Myocarditis

Last reviewed: 18 Apr 2022
Last updated: 06 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • viral syndrome (prior)
  • autoimmune disease
  • infectious disease
  • drugs and toxins
More key diagnostic factors

Other diagnostic factors

  • age <50 years
  • chest pain
  • dyspnea
  • orthopnea
  • fatigue
  • palpitations
  • rales
  • elevated neck veins
  • S3 gallop
  • sinus tachycardia
  • atrial and ventricular arrhythmias
  • syncope
  • S3 and S4 summation gallop
  • pericardial friction rub
  • peripheral hypoperfusion
  • hypotension
  • altered sensorium
  • lymphadenopathy
Other diagnostic factors

Risk factors

  • infection (non-HIV)
  • HIV infection
  • smallpox vaccination
  • autoimmune/immune-mediated diseases
  • peripartum and postpartum periods
  • drugs and toxins
More risk factors

Diagnostic investigations

1st investigations to order

  • 12-lead ECG
  • CXR
  • serum CK
  • serum CK-MB
  • serum troponin (I or T)
  • serum B-type natriuretic peptide
  • two-dimensional echocardiogram
More 1st investigations to order

Investigations to consider

  • endomyocardial biopsy (EMB)
  • coronary angiography
  • cardiac MRI
More investigations to consider

Emerging tests

  • MRI-guided EMB

Treatment algorithm

ACUTE

hemodynamically stable: no evidence of LV systolic dysfunction

hemodynamically stable: evidence of LV systolic dysfunction

hemodynamically unstable

ONGOING

end-stage heart failure or refractory life-threatening arrhythmias

Contributors

Authors

Katherine C. Wu, MD, FACC

Associate Professor of Medicine

Johns Hopkins University

School of Medicine

Baltimore

MD

Disclosures

KCW declares that she has no competing interests.

Acknowledgements

Dr Katherine Wu would like to gratefully acknowledge Dr James E. Harvey and Dr Arman T. Askari, previous contributors to this topic. JEH and ATA declare that they have no competing interests.

Peer reviewers

David A. Leaf, MD, MPH

Professor of Medicine

School of Medicine

VA Greater Los Angeles Healthcare System

UCLA

Los Angeles

CA

Disclosures

DAL declares that he has no competing interests.

John Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

JC declares that he has no competing interests.

Lokesh Tejwani, MD, FACC

Assistant Professor of Clinical Medicine

University of Missouri Hospitals and Clinics

Harry S. Truman VA Hospital

Columbia

MO

Disclosures

LT declares that he has no competing interests.

  • Myocarditis images
  • Differentials

    • Acute coronary syndrome
    • Dilated cardiomyopathy
    • Pericarditis
    More Differentials
  • Guidelines

    • Diagnosis and management of myocardial involvement in systemic immune-mediated diseases: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease
    • Current diagnostic and treatment strategies for specific dilated cardiomyopathies: A scientific statement from the American Heart Association
    More Guidelines
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