Overview
Acute myocarditis involves inflammation of the myocardium, often leading to significant cardiac dysfunction and potentially requiring advanced life support interventions such as extracorporeal membrane oxygenation (ECMO). 12Diagnosis
Clinical suspicion based on symptoms (fever, chest pain, dyspnea) and signs (cardiomegaly, arrhythmias).
Elevated cardiac biomarkers (creatine kinase, troponin T).
Electrocardiogram (ECG) abnormalities (ST-segment changes, arrhythmias).
Echocardiography showing regional wall motion abnormalities.
Cardiac MRI or endomyocardial biopsy for definitive diagnosis when available. 1Management
First-line treatments: Supportive care including hemodynamic monitoring, fluid management, and inotropic support as needed.
Adjunctive treatments:
- Extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock. 2
- Intravenous immunoglobulin (IVIG) in conjunction with ECMO for severe cases. 2
Risk stratification: Use a scoring system incorporating initial mean blood pressure <65 mmHg, cardiac arrest, Glasgow Coma Scale score ≤12, and platelet count <100×10^9/L to predict need for ECMO. 1Special Populations
No specific data provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts. 12Key Recommendations
Implement a risk scoring system using initial mean blood pressure, presence of cardiac arrest, Glasgow Coma Scale score, and platelet count to predict the need for ECMO in acute myocarditis patients. (Evidence: Moderate) 1
Consider extracorporeal membrane oxygenation (ECMO) as a rescue therapy for patients with acute myocarditis presenting with refractory cardiogenic shock. (Evidence: Weak) 2
Monitor and manage elevated cardiac biomarkers closely, with troponin T decline potentially indicating myocardial recovery. (Evidence: Expert opinion) 2References
1 Hong D, Bak M, Park H, Kim HY, Lee S, Kim IC et al.. Novel Risk Scoring Model to Predict the Implementation of Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocarditis. Circulation journal : official journal of the Japanese Circulation Society 2025. link
2 Chen YS, Wang MJ, Chou NK, Han YY, Chiu IS, Lin FY et al.. Rescue for acute myocarditis with shock by extracorporeal membrane oxygenation. The Annals of thoracic surgery 1999. link01174-1)