Myocarditis - Revision history

Danbot: Strip excess bold text

2026-03-22T09:24:11Z

Strip excess bold text

Danbot: Comprehensive update: expanded causes (checkpoint inhibitors, giant cell), added EM-focused management (avoid NSAIDs, fluid caution, MCS), activity restriction, updated references with PMIDs

2026-03-21T19:35:32Z

Comprehensive update: expanded causes (checkpoint inhibitors, giant cell), added EM-focused management (avoid NSAIDs, fluid caution, MCS), activity restriction, updated references with PMIDs

Show changes

Ostermayer at 18:03, 16 January 2026

2026-01-16T18:03:54Z

← Older revision		Revision as of 18:03, 16 January 2026
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	{{~~Adult top}} [[~~myocarditis (peds)]]		{{AdultPage\|myocarditis (peds)}}
	==Background==		==Background==
	[[File:KVIR A 2180951 F0001 OC.jpg\|thumb\|Triggers of myocarditis. Myocarditis can be induced by both infectious and non-infectious pathogens, with viral infection being the most common cause (red background).]]		[[File:KVIR A 2180951 F0001 OC.jpg\|thumb\|Triggers of myocarditis. Myocarditis can be induced by both infectious and non-infectious pathogens, with viral infection being the most common cause (red background).]]

Patricklin at 20:11, 25 June 2025

2025-06-25T20:11:55Z

← Older revision		Revision as of 20:11, 25 June 2025
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	==Clinical Features==		==Clinical Features==
	*Typically young patients (20 - 50 years) with few risk factors for CAD		*Typically young patients (20 - 50 years) with few risk factors for CAD
	*[[Chest pain]]		*[[Chest pain]] or chest pressure/tightness
	*New onset [[congestive heart failure]], which may include fatigue, orthopnea, or ~~dyspnea on exertion~~
	*Arrhythmias
	*[[Flu-like symptoms]]		*[[Flu-like symptoms]]
	**[[Fever]], [[fatigue]], [[myalgia]], [[nausea and vomiting]]		**[[Fever]], [[fatigue]], [[myalgia]], [[nausea and vomiting]]
	**[[Tachycardia]] (out of proportion to fever)		**[[Tachycardia]] (out of proportion to fever)
	**[[Tachypnea]]		**[[Tachypnea]]
			*New onset [[congestive heart failure]], which may include fatigue, orthopnea, or dyspnea on exertion
			*Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids
	*Pediatric patients: See [[myocarditis (peds)]]		*Pediatric patients: See [[myocarditis (peds)]]
	*Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids


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	''Consider other causes of [[CHF]]''		''Consider other causes of [[CHF]]''
	{{Chest Pain DDX}}		{{Chest Pain DDX}}


	==Evaluation==		==Evaluation==
	[[File:PericarditisMyocarditis.jpg\|thumb\|Diffuse ST elevation in a patient with combined myocarditis and [[pericarditis]].]]		[[File:PericarditisMyocarditis.jpg\|thumb\|Diffuse ST elevation in a patient with combined myocarditis and [[pericarditis]].]]
	*[[ECG]]		*[[ECG]] needs to be obtained to rule out ischemia. Myocarditis may exhibit the following findings:
	**Sinus [[tachycardia]]		**Sinus [[tachycardia]]
			**Nonspecific ST-T changes
	**[[low voltage ECG\|Low voltages]]		**[[low voltage ECG\|Low voltages]]
	**[[Prolonged QTc]]		**[[Prolonged QTc]]
	**[[AV block]]		**[[AV block]] may be present in [[Lyme disease]] or [[Sarcoidosis]] as the infiltrative process involves the AV node
	**[[~~ST elevation~~]]~~s (Usually >1 vessel distribution)~~		**Wide QRS, including [[Left bundle branch block]], may be seen
	*Elevated [[troponin]]		**Note that a normal EKG does not rule out myocarditis
			*Elevated [[troponin]] or [[Brain natriuretic peptide]]
			*CXR
			**May demonstrate indirect signs such as cardiomegaly, pulmonary edema, or pleural effusion
	*[[Echocardiography]]		*[[Echocardiography]]
	**Decreased LVEF		**Decreased LVEF
	**Global hypokinesis		**Global hypokinesis or regional wall motion abnormalities
	**~~Regional wall motion abnormalities~~		**Changes to LV geometry
	*~~Contrast MR~~		**Detection of concomitant pericarditis (if present, would then be named myopericarditis)
			*Cardiac MRI with contrast
			**Noninvasive gold standard for structural-functional changes
	*Nuclear Study		*Nuclear Study
	**Widespread uptake indicating myocyte necrosis		**Widespread uptake indicating myocyte necrosis
	*Viral titres		*Viral titres
	*~~Endocardial~~ biopsy: ~~Gold~~ standard, but rarely used		*Endomyocardial biopsy (EMB): Invasive gold standard, but rarely used
			*Coronary angiography is indicated in selected patients where [[acute coronary syndrome]] is suspected


