Diagnosis
Cardiac MRI
Figure caption: Cardiovascular magnetic resonance criteria for myocarditis (Lake Louise Criteria) in the same patients: regional myocardial edema (top left), hyperemia in images acquired early after contrast injection (top right), and inflammatory necrosis in images acquired late (>10 minutes) after contrast injection (bottom). All 3 criteria are positive. (Source)
Myopericarditis
- Nomenclature: Pericarditis with known or clinically suspected concomitant myocardial involvement should be referred to as ‘myopericarditis’, while predominant myocarditis with pericardial involvement should be referred to as ‘perimyocarditis’, according to Task Force consensus.
- The diagnosis of predominant pericarditis with myocardial involvement, or ‘myopericarditis’, can be clinically established if patients with definite criteria for acute pericarditis show elevated biomarkers of myocardial injury (troponin I or T, CK-MB fraction) without newly developed focal or diffuse impairment of left ventricular function in echocardiography or CMR.
- Think perimyocarditis if evidence of new-onset focal or diffuse reduction of left ventricular function in patients with elevated myocardial biomarkers and clinical criteria for acute pericarditis
- Diagnosis
- Cath
- r/o ACS
- Cardiac MRI
- Confirm myocardial involvement and r/o ischemic myocardial necrosis in absence of significant CAD
- Cath
- Management
- Similar to acute pericarditis, but activity restriction extends to at least 6 months