“#431 Myocarditis and Pericarditis” From The Curbsiders

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

  1. Positional chest pain should increase clinical suspicion for pericarditis.
  2. All patients with suspected pericarditis should receive a prompt transthoracic echocardiogram (TTE).
  3. Rapid fluid accumulation in a pericardial effusion can lead to tamponade at a much smaller volume than gradual fluid accumulation.
  4. 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.
  5. Myocarditis has a broad spectrum of clinical presentations, including chest pain, constitutional symptoms, heart failure, and arrhythmias.
  6. Myocarditis is associated with elevated troponins but typically without the dynamic rise and fall of troponin levels seen in acute coronary syndromes.
  7. The diagnostic test of choice for most acute myocarditis cases is a cardiac MRI, typically after ischemic evaluation and TTE is performed.
  8. Cases of fulminant “crash and burn” myocarditis should receive an endomyocardial biopsy for rapid diagnosis and initiation of disease-specific treatment.
  9. Immune checkpoint inhibitor myocarditis is a serious and increasingly recognized clinical entity in patients undergoing cancer treatment.
  10.  Patients with a diagnosis of myopericarditis should be appropriately counseled on activity/exercise restriction until myocardial inflammation has resolved.


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