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Guidance Issued for Management of Fulminant Myocarditis

Patients with fulminant myocarditis typically younger, healthier, present late or are recognized late

WEDNESDAY, Jan. 8, 2020 (HealthDay News) — In a scientific statement from the American Heart Association, published online Jan. 6 in Circulation, considerations are presented for the recognition and initial management of fulminant myocarditis (FM).

Noting that FM can develop quickly and prove fatal without early recognition and advanced medical therapy, Robb D. Kociol, M.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues outlined the resources necessary to manage FM.

The authors noted that the main features of FM include rapidly progressive heart failure and cardiogenic shock, as well as electric instability, and can result in sudden death. To distinguish FM from other forms of acute circulatory compromise, early evaluation and management are important. Early recognition, usually guided by endomyocardial biopsy, is necessary for individualized management strategies that provide the optimal chance for recovery. To ensure that full circulatory support can be implemented to prevent multiorgan system failure, the diagnosis should be made rapidly with a high index of suspicion. FM patients are typically younger and healthier, present with atypical manifestations of myocardial ischemia and organ system failure, and often present late or are recognized late. Recognizing these patients and initiating diagnostic and therapeutic treatment in a timely manner should be a metric that is followed.

“These are not guideline-based recommendations because the evidence to date is not strong enough to reach the rigor required to be classified as guidelines,” the authors write. “Rather, these are considerations for the clinician to review that are based on our expert experience.”

Several authors disclosed financial ties to the pharmaceutical industry.

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