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Acute Fulminant Myocarditis
Common Misconceptions
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Myocarditis is a rare cause of acute nonischemic cardiomyopathy.
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Corticosteroids are of benefit in mild to moderately severe acute myocarditis.
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All patients with eosinophilic myocarditis will have a peripheral eosinophilia.
Clinical Presentation
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Myocarditis is defined as inflammation of the myocardium owing to infection, ischemia, or trauma.
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Approximately 2.5 million cases of myocarditis and cardiomyopathy were diagnosed globally in 2015.
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Most cases of acute myocarditis present with chest pain or mild left ventricular systolic dysfunction
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Fulminant myocarditis (FM), a specific form of myocarditis requiring circulatory support to maintain tissue perfusion, accounts for less than 10% of cases.
Etiology
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Most commonly, FM is caused by a viral infection.
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Enteroviruses were previously the most common cause, but more recently parvovirus B19 has superseded them.
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In 2020, the SARS-CoV-2 (COVID-19) virus, causing a pandemic affecting much of the world, has been cited in numerous case reports as causing FM.
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Giant cell and necrotizing eosinophilic myocarditis are also rapidly fatal forms of myocarditis.
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Immune checkpoint inhibitors, used in numerous cancers, have recently been recognized as a cause of myocarditis.
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