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Medical Management of Acute Fulminant Myocarditis

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Pediatric Critical Care

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Abstract

Myocarditis is a disease characterized by inflammation in the myocardium that results in cardiac-histologic and anatomical alterations as well as functional derangements secondary to myocardial destruction. While viruses frequently cause myocarditis, toxins or immunologic disease can also be the cause of myocarditis. Parvovirus B19 and human herpesvirus 6 are frequently the causative agent.

There are three phases in the myocarditis course. The first phase is viral damage to the myocardium. Phase 2 is characterized by a cross-reaction between myocardial-specific antigens and viral structure. In phase 3, patients develop chronic dilated cardiomyopathy due to persistent virus or persistent inflammation.

Myocarditis may present with a variety of symptom from abdominal pain to cardiogenic shock and sudden death. Echocardiography is essential to diagnose and quantitate regional and global left and right ventricular function, the presence of pericardial effusion, and valvular regurgitation. Cardiac magnetic resonance imaging has been increasingly utilized as part of the diagnostic evaluation for myocarditis. The gold standard for diagnosis of myocarditis is endomyocardial biopsy. Management is tailored to alleviating the symptoms of heart failure and improving hemodynamic abnormalities. Some patients with myocarditis fail medical therapy and progress to refractory end-stage shock with extremely poor cardiac performance, necessitating advanced life support. Corticosteroid, immunoglobulin, and immunosuppressive therapy are also being used in some patients with fulminant myocarditis.

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Authors and Affiliations

  1. Baylor College of Medicine, Texas Children’s Hospital, Section of Critical Care Medicine, Houston, TX, USA

    Fabio Savorgnan & Paul A. Checchia

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  1. Fabio Savorgnan
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  2. Paul A. Checchia
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Correspondence to Fabio Savorgnan .

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Editors and Affiliations

  1. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Christopher W. Mastropietro

  2. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Kevin M. Valentine

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Savorgnan, F., Checchia, P.A. (2019). Medical Management of Acute Fulminant Myocarditis. In: Mastropietro, C., Valentine, K. (eds) Pediatric Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96499-7_5

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  • DOI: https://doi.org/10.1007/978-3-319-96499-7_5

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