Fulminant Myocarditis

Table 1.

Baseline Clinical Characteristics of Patients With Acute Fulminant and Nonfulminant Myocarditis^[28]

Table 2.

Differential Diagnosis of Fulminant Myocarditis

Table 3.

Clinicopathologic Classification of Myocarditis^[61]

Table 4.

Histologic, Hemodynamic and Echocardiographic Characteristics of Patients With Acute Fulminant Versus Nonfulminant Myocarditis^[28]

Table 5.

Mechanical Support for Acute Fulminant Myocarditis: Types of Devices and Survival^[62]

Box 1.

Potential Causes of Myocarditis

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Author(s)

Sachin Gupta, MD

Cardiology Fellow, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas

Disclosures

Disclosure: Sachin Gupta, MD, has disclosed no relevant financial relationships.

David W Markham, MD

Assistant Professor, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas

Disclosures

Disclosure: David W. Markham, MD, has disclosed no relevant financial relationships.

Mark H Drazner, MD

Associate Professor of Internal Medicine, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas

Disclosures

Disclosure: Mark H. Drazner, MD, has disclosed no relevant financial relationships.

Pradeep PA Mammen, MD

Assistant Professor, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas

Disclosures

Disclosure: Pradeep P.A. Mammen, MD, has disclosed no relevant financial relationships.

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Summary and Introduction

Summary

Fulminant myocarditis is an inflammatory process that occurs in the myocardium and causes acute-onset heart failure. If patients with fulminant myocarditis are aggressively supported in a timely manner, nearly all can have an excellent recovery. In this Review, we discuss the clinical and histological distinguishing features of fulminant myocarditis and contrast this disease entity with nonfulminant myocarditis. The epidemiology, pathophysiology, clinical presentation, methods of diagnosis, management options and prognosis of fulminant myocarditis are reviewed in detail.

Introduction

Myocarditis is an inflammation of the myocardium that results in ventricular systolic dysfunction and may be the causative factor in up to 10% of patients with acute-onset heart failure.^[1-3] In most patients with myocarditis the clinical course is self-limiting. The disease can have a fulminant or nonfulminant presentation. In patients with acute, nonfulminant myocarditis, the initial course can be insidious and followed by acute onset of heart failure with subsequent development of chronic myocarditis. These patients either develop chronic, stable, dilated cardiomyopathy or progress to advanced, end-stage heart failure. By comparison, patients with fulminant myocarditis present with acute, severe heart failure and are often in cardiogenic shock. If fulminant myocarditis is quickly recognized and patients are given aggressive treatment, more than 90% will make a full recovery with minimal long-term sequelae.^[4]

Currently, the factors that determine whether a patient presents with fulminant or nonfulminant myocarditis are not known. In this Review, we focus on the epidemiology, pathophysiology, clinical presentation, methods of diagnosis, management, and prognosis of fulminant myocarditis and highlight the importance of early recognition of this disease entity. When appropriate, certain features of fulminant myocarditis are contrasted with those of nonfulminant myocarditis. To our knowledge, this article is the first comprehensive review of fulminant myocarditis.