Browse categories and answer follow-up questions to refine your symptom profile.
Immediate priorities
High-risk myocarditis states
Cardiogenic shock
SCAI shock stage C to E framework
Malignant arrhythmia
Sustained VT
VF
High-grade AV block
Fulminant myocarditis phenotype
Rapid onset heart failure within 2 weeks of viral-like illness
Severe hemodynamic compromise despite limited time course
Myopericarditis with tamponade concern
Hypotension with elevated JVP and muffled heart sounds
Monitoring and access
Continuous ECG monitoring
Defibrillator pads in place for unstable rhythm risk
Two large-bore IV lines
Central access if vasoactive infusion anticipated
Arterial line if shock or vasoactive titration
MAP target per perfusion and lactate trend
Time-critical tests
12-lead ECG within 10 minutes for chest pain equivalent
STEMI pathway activation if criteria met
High-sensitivity troponin serial strategy
Dynamic change supports acute myocardial injury
Point-of-care ultrasound focused cardiac exam
LV systolic function estimate
RV size and function estimate
Pericardial effusion with tamponade physiology
Immediate escalation triggers
If shock with suspected myocarditis, early cardiology and ICU
Mechanical circulatory support capability discussion
If sustained VT or VF, ACLS with reversible cause workup
Consider myocarditis as non-ischemic trigger
If high-grade AV block with instability, transcutaneous pacing
Transition to transvenous pacing if persistent
Hemodynamic goals
Perfusion targets
MAP at least 65 mmHg for most adults
Higher target if chronic hypertension or ongoing ischemia concern
Urine output at least 0.5 mL/kg/hour
Trend with creatinine and lactate
Lactate downtrend over 2 to 6 hours
Persistent elevation suggests inadequate flow or sepsis overlap
Ventilation and oxygenation targets
SpO2 92 to 96 percent for most
Avoid hyperoxia when stable
If ABG obtained, PaO2 adequate for clinical state
Use mmHg for PaO2 and PaCO2 reporting
Fluid strategy
Cautious bolus approach if pulmonary edema risk
Small aliquots 250 mL with reassessment
Early diuresis if congestion with preserved perfusion
Loop diuretic strategy in treatment section
Risk stratification and pathway
ACC myocarditis pathway concepts
Classic presentation clusters
Chest pain syndrome mimicking ACS
New or worsening heart failure or shock
Arrhythmia or conduction disease
Etiology categories
Viral or post-viral
Autoimmune or inflammatory
Hypersensitivity or eosinophilic
Giant cell
Sarcoid
Immune checkpoint inhibitor myocarditis
Admission level-of-care triggers
ICU level of care criteria
Vasoactive support requirement
Rising lactate or escalating oxygen requirement
Sustained ventricular arrhythmia
High-grade AV block
Stepdown criteria
Stable vitals without vasoactive support
No malignant rhythm and stable conduction
No rapid biomarker rise after initial evaluation
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.