Management of myopericarditis

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.