New Guidelines Issued By American Heart Association On Treating Fulminant Myocarditis
The new guidelines and resources needed to treat fulminant myocarditis
ie severe, inflammation of the heart
that develops rapidly, are outlined in a new Scientific Statement from the American Heart Association
on how best to reduce fatalities from this rare condition. The Statement is published today in the Association's premier cardiovascular journal Circulation
Typically, fulminant myocarditis
is often caused by a viral infection and comes on suddenly and often with significant severity, resulting in an exceptionally high risk of death caused by cardiogenic shock (the heart
's inability to pump enough blood), fatal arrhythmias (abnormal heart
beats) and multiorgan failure. Besides viral infections, other common etiologies include bacterial and protozoal infections, toxins, drug reactions, autoimmune diseases, giant cell myocarditis
, and sarcoidosis.
With numerous advances in today's technology, there are a lot of devices that can fully support a patient's circulation and oxygenation/ventilation when necessary. The early recognition of fulminant myocarditis
, institution of circulatory support and maintenance of end-organ function (especially avoiding prolonged neurologic hypoxemia) can result in favorable outcomes for this previously almost universally fatal condition.
The new guidelines details increasing awareness and education of fulminant myocarditis
among health care providers to speed evaluation, diagnosis and treatment. Treatment options for optimal outcomes include supporting patients through the use of extracorporeal life support (heart
lung machine), percutaneous and durable ventricular assist devices (devices to help the heart
pump) and heart
Dr Leslie T. Cooper, M.D., FAHA, Vice Chair of the Guideline Writing Committee told Thailand Medical
News, "It is fortunate that fulminant myocarditis
is rare and that it usually presents in typically younger and healthier patients, rather than critically ill patients seen in the office or emergency department. This is where there are the greatest opportunities: early diagnosis, rapid treatment and the ability of frontline clinicians to detect the subtle signs and symptoms of this serious condition."
The Guideline and statement has been endorsed by the Heart
Failure Society of America and the Myocarditis Foundation.
Reference : Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart
Association, Robb D. Kociol, Leslie T. Cooper, James C. Fang, Javid J. Moslehi, Peter S. Pang, Marwa A. Sabe, Ravi V. Shah, Daniel B. Sims, Gaetano Thiene, Orly Vardeny
Circulation (2020). DOI: 10.1161/CIR.0000000000000745