Acute myocarditis: 16 topics every physician must know
Keywords:
myocarditis, cardiomyopathy, inflammation, heart failureAbstract
Acute myocarditis is a polymorphic adquired and subdiagnosed cardiomyopathy due inflammation of the heart muscle that most often affects young patientes and causes approximately 10%-12% of sudden deaths and ¾ of dilated cardiomyopathies. Symptons can vary since none at all or a mild thoracic pain to life-threatening heart failure, and may occurs dramatic presentation as fulminat myocarditis characterized by cardiogenic shock, hemodinamically significant arrhythmias (heart blocks, ventricular tachycardia), kidney failure and multiple organs dysfunction requiring circulatory support as ECMO assistence. As the presentation might be innespecific, suspicious and investigations strategies are needed to help generalists, pediatrics, cardiologists and intensivists to proceed the dignosis. Byomarkers, ECG and multimodallity image can be the key for the stratification and protection of most patients from a worsening disease course.
References
Kociol RD, Cooper LT, Fang JC, Moslehi FL, Pang PS, Sabe MA, Shah RV, Sims DB, Thiene G, Vardeny O. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement from the American Heart Association. Circulation 2020, 141, E69-E92. [CrossRef] [PubMed].
Caforio ALP, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, Fu M, Heliõ T, Heymans S, Jahns R, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013, 34, 2636-2648. [CrossRef] [PubMed].
Law YM, Lal AK, Chen S, iháková D, Cooper LT Jr., Deshpande S, Godown J, Grosse-Wortmann L, Robinson JD, Towbin JA. Diagnosis and Management of Myocarditis in Children: A Scientific Statement from the American Heart Association. Circulation 2021, /44, e123-e135. [CrossRef] [PubMed].
Caforio ALP, Malipiero G, Marcolongo R, Iliceto S. Myocarditis: A Clinicai Overview. Curr Cardiol Rep. 2017, 19, 63. [CrossRef] [PubMed].
Tschõpe C, Ammirati E, Bozkurt B, Caforio ALP, Cooper LT, Felix SB, Hare JM, Heidecker B, Heymans S, Hübner N, et al. Myocarditis and inflammatory cardiomyopathy: Current evidence and future directions. Nat Rev Cardiol. 2021, /8, 169-193. [CrossRef].
Montera, Marcelo Westerlund et al. Diretriz de Miocardites da Sociedade Brasileira de Cardiologia–2022. Arquivos Brasileiros de Cardiologia, v. 119, p. 143-211, 2022.
Pomiato, Elettra et al. Pediatric Myocarditis: What Have We Learnt So Far?. Journal of Cardiovascular Development and Disease, v. 9, n. 5, p. 143, 2022.
Ryan TD, Nagarajan R, Godown J. Cardiovascular toxicities in pediatric cancer survivors. Cardiol Clin. 2019;37(4):533-44. doi: 10.1016/j. ccl.2019.07.002.
Neilan TG, Rothenberg ML, Amiri-Kordestani L, Sullivan RJ, Steingart RM, Gregory W, et al. Myocarditis associated with immune checkpoint inhibitors: an expert consensus on data gaps and a call to action. oncologist. 2018;23(8):874-78. doi: 10.1634/theoncologist.2018-0157.
Bonaca MP, Olenchock BA, Salem JE, Wiviott SD, Ederhy S, Cohen A, et al. Myocarditis in the setting of cancer therapeutics: proposed case definitions for emerging clinical syndromes in cardio-oncology. Circulation. 2019;140(2):80-91. doi: 10.1161/CIRCULATIONAHA.118.034497.
Law, Yuk M, et al. Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association. Circulation, v. 144, n. 6, p. e123-e135, 2021.
Pillay, Jennifer et al. Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review. BMJ, v. 378, 2022.
Torbey AFM, Grippa de Souza ALAA, Bustamante ACD, Brandão ACZ, Abdallah LR, March e Souza YPD, Mesquita ET. Acute Myocarditis in Childhood and Adolescence in the Covid-19 Era. ABC Heart Fail Cardiomyop. 2021; 1(1):44-54. doi: https://doi.org/10.36660/abchf.20210008
Bajaj R, Sinclair HC, Patel K, Low B, Pericao A, Manisty C, et al. Delayed-onset myocarditis following COVID-19. Lancet Respir Med. 2021;9(4):e32-e34. doi: 10.1016/S2213-2600(21)00085-0.
Vogel TP, Top KA, Karatzios C, et al. Multisystem inflammatory syndrome in children and adults (MIS-C/A): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 39 (2021) 3037–3049. doi: 10.1016/j.vaccine.2021.01.054
Piazza I, Ferrero P, Marra A, Cosentini R. Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol. Diagnostics 2022, 12, 481. doi: 10.3390/diagnostics12020481
Buttà C, Zappia L, Laterra G, Roberto M. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Ann Noninvasive Electrocardiol. 2020;25:e12726. doi: 10.1111/anec.12726
