Diagnosing and Treating Pericarditis and Myocarditis in the Emergency Department

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Delivery Method:	Online
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Publication Date: July 2023 (Volume 25, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 07/01/2026.

Authors

Peer Reviewers

Abstract

Pericarditis and myocarditis represent a challenging set of diseases to diagnose and treat. These diseases typically present with chest pain and dyspnea in previously healthy young people, often in the weeks following a viral illness, including COVID-19. Nonetheless, the etiologies can be very diverse, including infectious, noninfectious, drug-induced, and autoimmune causes. This review focuses on the evaluation, diagnosis, and management of emergency department patients presenting with pericarditis and myocarditis and summarizes current guidelines and best-practice medical management strategies in order to avoid potential life-threatening cardiac complications.

Case Presentations

A 30-year-old man, who is otherwise healthy, presents with chest pain that has been present and progressive for the last 3 days…

• He reports having had a mild viral-like illness 1 week ago.
• The patient appears mildly volume-overloaded on examination, with a temperature of 38.1°C, heart rate of 105 beats/min, blood pressure of 125/74 mm Hg, and oxygen saturation of 98%.
• You suspect a viral syndrome but wonder whether a troponin and electrocardiogram are indicated...

A 22-year-old woman who was diagnosed with suspected myocarditis 1 month ago returns to the ED with a cough…

• She is well in appearance, with a normal chest x-ray and negative rapid viral testing today.
• Her temperature is 37°C; heart rate, 72 beats/min; blood pressure, 110/80 mm Hg; and oxygen saturation, 99%.
• She is a college athlete and says she would like to return to activity. She looks well, but you wonder whether she needs further testing and whether it is safe for her to return to sports...

EMS arrives with a 40-year-old man who suffered an out-of-hospital cardiac arrest…

• The patient was found to be in VTACH and was brought into the ED, now with return of spontaneous circulation following 2 defibrillations.
• EMS reports that the man’s family said he was otherwise healthy, aside from a recent viral illness.
• His temperature is 37°C; heart rate, 32 beats/min; blood pressure, 80/45 mm Hg; and oxygen saturation, 90%.
• He is poorly responsive, with a third-degree heart block and markedly reduced ejection fraction seen on bedside ultrasound.
• You wonder: why would such a young man have a cardiac arrest? What treatments should be initiated immediately, and what additional specialty services might this patient require?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.