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.

30. Myocarditis with Drs. JoAnn Lindenfeld, Javid Moslehi and Dr. Enrico Ammirati: Part 2


Cardiovascular experts, Drs. JoAnn Lindenfeld, Javid Moslehi and Richa Gupta from Vanderbilt University Medical Center and Dr. Enrico Ammirati from Milan, Italy join Amit and Dan for a two part discussion about all things to consider for myocarditis in general (part 1) and COVID-19 myocarditis and heart transplantation in the COVID-19 era (part 2). Flutter Moment by Barrie Stanton (RN).

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.

Take me to the Myocarditis Series Page 
Take me to the COVID-19 Series Page
Take me to the Episode Topics Page

Dr. JoAnn Lindenfeld, is a Professor of Medicine and the Director of Heart Failure and Heart Transplantation Section at Vanderbilt Heart and Vascular Institute.  She is the past president of the Heart Failure Society of America and serves on editorial boards of numerous journals including JACC, JACC Heart Failure and JHLT.  She is also a member of the AHA/ACC/HFSA heart failure guideline writing committee and was previously chair of the HFSA practice guidelines for the 2006 and 2010 guidelines. In addition to this she’s been an investigator in multiple large-scale clinical trials including the COAPT trial and has served on numerous steering committees, end point committees and data and safety monitoring committees. She is the author of a more than 300 original papers, reviews, and book chapters in the field of heart failure and heart transplantation.

Dr. Javid Moslehi is an associate professor of medicine at Vanderbilt University Medical Center where he is the director of the cardio-oncology program.  He is a clinical cardiologist and basic/translational biologist interested in cardiovascular complications associated with novel molecular targeted cancer therapies and the implications of these on our knowledge of basic cardiovascular biology. At Vanderbilt he runs an independent basic and translational research laboratory and program with a focus on signal transduction in the myocardium and vasculature as well as establishing pre-clinical models of cardiotoxicity involving novel targeted oncologic therapies.

Dr. Enrico Ammirati is an assistant professor of cardiology and advanced heart failure and transplant cardiologist in Milan, Italy at the Niguarda Hospital with a special research interest and expertise in acute myocarditis and acute heart failure.  He is a fellow of the European Society of Cardiology and has won numerous awards, he has also published incredibly important work on the distinction between fulminant and nonfulminant myocarditis and the prognostic implication of histologic subtypes.  His research interests also include the role of adaptive immunity in heart transplantation and atherosclerosis and he is the author of well over 100+ peer reviewed publications.

29. Myocarditis with Drs. JoAnn Lindenfeld, Javid Moslehi and Dr. Enrico Ammirati: Part 1

Cardiovascular experts, Drs. JoAnn Lindenfeld, Javid Moslehi and Richa Gupta from Vanderbilt University Medical Center and Dr. Enrico Ammirati from Milan, Italy join Amit and Dan for a two part discussion about all things to consider for myocarditis in general (part 1) and COVID-19 myocarditis and heart transplantation in the COVID-19 era (part 2). Flutter Moment/Song by Drs. Matt (Internal Medicine) and Beth Faiman (Oncology).

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.

Take me to the Myocarditis Series Page 
Take me to the COVID-19 Series Page
Take me to the Episode Topics Page

Interview Questions

  1. What is myocarditis?
  2. How do we classify it?
  3. How do we diagnose myocarditis?
  4. Why don’t we biopsy everyone?
  5. When do we think biopsy may change management?
  6. Do we really understand the mechanism of myocardial injury in what we call myocarditis?
  7. How do we figure mechanisms out and why is this important?

Guests and Experts

Dr. JoAnn Lindenfeld, is a Professor of Medicine and the Director of Heart Failure and Heart Transplantation Section at Vanderbilt Heart and Vascular Institute.  She is the past president of the Heart Failure Society of America and serves on editorial boards of numerous journals including JACC, JACC Heart Failure and JHLT.  She is also a member of the AHA/ACC/HFSA heart failure guideline writing committee and was previously chair of the HFSA practice guidelines for the 2006 and 2010 guidelines. In addition to this she’s been an investigator in multiple large-scale clinical trials including the COAPT trial and has served on numerous steering committees, end point committees and data and safety monitoring committees. She is the author of a more than 300 original papers, reviews, and book chapters in the field of heart failure and heart transplantation.

Dr. Javid Moslehi is an associate professor of medicine at Vanderbilt University Medical Center where he is the director of the cardio-oncology program.  He is a clinical cardiologist and basic/translational biologist interested in cardiovascular complications associated with novel molecular targeted cancer therapies and the implications of these on our knowledge of basic cardiovascular biology. At Vanderbilt he runs an independent basic and translational research laboratory and program with a focus on signal transduction in the myocardium and vasculature as well as establishing pre-clinical models of cardiotoxicity involving novel targeted oncologic therapies.

Dr. Enrico Ammirati is an assistant professor of cardiology and advanced heart failure and transplant cardiologist in Milan, Italy at the Niguarda Hospital with a special research interest and expertise in acute myocarditis and acute heart failure.  He is a fellow of the European Society of Cardiology and has won numerous awards, he has also published incredibly important work on the distinction between fulminant and nonfulminant myocarditis and the prognostic implication of histologic subtypes.  His research interests also include the role of adaptive immunity in heart transplantation and atherosclerosis and he is the author of well over 100+ peer reviewed publications.

21. COVID-19: The Italian Experience with Dr. Gianluca Pontone

Tune in to hear the Italian perspective from a “COVID A” cardiovascular hospital in Milan, the heart of the country’s epidemic shared by Dr. Gianluca Pontone, who serves as Director of Cardiovascular Imaging Department Centro Cardiologico Monzino IRCCS, University of Milan. We discuss management of COVID-19 patients with underlying cardiovascular disease and cardiac manifestations of COVID-19 including acute coronary syndromes, cardiogenic shock, and myocarditis. Dr. Pontone shares his personal experience in terms of how he prepares himself to take care of patients during this time and his message for all CardioNerds to hear. Flutter Moment by Nino Isakadze (Cardiology).

Check out the COVID-19 series page!
Take me to episode topics page
Ventilation primer for the cardiologist (Youtube)

Dr. Gianluca Pontone serves as Director of Cardiovascular Imaging Department Centro Cardiologico Monzino IRCCS, University of Milan, Italy. He graduated with honors in medicine in 1997 followed by post-graduate degree in cardiology and radiology at University of Milan in 2001 and 2006 respectively. He is currently in the board of directors of Society of Cardiovascular Computed Tomography (SCCT), chairman of CT certification committee of European Association of Cardiovascular Imaging (EACVI) and chairman of working group of cardiac magnetic resonance of Italian society of cardiology.