Treatment for ST Elevation Myocarditis

Initial Management

The American College of Cardiology recommends aspirin as the primary anti-inflammatory treatment for ST elevation myocarditis presenting with pericarditis 1, 2
Cardiac imaging with echocardiography should be performed during hospital stay to assess ventricular function, detect mechanical complications, and exclude left ventricular thrombus, as recommended by the European Heart Journal 3

The American College of Cardiology recommends colchicine 0.6 mg every 12 hours orally as a reasonable addition for cases not adequately controlled with aspirin alone 1, 2
Acetaminophen 500 mg orally every 6 hours can be added if pain control is inadequate with aspirin and colchicine, according to the American College of Cardiology 1, 2
Narcotic analgesics may be considered if pain remains uncontrolled despite aspirin, colchicine, and acetaminophen, as suggested by Circulation 2

The American College of Cardiology and Circulation recommend avoiding glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) for treatment of pericarditis after STEMI, as they are potentially harmful 1, 2
If NSAIDs must be used for pain relief, they should not be used for extended periods due to their effects on platelet function and increased risk of myocardial scar thinning and infarct expansion, according to the American College of Cardiology 1

The European Heart Journal recommends ACE inhibitors within the first 24 hours for patients developing heart failure 3
Beta-blockers are indicated in patients with heart failure and/or LVEF < 40% unless contraindicated, as recommended by the European Heart Journal and Circulation 3, 4
High-intensity statin therapy should be initiated or continued in all patients with no contraindications, according to Circulation 5, 6
For patients with cardiogenic shock, emergency revascularization with either PCI or CABG is recommended if suitable, as suggested by Circulation 2, 5
Intra-aortic balloon pump counterpulsation can be useful for patients who don't quickly stabilize with pharmacological therapy, according to Circulation 2, 5
Alternative left ventricular assist devices may be considered in patients with refractory cardiogenic shock, as recommended by Circulation 2, 5

Left ventricular ejection fraction should be measured in all patients, according to Circulation 4
Patients with initially reduced LV ejection fraction who are candidates for implantable cardioverter-defibrillator therapy should undergo reevaluation of LV ejection fraction 40 or more days after discharge, as recommended by Circulation 4
Exercise-based cardiac rehabilitation programs are recommended for recovery, according to Circulation 4