	==Management==		==Management==
	*Acute phase		*Acute phase
	**Antiviral agents (Pleconaril/[[Ribavirin]]) may be effective		**Discontinue offending agent, if possible/known
			**Antiviral agents (Pleconaril/[[Ribavirin]]) may be effective for specific viruses
	**COVID-related: limited/conflicting evidence regarding efficacy of high-dose [[steroids]] and/or [[IVIG]] <ref>[https://link.springer.com/article/10.1007/s11739-021-02635-w Mele D, Flamigni F, Rapezzi C, Ferrari R. Myocarditis in COVID-19 patients: current problems. Internal and Emergency Medicine. 2021. doi:10.1007/s11739-021-02635-w]</ref>		**COVID-related: limited/conflicting evidence regarding efficacy of high-dose [[steroids]] and/or [[IVIG]] <ref>[https://link.springer.com/article/10.1007/s11739-021-02635-w Mele D, Flamigni F, Rapezzi C, Ferrari R. Myocarditis in COVID-19 patients: current problems. Internal and Emergency Medicine. 2021. doi:10.1007/s11739-021-02635-w]</ref>
	*Subacute phase		*Subacute phase
	**Studies have not shown efficacy of ~~immunosupressants~~		**Studies have not shown efficacy of immunosuppressants for acute myocarditis, unless in specific EMB-proven cases
	**Pediatric patients may receive high-dose [[IVIG]]		**Pediatric patients may receive high-dose [[IVIG]]
	*Chronic phase		*Chronic phase
	**Treatment for CHF symptoms		**Treatment for CHF symptoms, which may include GDMT meds or diuresis
	**Ventricular Assist Devices ([[LVAD\|VAD]])		**Ventricular Assist Devices ([[LVAD\|VAD]])
	**Cardiac transplant		**Cardiac transplant

	==Disposition==		==Disposition==
	*If [[CHF]] is present, admit to monitored bed		*If [[CHF]] is present, admit to a monitored bed
	*If hemodynamically unstable, admit to ICU		*If hemodynamically unstable, admit to ICU

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	==External Links==		==External Links==
			2024 ACC Expert Consensus on Myocarditis<ref>Writing Committee; Drazner MH, Bozkurt B, Cooper LT, Aggarwal NR, Basso C, Bhave NM, Caforio ALP, Ferreira VM, Heidecker B, Kontorovich AR, Martín P, Roth GA, Van Eyk JE. 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2025 Feb 4;85(4):391-431. doi: 10.1016/j.jacc.2024.10.080. Epub 2024 Dec 10. PMID: 39665703.</ref>

	==References==		==References==
	<references/>		<references/>
	[[Category:Cardiology]]		[[Category:Cardiology]]

Patricklin at 20:08, 25 June 2025

2025-06-25T20:08:00Z

← Older revision		Revision as of 20:08, 25 June 2025
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	==Background==		==Background==
	[[File:KVIR A 2180951 F0001 OC.jpg\|thumb\|Triggers of myocarditis. Myocarditis can be induced by both infectious and non-infectious pathogens, with viral infection being the most common cause (red background).]]		[[File:KVIR A 2180951 F0001 OC.jpg\|thumb\|Triggers of myocarditis. Myocarditis can be induced by both infectious and non-infectious pathogens, with viral infection being the most common cause (red background).]]
	*Inflammatory ~~(dilated)~~ cardiomyopathy caused by necrosis of myocytes		*Inflammatory cardiomyopathy caused by damage and necrosis of myocytes
			**Viral-induced is the most common etiology<ref>Cooper LT Jr. Myocarditis. N Engl J Med. 2009 Apr 9;360(15):1526-38. doi: 10.1056/NEJMra0800028. PMID: 19357408; PMCID: PMC5814110.</ref>
			*Clinical presentation ranges from smoldering heart failure to fulminant cardiogenic shock or sudden death
			*Maintain a high index of suspicion in younger patients without traditional CAD risk factors

