Clinical Management of Acute myocarditis in daily practice: an expert practical view.

Abstract

Background: Acute Myocarditis (AM) encompasses a broad spectrum of clinical presentations and causes. Despite the recent advances in cardiovascular imaging, pathology, virology and genetics, specific therapies are still lacking.

Purpose: This collaborative review aims to analyze the current evidence to answer practical questions that physicians may face during the early management of patients presenting with an acute form of the disease, complicated or not.This review analyzes current evidence to address practical questions posed by acute cardiovascular physicians during the early management of acute, often fulminant, myocarditis.

Methods and results: Based on the current literature, this review provides a step-by-step approach to treat AM patients from their admission in the cardiac intensive care unit (CICU) to discharge, by answering 10 clinical questions: Might this patient be suffering from an AM? Should I hospitalize this patient and, if so, where? Which cardiac imaging exam should I perform and what can I learn from it? Is this patient requiring an EMB? What should the non-invasive etiological work-up be? Is his episode of AM of viral, toxic, or other origin? Does this patient need specific treatments or mechanical circulatory support? Is there an indication for guideline-directed medical heart failure treatment? When can the patient be discharged and resume physical activity? Notably, this review highlights the need to build a multidisciplinary response team to address the many diagnostic and therapeutic challenges of AM patients. It also points out the lack of evidence to guide treatment of these patients.