Myocarditis CCS Guidelines

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Overview

The Canadian Cardiovascular Society has guidelines on the diagnosis of myocarditis, and in which clinical scenarios myocarditis should be suspected as a diagnosis. They also outline the situations in which a patient should be referred for cardiac transplantation or mechanical circulatory support, as well as the guidelines for clinical follow-up.

2009 Canadian Cardiovascular Society Guidelines on Myocarditis

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Class I Myocarditis should be suspected in the following clinical scenarios: (Level of evidence: C) Cardiogenic shock due to LV systolic dysfunction (global or regional), where etiology is not apparent. Acute or subacute development of LV systolic dysfunction (global or regional), where etiology is not apparent. Evidence of myocardial damage not attributable to epicardial coronary artery disease or another cause. Referral to a centre with experience and expertise in the assessment and management of myocarditis should be considered for patients with suspected myocarditis (Level of evidence: C). Urgent referral for evaluation/consideration for cardiac transplantation or mechanical circulatory support should be considered for patients with heart failure and evidence of resulting progressive clinical deterioration or end-organ dysfunction (Level of evidence: C). Referral for further evaluation/consideration for transplantation or mechanical circulatory support should be considered for patients who remain in severe heart failure following implementation of standard heart failure therapy (Level of evidence: C). Best medical therapy, including supportive care is recommended for the treatment of myocarditis (Level of evidence: C). Class IIa Expert clinical follow-up is required until myocarditis is determined to be resolved or until a chronic management plan is in place (Level of evidence: C). Class III Routine use of general or specific immunological therapies directed toward myocarditis are not recommended, as this has not been shown to alter outcomes, and may lead to side effects or complications (Level of evidence: B).

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Sources

• Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials.