American College of Cardiology Issues Guide for Diagnosing and Managing Myocarditis - American College of Cardiology

Contact: Olivia Walther, [email protected],

WASHINGTON (Dec 10, 2024) -

The American College of Cardiology has issued guidance for the diagnosis and management of acute myocarditis in adult patients, delivering a streamlined decision-making framework that reflects recent advancements in clinical practice. The Expert Consensus Decision Pathway (ECDP) incorporates the latest evidence to support clinicians at the point of care, offering tailored strategies that account for genetic and social determinants of health factors.

Key highlights include a novel 4-stage classification of myocarditis; strategies for diagnosis, risk stratification, and longitudinal surveillance of patients; guidance on safe return-to-exercise protocols; and identification of knowledge gaps and priorities for future research to advance myocarditis care.

Myocarditis is an inflammation of the heart muscle, or the myocardium. It can impair the heart's ability to pump blood and may cause irregular heart rhythms, or arrhythmias. It is one of the causes of dilated cardiomyopathy or a weak heart. When severe, the condition disrupts blood flow to the rest of the body and results in cardiogenic shock or death. Although rare, myocarditis affects thousands of Americans each year.

Though patients with myocarditis can present with diverse signs including just having vague symptoms, the ECDP highlights three classic presentations: chest pain, symptoms related to arrhythmia such as palpitations or syncope, or symptoms of heart failure (HF)/cardiogenic shock.

"The evaluation and management of a patient with clinically suspected myocarditis is described as a 5-step pathway in the ECDP. The initial step for a clinician is to recognize the condition by being aware of its three classic presentations as outlined in the ECDP," said Mark H. Drazner, MD, MSc, FACC, writing committee chair and Clinical Chief of Cardiology at the University of Texas Southwestern Medical Center. "Once a patient is diagnosed, clinicians can then follow the next 4 steps in the care pathway, including triaging the patient, obtaining pivotal diagnostic tests, providing appropriate therapies, and then longitudinal follow-up."

"Another novel aspect of the ECDP is a proposed 4-stage classification of patients with myocarditis," said Drazner. "This structure, stages A through D, should be familiar to clinicians as it is similar to those previously proposed for other cardiac conditions, such as heart failure or valvular heart disease." The ECDP then provides recommendations for surveillance and treatment for each of these 4 stages of myocarditis.

The ECDP addresses the importance of advanced imaging and endomyocardial biopsy (EMB) when confirming a diagnosis of myocarditis. It provides detailed guidance on identifying the indications and appropriate timing for referring patients to advanced HF centers and potential therapies available for those with advanced myocarditis. The document also provides comprehensive recommendations for the pharmacological treatment of myocarditis, highlights the need for ongoing patient monitoring and follow-up, and underscores the increasing significance of genetic predisposition in influencing myocarditis risk, progression, and outcomes.

The 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis will be published in JACC, the flagship journal of the American College of Cardiology.

The American College of Cardiology(ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family ofJACCJournals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring aworld where science, knowledge and innovation optimize patient care and outcomes.Learn more at www.ACC.orgor follow @ACCinTouch.

The ACC's JACC Journals rank among the top cardiovascular journals in the world for scientific impact. The flagship journal, the Journal of the American College of Cardiology (JACC) - and specialty journals consisting of JACC: Advances, JACC: Asia, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Case Reports, JACC: Clinical Electrophysiology and JACC: Heart Failure - pride themselves on publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

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