Fulminant myocarditis

It is an uncommon form of myocarditis which is characterized by a fast progression of the disease. Usually in the term of just several days, often one or two, before the first manifestation of the disease, prodrome of a viral infection is quite frequent (fever, myalgia, arthralgia etc.). Patients present with acute heart failure and sometimes even with cardiogenic shock and a rapid decrease of the left ventricular ejection fraction may be observed [16]. Frequent ECHO finding is non-enlarged left ventricle with thickening of its walls [16]. In fulminant myocarditis, it is recommended to exclude giant cell and eosinophilic myocarditis as the cause of the disease, because they require specific therapy (see other chapters). If patients do not respond to the pharmacological treatment and/or their state of health deteriorates rapidly, mechanical cardiac support, including ECMO, is often necessary what then serves either as “bridge to recovery” or “bridge to transplant” [96]. When patients survive the acute stage of heart failure, their prognosis is usually favorable [16, 87]. According to the research from 2000 including 147 patients with myocarditis (14 of them with the fulminant form of myocarditis), the long-term prognosis of patients with fulminant myocarditis is even better than in patients with “classical” acute form. After 11 years, 93 % of patients with fulminant myocarditis (including patients without heart transplant) survived, compared to the group of patients with acute myocarditis with the survival rate of 45 % [87].

Acute myocarditis

Acute myocarditis is a “classical” form of myocarditis which differs from fulminant myocarditis in the milder initial course of the disease and often in the slower manifestation of symptoms. Symptoms of a viral infection (primarily of the respiratory and gastrointestinal system) may be observed in patients even several weeks before the cardiac manifestation. The myocarditis itself usually manifests according to the resources with heart failure, arrhythmias or chest pain mimicking acute coronary syndrome [16, 86].

Chronic myocarditis

It is a long-term damage to the myocardium with inflammatory processes. In the case that this process is connected with the systolic dysfunction and dilatation of the left ventricle, it is called ICMP. Earlier, chronic myocarditis was classified in chronic active form (repeated relapses of acute myocarditis connected with chronic inflammatory changes of the myocardium and with the fibrosis and left ventricular dysfunction) and chronic persisting form (presence of the persisting inflammatory infiltrate and necrosis of cardiomyocytes, however, without signs of the left ventricular dysfunction), [4, 43].

Authors of the opening picture: Video file from Bogabathina H, Olson P, Rathi V, Biederman R (2012). “Cardiac Sarcoidosis or Giant Cell Myocarditis? On Treatment Improvement of Fulminant Myocarditis as Demonstrated by Cardiovascular Magnetic Resonance Imaging”. Case Reports in Cardiology. DOI:10.1155/2012/647041. PMID 24826266. PMC: 4008442.

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References:

4) AL-AQEEDI R.F., Chapter 2: Clinical Presentation. In: WILSON J. Clinical Handbook of Myocarditis. New Jersey: Foster Academics, 2015. pp. 33–69. ISBN: 978-1-63242-083-1.

16) KUBÁNEK M., Kapitola 8.2.: Myokarditidy. In: KAUTZNER J., MELENOVSKÝ V., et al. Srdeční selhání – aktuality pro klinickou praxi. Praha: Mladá fronta a.s., 2015. pp. 147–157. ISBN: 978-80-204-3573-6.

43) M, HOLICKÁ a ŠPINAR J. Myokarditidy. ACTA MEDICINAE. 2013, 2013(7), 68-74.

86) E., AMM a COOPER L.T., JR. Management of myocarditis. Heart Metab. 2014, 62(2014), 8-12.

87) E., MCCARTHY a et al. Long-Term Outcome of Fulminant Myocarditis as Compared with Acute (Nonfulminant) Myocarditis. The New England Journal of Medicine [online]. 2000, 342(-), 690-695 [cit. 2017-02-07].

96) Onemocnění myokardu: Myokarditida, zánětlivá kardiomyopatie. ECardio.cz [online]. -: -, – [cit. 2017-01-30].