	===Causes===		===Causes===
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	**[[Chagas]] (most common cause worldwide)		**[[Chagas]] (most common cause worldwide)
	**[[Trichinosis]]		**[[Trichinosis]]
			**[[Sarcoidosis]]
			**[[Systemic lupus erythematosus]]
	**[[Diphtheria]]		**[[Diphtheria]]
	**[[Lyme disease]]		**[[Lyme disease]]
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	===Phases===		===Phases===
	*Acute		*Acute
	**~~Viral~~ cytotoxicity and focal necrosis		**Direct cytotoxicity and focal necrosis from viral, autoimmune, or toxins
	*Subacute		*Subacute
	**Host's humoral/immune response leading to further cell injury		**Host's humoral/immune response (viral molecular mimicry and anti-myocyte antibody production) leading to further cell injury
	*Chronic		*Chronic
	**Diffuse myocardial fibrosis and cardiac dysfunction		**Diffuse myocardial fibrosis and cardiac dysfunction
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	*Typically young patients (20 - 50 years) with few risk factors for CAD		*Typically young patients (20 - 50 years) with few risk factors for CAD
	*[[Chest pain]]		*[[Chest pain]]
	*~~Pericardial friction rub~~		*New onset [[congestive heart failure]], which may include fatigue, orthopnea, or dyspnea on exertion
			*Arrhythmias
	*[[Flu-like symptoms]]		*[[Flu-like symptoms]]
	**[[Fever]], [[fatigue]], [[myalgia]], [[nausea and vomiting]]		**[[Fever]], [[fatigue]], [[myalgia]], [[nausea and vomiting]]
	**[[Tachycardia]] (out of proportion to fever)		**[[Tachycardia]] (out of proportion to fever)
	**[[Tachypnea]]		**[[Tachypnea]]
	*New onset [[congestive heart failure]]		*Pediatric patients: See [[myocarditis (peds)]]
	*Pediatric patients:		*Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids
	**Grunting
	**Retractions
	**Rhonchi
	*Infants may have fulminant syndrome
	**[[~~Fever]]~~
	**Cyanosis
	**[[Shortness of breath (peds)~~\|Respiratory distress]]~~
	**[[Tachycardia]]
	**[[Heart failure]]
	**[[Ventricular dysrhythmias]]

	*Consider this diagnosis in the septic-appearing patient who gets WORSE after receiving IV fluids

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Evaluation */

2024-10-02T20:09:32Z

Evaluation

← Older revision		Revision as of 20:09, 2 October 2024
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	==Evaluation==		==Evaluation==
			[[File:PericarditisMyocarditis.jpg\|thumb\|Diffuse ST elevation in a patient with combined myocarditis and [[pericarditis]].]]
	*[[ECG]]		*[[ECG]]
	**Sinus [[tachycardia]]		**Sinus [[tachycardia]]

Rossdonaldson1: /* See Also */

2024-10-02T20:05:10Z

Rossdonaldson1: /* Background */

2024-10-02T20:04:45Z

Background

← Older revision		Revision as of 20:04, 2 October 2024
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	{{Adult top}} [[myocarditis (peds)]]		{{Adult top}} [[myocarditis (peds)]]
	==Background==		==Background==
			[[File:KVIR A 2180951 F0001 OC.jpg\|thumb\|Triggers of myocarditis. Myocarditis can be induced by both infectious and non-infectious pathogens, with viral infection being the most common cause (red background).]]
	*Inflammatory (dilated) cardiomyopathy caused by necrosis of myocytes		*Inflammatory (dilated) cardiomyopathy caused by necrosis of myocytes

Ritch2: /* Clinical Features */

2024-09-16T07:24:49Z

Clinical Features

← Older revision		Revision as of 07:24, 16 September 2024
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	**Grunting		**Grunting
	**Retractions		**Retractions
	**~~Ronchi~~		**Rhonchi
	*Infants may have fulminant syndrome		*Infants may have fulminant syndrome
	**[[Fever]]		**[[Fever]]

