ICU · Cardiovascular

Acute myocarditis and pericarditis

Also known as Acute myocarditis · Fulminant myocarditis · Giant cell myocarditis · Eosinophilic myocarditis

Acute myocarditis is inflammation of the myocardium — commonest causes: viral (coxsackie, parvovirus B19, COVID-19), autoimmune, drug-induced (immune checkpoint inhibitors), idiopathic. Presents with: chest pain (may mimic MI), heart failure, arrhythmia, or cardiogenic shock (fulminant myocarditis). Diagnosis: troponin elevated, ECG changes (non-specific ST/T changes, may mimic MI), echo (regional wall motion abnormalities, reduced EF), cardiac MRI (gold non-invasive — oedema, late gadolinium enhancement in subepicardial/mid-wall pattern), endomyocardial biopsy (gold standard but rarely performed). Treatment: supportive (heart failure therapy, mechanical support if fulminant), avoid NSAIDs in acute phase (may worsen inflammation). Giant cell myocarditis: urgent immunosuppression + transplant evaluation.