Management of Fulminant Myocarditis in Infants
Initial Assessment and Stabilization
- The European Society of Cardiology recommends immediate transfer to a center with experience in advanced heart failure and mechanical circulatory support, initiating aggressive hemodynamic support with inotropics while preparing for percutaneous mechanical circulatory support (ECMO or percutaneous cardiopulmonary support) if not responding rapidly to pharmacological therapy 1, 2, 4
- The American Heart Association suggests starting dopamine at 5 mcg/kg/min, gradually increasing in increments of 5-10 mcg/kg/min up to 20-50 mcg/kg/min based on hemodynamic response 5
Mechanical Circulatory Support
- The European Heart Journal recommends initiating mechanical circulatory support urgently if cardiogenic shock does not reverse rapidly with pharmacological therapy, or if there is refractory ventricular tachycardia or fibrillation 1, 2, 4, 6
- The American College of Cardiology suggests considering percutaneous cardiopulmonary support if ventricular tachycardia or fibrillation is refractory to defibrillation 1, 2, 4
Monitoring and Management of Arrhythmias
- The European Heart Journal recommends continuous electrocardiographic monitoring and insertion of a temporary pacemaker if symptomatic or high-grade atrioventricular block triggers ventricular tachyarrhythmias 1, 2, 4
- The American Heart Association suggests considering permanent pacemaker implantation if atrioventricular block persists, selecting the device based on the presence and prognosis of ventricular dysfunction 1, 2, 4
Medical Therapy
- The American College of Cardiology recommends starting ACE inhibitors with low doses (e.g., captopril 1-6.25 mg) if systolic blood pressure is >100 mmHg 6, 1, 2, 3, 4
- The European Society of Cardiology suggests using beta-blockers only if hemodynamically stable, avoiding in overt heart failure with pulmonary congestion or low output 6, 1, 2, 3