Myocarditis registry-Topic Video

Video Transcription

Video Summary

Myocarditis is difficult to diagnose because the gold standard, myocardial biopsy, is invasive and usually not ideal in often young, otherwise healthy patients. Symptoms can mimic MI or heart failure, including chest pain, dyspnea, fatigue, ECG changes, and even cardiogenic shock. Because of the low specificity of older methods, cardiac MRI (CMR) has become central. The Lake Louise criteria diagnose myocarditis when two of three findings are present: edema, hyperemia, and necrosis/fibrosis. T2/STIR edema imaging and late gadolinium enhancement are most useful; early enhancement is now used less often. Functional findings like reduced ejection fraction and pericardial effusion also help with prognosis. CMR can distinguish myocarditis from infarction by its patchy, non-coronary distribution and sparing of the endomyocardium. Repeat CMR after 1–4 weeks may improve detection and prognostic assessment, and newer techniques like T1 mapping may further improve diagnosis.

Keywords

myocarditis

cardiac MRI

Lake Louise criteria

late gadolinium enhancement

T1 mapping