgias, fatigue to respiratory or gastrointestinal issues.
  • Fulminant myocarditis presents with acute heart failure, cardiogenic shock, arrhythmias, pericarditis, or tamponade.
  • EKG Findings
  • Common signs include AV block, aberrancy, ventricular tachycardia/fibrillation (VT/VF), ST-elevation, and low voltage.
  • 5 Principles of Myocarditis Management
  1. Build clinical suspicion: Through history, labs (inflammatory markers, troponin), imaging (echo/CMR), EKG, or cardiac catheterization.
  2. Decide on Endomyocardial Biopsy (EMBx): EMBx is recommended for cases with hemodynamic compromise or refractory heart failure. Pathologic findings may include lymphocytic, eosinophilic, giant cell, or neutrophilic myocarditis.
  3. Manage acute cardiac injury: Acute care may involve vasoactive agents, mechanical circulatory support (MCS), or temporary pacing.
  4. Manage chronic cardiac sequelae: Includes GDMT for HFrEF, advanced therapies like LVAD, heart transplant, or hospice care.
  5. Treat myocarditis:
    • Lymphocytic myocarditis: Steroids/azathioprine are under evaluation.
    • Giant cell myocarditis: Requires steroids and immunosuppressants.
    • Immune checkpoint inhibitor myocarditis: Treatment involves cessation of the offending agent and initiation of steroids and heart failure therapy.
    • Necrotizing eosinophilic myocarditis: Managed by identifying the underlying cause and using steroids.

Produced by Dr. Carine Hamo
“5 Principles of Myocarditis” by Dr. Amit Goyal


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CardioNerds Myocarditis, updated 1.20.21