ClaireLewis at 19:56, 24 February 2021

2021-02-24T19:56:11Z

← Older revision		Revision as of 19:56, 24 February 2021
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	**[[Diphtheria]]		**[[Diphtheria]]
	**[[Lyme disease]]		**[[Lyme disease]]
			**[[COVID-19]]<ref>[https://link.springer.com/article/10.1007/s11739-021-02635-w Mele D, Flamigni F, Rapezzi C, Ferrari R. Myocarditis in COVID-19 patients: current problems. Internal and Emergency Medicine. 2021. doi:10.1007/s11739-021-02635-w]</ref>
	*Drugs		*Drugs
	**[[Doxorubicin]]		**[[Doxorubicin]]
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	==Management==		==Management==
	*Acute phase		*Acute phase
	**Antiviral agents (Pleconaril/[[Ribavirin]]) may be effective		**Antiviral agents (Pleconaril/[[Ribavirin]]) may be effective
			**COVID-related: limited/conflicting evidence regarding efficacy of high-dose [[steroids]] and/or [[IVIG]] <ref>[https://link.springer.com/article/10.1007/s11739-021-02635-w Mele D, Flamigni F, Rapezzi C, Ferrari R. Myocarditis in COVID-19 patients: current problems. Internal and Emergency Medicine. 2021. doi:10.1007/s11739-021-02635-w]</ref>
	*Subacute phase		*Subacute phase
	**Studies have not shown efficacy of immunosupressants		**Studies have not shown efficacy of immunosupressants

← Older revision		Revision as of 20:05, 2 October 2024
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	==See Also==		==See Also==
	*[[Cardiomyopathy]]		*[[Cardiomyopathy]]
	*[[Pericarditis]]		*[[Pericarditis]]

			==External Links==

	==References==		==References==
	<references/>		<references/>
	[[Category:Cardiology]]		[[Category:Cardiology]]

← Older revision		Revision as of 09:24, 22 March 2026
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	*Viral-induced is the most common etiology<ref>Cooper LT Jr. Myocarditis. ''N Engl J Med''. 2009;360(15):1526-38. PMID 19357408</ref>		*Viral-induced is the most common etiology<ref>Cooper LT Jr. Myocarditis. ''N Engl J Med''. 2009;360(15):1526-38. PMID 19357408</ref>
	*Clinical presentation ranges from smoldering [[heart failure]] to fulminant [[cardiogenic shock]] or sudden death		*Clinical presentation ranges from smoldering [[heart failure]] to fulminant [[cardiogenic shock]] or sudden death
	*Maintain ~~'''~~high index of suspicion in younger patients~~'''~~ without traditional CAD risk factors		*Maintain high index of suspicion in younger patients without traditional CAD risk factors
	*Incidence: estimated 1.5 million cases worldwide annually		*Incidence: estimated 1.5 million cases worldwide annually
	*'''Giant cell myocarditis''' is a rapidly fatal variant requiring early recognition		*'''Giant cell myocarditis''' is a rapidly fatal variant requiring early recognition

	===Causes===		===Causes===
	*~~'''~~Viral~~'''~~ (most common):		*Viral (most common):
	**Enterovirus (Coxsackie B) and adenovirus (historically most common)		**Enterovirus (Coxsackie B) and adenovirus (historically most common)
	**Parvovirus B19 and HHV-6 (currently most detected on biopsy)		**Parvovirus B19 and HHV-6 (currently most detected on biopsy)
	**Influenza A and B, [[HIV]], [[hepatitis]] B/C, COVID-19		**Influenza A and B, [[HIV]], [[hepatitis]] B/C, COVID-19
	*~~'''~~Bacterial~~'''~~: [[Lyme disease]], beta-hemolytic strep, [[Mycoplasma]], diphtheria		*Bacterial: [[Lyme disease]], beta-hemolytic strep, [[Mycoplasma]], diphtheria
	*~~'''~~Parasitic~~'''~~: Chagas disease (most common cause worldwide), toxoplasma, trichinosis		*Parasitic: Chagas disease (most common cause worldwide), toxoplasma, trichinosis
	*~~'''~~Autoimmune~~'''~~: [[sarcoidosis]], [[SLE]], giant cell myocarditis		*Autoimmune: [[sarcoidosis]], [[SLE]], giant cell myocarditis
	*~~'''~~Drugs/toxins~~'''~~: ~~'''~~cocaine~~'''~~, doxorubicin, immune checkpoint inhibitors, [[amphetamines]]		*Drugs/toxins: cocaine, doxorubicin, immune checkpoint inhibitors, [[amphetamines]]

