FULMINANT MYOCARDITIS: EVIDENCE-BASED MANAGEMENT AND TREATMENT STRATEGIES

Abstract

Fulminant myocarditis is a rare and severe form of myocardial inflammation, characterized by abrupt onset and rapid progression to acute heart failure and cardiogenic shock, associated with high mortality when diagnosis and treatment are delayed (Ammirati et al., 2020; Tschöpe et al., 2021). This study aims to critically review the current evidence on the management and treatment of fulminant myocarditis. This is a narrative review of the literature, conducted through a search of the PubMed database, including articles published in the last five years in Portuguese and English. The evidence indicates that diagnosis should be rapid and guided by clinical severity, with cardiac magnetic resonance imaging being the main noninvasive method, while endomyocardial biopsy remains essential in fulminant cases for etiological definition and therapeutic guidance (Ammirati et al., 2020; Tschöpe et al., 2021). Treatment is based on intensive hemodynamic support, with early use of mechanical circulatory support, especially venoarterial extracorporeal membrane oxygenation, associated with ventricular unloading strategies (Ammirati et al., 2020). Immunosuppression has proven benefits in specific subtypes, but remains controversial in virus-negative lymphocytic forms (Lampejo et al., 2021). It is concluded that the management of fulminant myocarditis requires accurate etiological diagnosis, early intervention, and treatment in specialized centers.