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Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association
Open accessAbstract
Fulminant myocarditis (FM) is an uncommon syndrome characterized by sudden and severe diffuse cardiac inflammation often leading to death resulting from cardiogenic shock, ventricular arrhythmias, or multiorgan system failure. Historically, FM was almost exclusively diagnosed at autopsy. By definition, all patients with FM will need some form of inotropic or mechanical circulatory support to maintain end-organ perfusion until transplantation or recovery. Specific subtypes of FM may respond to immunomodulatory therapy in addition to guideline-directed medical care. Despite the increasing availability of circulatory support, orthotopic heart transplantation, and disease-specific treatments, patients with FM experience significant morbidity and mortality as a result of a delay in diagnosis and initiation of circulatory support and lack of appropriately trained specialists to manage the condition. This scientific statement outlines the resources necessary to manage the spectrum of FM, including extracorporeal life support, percutaneous and durable ventricular assist devices, transplantation capabilities, and specialists in advanced heart failure, cardiothoracic surgery, cardiac pathology, immunology, and infectious disease. Education of frontline providers who are most likely to encounter FM first is essential to increase timely access to appropriately resourced facilities, to prevent multiorgan system failure, and to tailor disease-specific therapy as early as possible in the disease process.
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“EMB remains the gold standard for diagnosing acute myocarditis”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [242]
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“Patients with complicated myocarditis typically present with severely reduced ejection fraction and cardiogenic shock”
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Fulminant Myocarditis Temporally Associated with COVID-19 Vaccination
Ammirati, E., Conti, N., Palazzini, M., Rocchetti, M., Spangaro, A., Garascia, A., Lupi, L., & Cereda, A. F. (2024) · Current Cardiology Reports · doi:10.1007/s11886-024-02021-w · Cited by 6
Yang, S., Yang, K., Zhang, L., Ren, Y., Liu, L., Zhang, H., Feng, L., Ma, Z., Zhou, S., He, Y., et al. (2024) · Cardiovascular Innovations and Applications · doi:10.15212/cvia.2024.0031 · Cited by 6
The Role of MicroRNA in the Pathophysiology and Diagnosis of Viral Myocarditis
Młynarska, E., Badura, K., Kurciński, S., Sinkowska, J., Jakubowska, P., Rysz, J., & Franczyk, B. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252010933 · Cited by 6
Ji, M., Ran, X., Zuo, H., & Zhang, Q. (2024) · Journal of Inflammation Research · doi:10.2147/jir.s488237 · Cited by 6
Omori, T., Maruyama, K., Ohta‐Ogo, K., Hatakeyama, K., Ishibashi‐Ueda, H., Onoue, K., Nagai, T., Kato, S., Okumura, T., Oikawa, M., et al. (2024) · Circulation Journal · doi:10.1253/circj.cj-24-0506 · Cited by 6
Lauriero, F., Vita, C. H., Perazzolo, A., Sanseverino, G., Moliterno, E., Rovere, G., Marano, R., & Natale, L. (2025) · Echocardiography · doi:10.1111/echo.70099 · Cited by 6
Diagnostic efficacy of soluble ST2 in pediatric fulminant myocarditis
Huang, Y., Lin, Y., Fu, M., & Zhang, W. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1417341 · Cited by 6
Matsuura, H., Watanabe, N., Shibata, Y., & Asada, Y. (2021) · Journal of Echocardiography · doi:10.1007/s12574-021-00521-0 · Cited by 6
Review of COVID-19 Myocarditis in Competitive Athletes: Legitimate Concern or Fake News?
