Today I review, link to, and excerpt from The Curbsiders‘ #431 Myocarditis and Pericarditis.*
*Barelski AM, Kulkarni V, Williams PN, Jyang, E, Witt, L, Watto MF. “#431 Myocarditis and Pericarditis”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/category/curbsiders-podcast Final publishing date March 18, 2024.
The show notes are, as usual, excellent and I have reviewed them completely. I have included only some excerpts below.
All that follows is from the above resource.
Pericarditis and Myocarditis Pearls
- Positional chest pain should increase clinical suspicion for pericarditis.
- All patients with suspected pericarditis should receive a prompt transthoracic echocardiogram (TTE).
- Rapid fluid accumulation in a pericardial effusion can lead to tamponade at a much smaller volume than gradual fluid accumulation.
- Treatment of choice for most cases of uncomplicated pericarditis should include high-dose non-steroidal anti-inflammatory drugs (NSAIDs)—along with colchicine to prevent recurrent pericarditis.
- Myocarditis has a broad spectrum of clinical presentations, including chest pain, constitutional symptoms, heart failure, and arrhythmias.
- Myocarditis is associated with elevated troponins but typically without the dynamic rise and fall of troponin levels seen in acute coronary syndromes.
- The diagnostic test of choice for most acute myocarditis cases is a cardiac MRI, typically after ischemic evaluation and TTE is performed.
- Cases of fulminant “crash and burn” myocarditis should receive an endomyocardial biopsy for rapid diagnosis and initiation of disease-specific treatment.
- Immune checkpoint inhibitor myocarditis is a serious and increasingly recognized clinical entity in patients undergoing cancer treatment.
- Patients with a diagnosis of myopericarditis should be appropriately counseled on activity/exercise restriction until myocardial inflammation has resolved.