	===Phases===		===Phases===
	*~~'''~~Acute~~'''~~: direct cytotoxicity and focal necrosis from viral, autoimmune, or toxins		*Acute: direct cytotoxicity and focal necrosis from viral, autoimmune, or toxins
	*~~'''~~Subacute~~'''~~: host immune response (viral molecular mimicry, anti-myocyte antibody production)		*Subacute: host immune response (viral molecular mimicry, anti-myocyte antibody production)
	*~~'''~~Chronic~~'''~~: diffuse myocardial fibrosis and cardiac dysfunction		*Chronic: diffuse myocardial fibrosis and cardiac dysfunction

	==Clinical Features==		==Clinical Features==
	*Typically ~~'''~~young patients (20-50 years)~~'''~~ with few risk factors for CAD		*Typically young patients (20-50 years) with few risk factors for CAD
	*~~'''~~Preceding viral illness~~'''~~ in 50-80% of cases (1-2 weeks prior)		*Preceding viral illness in 50-80% of cases (1-2 weeks prior)
	*Chest pain or chest pressure/tightness (mimics [[ACS]])		*Chest pain or chest pressure/tightness (mimics [[ACS]])
	*Flu-like symptoms: [[fever]], fatigue, [[myalgia]]s, nausea/vomiting		*Flu-like symptoms: [[fever]], fatigue, [[myalgia]]s, nausea/vomiting
	*~~'''~~Tachycardia out of proportion to fever~~'''~~		*Tachycardia out of proportion to fever
	*New-onset [[heart failure]]: fatigue, [[orthopnea]], [[dyspnea]] on exertion		*New-onset [[heart failure]]: fatigue, [[orthopnea]], [[dyspnea]] on exertion
	*~~'''~~Consider this diagnosis in the septic-appearing patient who worsens after IV fluids~~'''~~		*Consider this diagnosis in the septic-appearing patient who worsens after IV fluids
	*May present with [[sudden cardiac arrest]] (especially in young athletes)		*May present with [[sudden cardiac arrest]] (especially in young athletes)
	*Pediatric patients: see [[myocarditis (peds)]]		*Pediatric patients: see [[myocarditis (peds)]]
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	*Low voltages		*Low voltages
	*Prolonged QTc		*Prolonged QTc
	*AV block (especially with ~~'''~~[[Lyme disease]]~~'''~~ or ~~'''~~[[sarcoidosis]]~~'''~~)		*AV block (especially with [[Lyme disease]] or [[sarcoidosis]])
	*Wide QRS / new [[LBBB]]		*Wide QRS / new [[LBBB]]
	*~~'''~~Normal ECG does NOT rule out myocarditis~~'''~~		*Normal ECG does NOT rule out myocarditis

	===Labs===		===Labs===
	*~~'''~~Troponin~~'''~~: elevated in ~50% of cases; sensitivity limited		*Troponin: elevated in ~50% of cases; sensitivity limited
	*~~'''~~BNP/NT-proBNP~~'''~~: reflects degree of heart failure		*BNP/NT-proBNP: reflects degree of heart failure
	*CBC, BMP, LFTs		*CBC, BMP, LFTs
	*[[ESR]], [[CRP]] (usually elevated but nonspecific)		*[[ESR]], [[CRP]] (usually elevated but nonspecific)
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	===Imaging===		===Imaging===
	*~~'''~~CXR~~'''~~: cardiomegaly, pulmonary edema, or pleural effusion		*CXR: cardiomegaly, pulmonary edema, or pleural effusion
	*~~'''~~Echocardiography~~'''~~ (essential in ED):		*Echocardiography (essential in ED):
	**Decreased LVEF, global hypokinesis or regional wall motion abnormalities		**Decreased LVEF, global hypokinesis or regional wall motion abnormalities
	**Can detect pericardial effusion (myopericarditis)		**Can detect pericardial effusion (myopericarditis)
	**~~'''~~Fulminant myocarditis may show normal LV dimensions with increased wall thickness~~'''~~		**Fulminant myocarditis may show normal LV dimensions with increased wall thickness
	*~~'''~~Cardiac MRI~~'''~~ (noninvasive gold standard): myocardial edema and late gadolinium enhancement		*Cardiac MRI (noninvasive gold standard): myocardial edema and late gadolinium enhancement
	*~~'''~~Endomyocardial biopsy~~'''~~: invasive gold standard, reserved for unexplained cardiomyopathy or suspected giant cell myocarditis		*Endomyocardial biopsy: invasive gold standard, reserved for unexplained cardiomyopathy or suspected giant cell myocarditis

