Cafario et al reported criteria for when to suspect myocarditis. The authors are from multiple institutions in Europe participating in a European Society of Cardiology Working Group.
Parameters:
(1) clinical presentation (symptoms), see below
(2) diagnostic criteria, see below
(3) exclusions, see below
Clinical presentation:
(1) acute chest pain, pericarditic or pseudo-ischemia
(2) one or both of the following with or without signs of heart failure
(2a) worsening of dyspnea (at rest or exercise)
(2b) worsening of fatigue
(3) one or more of the following:
(3a) palpitations
(3b) unexplained arrhythmia
(3c) syncope
(3d) aborted sudden cardiac death
(4) unexplained cardiogenic shock
where:
• Symptoms may be new onset (<= 3 months) or subacute/chronic (> 3 months).
Diagnostic criteria:
(1) new abnormality on ECG or Holter monitor or stress test (atrioventricular block, ST or T wave changes, sinus arrest, ventricular tachycardia or fibrillation, asystole, atrial fibrillation, reduced R wave height, intraventricular conduction delay, abnormal Q wave, low voltage, frequent PVCs, supraventricular tachycardia)
(2) elevated serum troponin concentration (marker of myocardiocytolysis)
(3) functional and structural abnormality on cardiac imaging that is new and unexplained (structural or functional abnormality in left or right ventricle, regional wall motion abnormality, with or without: ventricular dilatation, increased wall thickness, pericardial effusion, endocavitary thrombi)
(4) edema and/or LGE (T1-weighted late gandolinium enhancement) on cardiovascular magnetic resonance imaging
Exclusions - one or more of the following:
(1) coronary artery disease on angiography with >= 50% stenosis
(2) known pre-existing cardiovascular disease
(3) known extra-cardiac condition that could explain symptoms
|
Clinical
|
Diagnostic Criteria
|
Exclusion(s)
|
Suspect Myocarditis
|
|
>= 1
|
>= 1
|
0
|
yes
|
|
0
|
>= 2
|
0
|
yes
|
|
>= 1
|
0
|
0
|
possible
|
|
0
|
1
|
0
|
possible
|
|
0
|
0
|
0
|
no
|
|
NA
|
NA
|
>= 1
|
no
|
Ancillary features that may support the clinical suspicion:
(1) fever >= 38°C within previous 30 days with or without signs of respiratory or gastroinetesinal infection
(2) peripartum period
(3) previous myocarditis
(4) personal and/or family history of allergic asthma, allergy or autoimmune disease
(5) personal exposure to toxin
(6) family history of myocarditis or dilated cardiomyopathy
