DALLAS, Jan. 6, 2019 -- The resources needed to treat fulminant myocarditis - severe, inflammation of the heart that develops rapidly - are outlined in a new Scientific Statement (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.
Fulminant myocarditis, often caused by a viral infection, 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 heartbeats) and multiorgan failure .
With many of today's technology advances, numerous devices 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 Statement 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 transplantation.
"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," said Leslie T. Cooper, M.D., FAHA, vice chair of the Statement Writing Group. "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 Statement has been endorsed by the Heart Failure Society of America and the Myocarditis Foundation.
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Co-authors are Robb D. Kociol, M.D., M.S., Chair; Leslie T. Cooper, M.D., Vice Chair; James C. Fang, M.D.; Javid J. Moslehi, M.D.; Peter S. Pang, M.D., M.S..; Marwa A. Sabe, M.D., M.P.H.; Ravi V. Shah, M.D.; Daniel B. Sims, M.D.; Gaetano Thiene, M.D.; Orly Vardeny, Pharm.D., M.S. Author disclosures are in the manuscript.
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Journal
Circulation