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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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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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