Khan, Z., Na, J. S., & Jerome, S. D. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.684780 · Cited by 6
Takura, T., Ōno, M., Ako, J., Ikari, Y., Toda, K., Sawa, Y., & for the ETICA Study Investigators (2022) · Circulation Journal · doi:10.1253/circj.cj-22-0439 · Cited by 6
Vila‐Olives, R., Uribarri, A., Martínez-Martínez, M., Argudo, E., Bonilla, C., Chiscano‐Camón, L., Herrador, L., Gabaldón, A., Buera, I., Vidal, M., et al. (2023) · Perfusion · doi:10.1177/02676591231170480 · Cited by 6
Sex-based differences in late gadolinium enhancement among patients with acute myocarditis
Cau, R., Pisu, F., Suri, J. S., Montisci, R., Bastarrika, G., Esposito, A., & Saba, L. (2023) · European Journal of Radiology · doi:10.1016/j.ejrad.2023.110980 · Cited by 6
Features of Myocarditis: Morphological Differential Diagnosis in Post-COVID-19 Children
Karev, V. E., Starshinova, A. Y., Glushkova, A. V., Kudlay, D. A., & Starshinova, A. (2023) · Diagnostics · doi:10.3390/diagnostics13152499 · Cited by 6
Park, J., & Kim, K. H. (2024) · Korean Circulation Journal · doi:10.4070/kcj.2024.0065 · Cited by 6
Incidence and outcomes of hospital treated acute myocarditis from 2003 to 2015 in Spain
Ortiz, M. R., Anguita-Sánchez, M. P., Bonilla‐Palomas, J. L., Fernández, C., Sobrino, J. L. B., Cequier, A. R., Bueno, H., Marín, F. R., & Somoza, F. J. E. (2020) · European Journal of Clinical Investigation · doi:10.1111/eci.13444 · Cited by 6
Fulminant Eosinophilic Myocarditis and VT Storm
Hoppens, K. R., Alai, H. R., Surla, J., Khokhar, H. O., & Hendel, R. C. (2021) · JACC Case Reports · doi:10.1016/j.jaccas.2020.12.028 · Cited by 6
Wang, W.-H., Wei, K., Huang, Y., Huang, K., Tsai, T., & Chang, Y.-C. (2023) · Drugs & Aging · doi:10.1007/s40266-022-00997-0 · Cited by 6
Case report: Electrocardiographic changes in pembrolizumab-induced fatal myocarditis
Nishiyama, K., Morikawa, K., Shinozaki, Y., Ueno, J., Tanaka, S., Tsuruoka, H., Azagami, S., Ishida, A., Yanagisawa, N., Akashi, Y. J., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1078838 · Cited by 6
Zemkova, M., Rob, D., Dusík, M., Pudil, J., Paleček, T., Vítková, I., & Bělohlávek, J. (2024) · ESC Heart Failure · doi:10.1002/ehf2.15001 · Cited by 4
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Qin, J., Aras, M. A., Song, E. J., Connolly, A. J., Zhou, L., O’Brien, C., Salem, J., Padmanabhan, A., & Moslehi, J. J. (2025) · Circulation · doi:10.1161/circulationaha.124.073058 · Cited by 5
Self-citationSoluble ST2 drives fulminant myocarditis progression via the IGF2R–YY1 mitochondrial axis
Zhuang, Y., Zhang, Z., Li, H., Abuduwufuer, K., Zhang, D., Wen, Z., Rao, X., Chen, C., Fleming, I., & Wang, D. W. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag105 · Cited by 5
Diagnostic and Therapeutic Options in Myocarditis and Inflammatory Cardiomyopathy
Schultheiss, H., Escher, F., Aleshcheva, G., Wiegleb, G., & Baumeier, C. (2026) · Biomedicines · doi:10.3390/biomedicines14030691 · Cited by 5
Brucella myocarditis with unusual clinical features & abnormal cardiac MRI: A case report
Salehi, M., Khalili, H., Khoshavi, M., Mollazadeh, R., Jahanshahi, B., & Hosseini, M. S. (2023) · IDCases · doi:10.1016/j.idcr.2023.e01868 · Cited by 5
Metadata
- Authors
- Kociol, R. D., Cooper, L. T., Fang, J. C., Moslehi, J. J., Pang, P. S., Sabe, M. A., Shah, R. V., Sims, D. B., Thiene, G., Vardeny, O., & On behalf of the American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology
- ORCID
- Venue
- Circulation
- Published
- 2020-02-11
- Volume
- 141
- Issue
- 6
- Pages
- e69-e92
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2999324438
- Cited by
- 625
- References
- 199
- Citations by year
- 2026: 78 · 2025: 69 · 2024: 98 · 2023: 100 · 2022: 121 · 2021: 91 · 2020: 66
- FWCI
- 58.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- fulminant myocarditis, cardiogenic shock, ventricular arrhythmias, multiple organ failure, mechanical circulatory support, extracorporeal life support, ventricular assist devices, heart transplantation, immunomodulatory therapy, advanced heart failure, delayed diagnosis
- MeSH terms
- American Heart Association, Arrhythmias, Cardiac, Female, Humans, Multiple Organ Failure, Myocarditis, Shock, Cardiogenic, United States, Extracorporeal Membrane Oxygenation, Heart Transplantation, Practice Guidelines as Topic
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