Viral myocarditis can produce variable degrees of illness, ranging from focal disease to diffuse pancarditis involving myocardium, pericardium, and valve structures.

CIBIS-II Investigators and Committees. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure.

Patients with viral myocarditis (median age, 42 years) are generally healthy and have no systemic disease.Acute viral myocarditis can mimic acute myocardial infarction, with patients sometimes presenting in the emergency department with chest pain; nonspecific electrocardiographic (ECG) changes; and abnormal, often highly elevated serum markers such as troponin, creatine kinase, and creatine kinase-MB.The diagnosis of viral myocarditis is mainly indicated by a compatible history and the absence of other potential etiologies, particularly if it can be supported by acute or convalescent sera.

Positive troponin I or T findings in the absence of myocardial infarction and the proper clinical setting confirm acute myocarditis.



To that end, mechanical circulatory support (MCS) devices or extracorporeal life support (ECLS) may be required.Patients without the need for extracorporeal oxygenation can receive percutaneous biventricular assist devices, which have the benefit of eliminating some risks associated with ECLS, as well as the need for an oxygenator, the authors state.An added advantage is that these devices can provide biventricular unloading, which decreases myocardial wall stress, thus lessening potential exacerbation of injury to a heart already suffering from inflammation.Following stabilization, the authors recommend that all patients with FM and contractile dysfunction — regardless of the pathogenesis of the disease — be treated with evidence-based neurohormonal antagonist therapy.The capacity of the heart to recover and the treatment trajectory will depend on the cause of FM. "This is the first statement of its kind for management of fulminant myocarditis," Leslie Cooper, MD, vice chair of the Statement Writing Group, told "The primary message of our statement is for frontline providers — primary emergency room doctors and hospitalists — to recognize cardiogenic shock early and refer patients to specialists or centers that have the capability to support patients through mechanical support or transplants," he said.The authors define FM as "a sudden and severe inflammation of the myocardium resulting in myocyte necrosis, edema, and cardiogenic shock. Forster O, Hilfiker-Kleiner D, Ansari AA, et al. Pieroni M, Chimenti C, De Cobelli F, et al. Moss AJ, Hall WJ, Cannom DS, et al. Perhaps Not DirectlyShare cases and questions with Physicians on Medscape consult. Cardiopulmonary exercise testing and its application.



Sachdeva A, Horwich TB, Fonarow GC. Smedema JP, Snoep G, van Kroonenburgh MP, et al.

The binary endocardial appearance is a poor discriminator of Anderson-Fabry disease from familial hypertrophic cardiomyopathy.

Eplerenone in patients with systolic heart failure and mild symptoms. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial.

Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy. Advanced heart failure treated with continuous-flow left ventricular assist device. Hufnagel G, Pankuweit S, Richter A, Schonian U, Maisch B. Mason JW, O'Connell JB, Herskowitz A, et al. Smedema JP, Snoep G, van Kroonenburgh MP, et al. Haghikia A, Podewski E, Libhaber E, et al. References.

Randomized Aldactone Evaluation Study Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. Feasibility and safety of autologous myoblast transplantation in patients with ischemic cardiomyopathy. Greenberg B, Butler J, Felker GM, et al. Intertwined with tissue edema is vasodilatation and increased blood tissue delivery to the site of inflammation.

Heartwire from Medscape. Idiopathic giant cell myocarditis: state of the art.

2002

Swedberg K, Komajda M, Bohm M, et al, for the SHIFT Investigators.


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