	==Management==		==Management==
	===ED Management===		===ED Management===
	*~~'''~~IV access, continuous monitoring, 12-lead ECG~~'''~~		*IV access, continuous monitoring, 12-lead ECG
	*~~'''~~Rule out ACS~~'''~~: may require coronary angiography if ST elevation or high clinical suspicion		*Rule out ACS: may require coronary angiography if ST elevation or high clinical suspicion
	*~~'''~~Avoid NSAIDs and aspirin~~'''~~ in acute phase (animal studies suggest increased inflammation)		*Avoid NSAIDs and aspirin in acute phase (animal studies suggest increased inflammation)
	*'''Volume status''': use caution with IV fluids — may worsen [[heart failure]]		*'''Volume status''': use caution with IV fluids — may worsen [[heart failure]]
	**If [[cardiogenic shock]]: consider vasopressors/inotropes (dobutamine, milrinone)		**If [[cardiogenic shock]]: consider vasopressors/inotropes (dobutamine, milrinone)
	*~~'''~~Dysrhythmia management~~'''~~:		*Dysrhythmia management:
	**Avoid class IC antiarrhythmics		**Avoid class IC antiarrhythmics
	**Amiodarone for sustained [[VT]]		**Amiodarone for sustained [[VT]]
	**Temporary pacing for complete heart block		**Temporary pacing for complete heart block
	*~~'''~~Anticoagulation~~'''~~ consideration if severely reduced LVEF with LV thrombus risk		*Anticoagulation consideration if severely reduced LVEF with LV thrombus risk

	===Definitive Treatment===		===Definitive Treatment===
	*~~'''~~Supportive care~~'''~~ is mainstay; most viral myocarditis self-resolves		*Supportive care is mainstay; most viral myocarditis self-resolves
	*~~'''~~GDMT for heart failure~~'''~~: ACE-I/ARB, beta-blockers, diuretics (as tolerated by hemodynamics)		*GDMT for heart failure: ACE-I/ARB, beta-blockers, diuretics (as tolerated by hemodynamics)
	*~~'''~~Mechanical circulatory support~~'''~~ (ECMO, VAD) for refractory cardiogenic shock		*Mechanical circulatory support (ECMO, VAD) for refractory cardiogenic shock
	*~~'''~~Giant cell myocarditis~~'''~~: requires immunosuppression (cyclosporine + corticosteroids)		*Giant cell myocarditis: requires immunosuppression (cyclosporine + corticosteroids)
	*Cardiac transplant for end-stage disease		*Cardiac transplant for end-stage disease
	*'''Activity restriction''': no competitive sports for 3-6 months per AHA guidelines<ref>Caforio ALP, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the ESC. ''Eur Heart J''. 2013;34(33):2636-2648. PMID 23824828</ref>		*'''Activity restriction''': no competitive sports for 3-6 months per AHA guidelines<ref>Caforio ALP, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the ESC. ''Eur Heart J''. 2013;34(33):2636-2648. PMID 23824828</ref>

	==Disposition==		==Disposition==
	*~~'''~~Admit all patients with suspected myocarditis~~'''~~ to a monitored bed		*Admit all patients with suspected myocarditis to a monitored bed
	*~~'''~~ICU admission~~'''~~ for hemodynamic instability, arrhythmias, or reduced LVEF		*ICU admission for hemodynamic instability, arrhythmias, or reduced LVEF
	*Early cardiology consultation		*Early cardiology consultation
	*Consider transfer to center with mechanical circulatory support capability		*Consider transfer to center with mechanical circulatory support capability

	==Prognosis==		==Prognosis==
	*~~'''~~Fulminant myocarditis~~'''~~ paradoxically has the ~~'''~~best long-term prognosis~~'''~~ if patient survives the acute phase		*Fulminant myocarditis paradoxically has the best long-term prognosis if patient survives the acute phase
	*Overall mortality: ~20% at 1 year, ~50% at 5 years for non-fulminant forms		*Overall mortality: ~20% at 1 year, ~50% at 5 years for non-fulminant forms
	*Children: ~70% survival rate at 5 years		*Children: ~70% survival rate at 5 years