Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

44 Acute Myocarditides

■Consider Swann-Ganz pulmonary artery catheter to measure cardiac

output, PCWP and vascular resistances and guide therapy, especially

if:

■Cardiogenic shock/ near shock unresponsive to fluid challenge

■Unresponsive pulmonary edema, especially with hypotension or

shock

■Assist in diagnosis between cardiogenic and non-cardiogenic etiology

■Bed rest/ restricted physical activity for 6 months and until normal

function

specific therapy

■Corticosteroids: controversial; in general felt not to be useful

■Immunosuppressive therapy: consider in Giant cell myocarditis

■NSAIDs: contraindicated during acute phase (first 2 weeks), but may

be useful in later

Treatment Options

■Amiodarone: May consider for atrial and ventricular arrhythmias

and perhaps to prevent death/ sudden death (also consider AICD)

➣Indication: Atrial arrhythmias, symptomatic ventricular arrhyth-

mias

➣Side Effects and Complications: arrhythmias, SA and AV block,

hepatic failure, severe pulmonary toxicity, corneal deposits; blue-

gray skin discoloration, peripheral neuropathy, ataxia, edema,

dizziness, hyper/ hypothyroidism

➣Absolute Contraindications: Severe SA node disease, 2nd/3rd

degree AV block, sick sinus syndrome, bradycardia-induced syn-

cope

➣Relative Contraindications: Thyroid disease, pulmonary disease,

impaired liver or renal function, elderly

follow-up

During Treatment

■Observe for progression of ventricular dysfunction

■Observe for progression of conduction system disease

Routine

■Reassess LV function in 6 months or if marked change in clinical status

complications and prognosis

■Many cases spontaneously resolve; some develop CHF

■Thromboembolic events (50% of Chagas’ patients)

■Death due to sudden death and progressive pump dysfunction