Management of Myopericarditis

Massimo Imazio; Leslie T Cooper

Disclosures

Expert Rev Cardiovasc Ther. 2013;11(2):193-201. 

In This Article

Abstract and Introduction

Abstract

Myopericarditis is a primarily pericardial inflammatory syndrome occurring when clinical diagnostic criteria for pericarditis are satisfied and concurrent mild myocardial involvement is documented by elevation of biomarkers of myocardial damage (i.e., increased troponins). Limited clinical data on the causes of myopericarditis suggest that viral infections are among the most common causes in developed countries. Cardiotropic viruses can cause pericardial and myocardial inflammation via direct cytolytic or cytotoxic effects and/or subsequent immune-mediated mechanisms. Many cases of myopericarditis are subclinical. In other patients, cardiac symptoms and signs are overshadowed by systemic manifestations of infection or inflammation. The increased sensitivity of troponin assays and contemporary widespread use of troponins has greatly increased the reported number of cases. Management is similar to that reported for pericarditis, generally with a reduction of empiric anti-inflammatory doses mainly aimed at the control of symptoms. Rest and avoidance of physical activity beyond normal sedentary activities has been recommended for 6 months, is recommended as for myocarditis. At present, there is no evidence that troponin elevation confers worse prognosis (i.e., a greater risk of recurrence, death or transplantation) in patients with preserved left ventricular function. Usually complete remission is seen in 3–6 months.

Introduction

In clinical practice, pericarditis is often accompanied by some degree of myocardial involvement, which is generally manifested by elevation of cardiac troponins.[1] The main reason for these findings is that pericarditis and myocarditis are not completely separate entities, and may share common etiological agents (especially viruses) and a spectrum of myopericardial inflammatory syndromes is encountered in clinical practice,[2] ranging from pure pericarditis to mixed forms with increasing myocardial involvement, often referred to as 'myopericarditis' and 'perimyocarditis'.[2–5] Such syndromes are rarely of equal intensity in their clinical manifestations. Most patients present with either primarily myocarditic or pericarditic symptoms. Although the terms 'myopericarditis' and 'perimyocarditis' are often used interchangeably, these two terms have been designated to distinguish primarily pericarditic syndromes (myopericarditis) from primary myocarditic disease (perimyocarditis).[2] The myocardial involvement is generally more evident and prominent in pediatric cases and in younger adults, especially males. In clinical practice and the literature, the term myopericarditis is somewhat more euphonious and commonly used to describe the entire spectrum of pericarditis associated with myocardial damage.[2,5,6]

The aim of the present review is to analyze the current available evidence on the etiology, definition, diagnosis, management and prognosis of myopericarditis with a focus on more recent publications within the last 5 years. Potentially relevant studies published up to September 2012 were searched in BioMed Central, the Cochrane Collaboration Database of Randomized Trials, ClinicalTrials.gov, EMBASE, Google Scholar, MEDLINE/PubMed and Scopus. Articles were selected on the basis of their clinical relevance and potential impact on disease management.

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