Page 19 - Heart Failure Clinical Guidelines

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X. MYOCARDITIS

A. Initial Evaluation for Patient with Possible Myocarditis

1. Additional Laboratories, Tests

MRI with contrast if clinically feasible (evaluate inflammation)
Laboratories
1. CK
2. CK-MB
3. Troponin
4. Respiratory Viral Panel
5. Serum PCR for Adenovirus, Coxsackie A&B, Enterovirus, Parvovirus B19, CMV, EBV

B. Long-Term Medical Management for Myocarditis

1. Outlined in Section I-B

C. Immunotherapy Management of Myocarditis

1. Idiopathic or Viral Myocardits
a) Mildly or Normal Ventricular Function
-No immunotherapy
b) Moderate or Severe Ventricular Dysfunction
-Cytogam may be of use in CMV+ myocarditis
-IVIG may be of help in patients with neonatal myocarditis and encephalitis
-isolated myocarditis does not warrant IVIG administration

2. Giant Cell Myocarditis
The Following Therapies Should Only Be Employed in Biopsy Proven Giant Cell Myocarditis
a) Methylprednisone or Prendisone
-Initial Dose of 10mg/kg/day x 3 days (maximum dose of 1gm)
-After Pulse, begin 1mg/kg/day with a taper of 3-6 months
b) Azathioprine
-goal dose of 1.5-2mg/kg/day
-adjust if needed for leukopenia, thrombocytopenia or elevated AST/ALT
c) Cyclosporine
-target level of 80-120 ug/L

D. Long-Term Follow-up Schedule for Myocarditis

1. Initial Six Months after Acute Myocarditis (normal-mildly decreased function at discharge)
1. F/U 2 months
2. Echo q 2-3 months
3. Holter & Stress Test at 6 months