Diagnostics and approaches to therapy of acute heart failure caused by myocarditis of various origin: a case series
https://doi.org/10.15829/1560-4071-2025-6311
EDN: FOWZRX
Abstract
Myocarditis, due to the heterogeneity of manifestations and, quite often, the course unpredictability, is one of the most difficult for timely diagnosis of disease groups in modern cardiology. At the same time, myocardial inflammatory diseases often have a severe course, requiring hospitalization, monitoring and treatment in the intensive care unit, mechanical circulatory support, temporary cardiac pacing, artificial ventilation, renal replacement therapy, etc. The paper presents the experience of treating patients admitted to the Kommunarka Multidisciplinary Clinical Center with acute left ventricular failure and arrhythmias caused by myocarditis of various origin. The approach to initial therapy and differential diagnosis is described.
About the Authors
A. Yu. LebedevaRussian Federation
Moscow
Competing Interests:
none
D. A. Kurenkov
Russian Federation
Moscow
Competing Interests:
none
R. S. Ilchenko
Russian Federation
Moscow
Competing Interests:
none
D. V. Drogashevskaya
Russian Federation
Moscow
Competing Interests:
none
V. M. Balan
Russian Federation
Moscow
Competing Interests:
none
M. A. Baidaev
Russian Federation
Moscow
Competing Interests:
none
References
1. Frustaci A, Alfarano M, Verardo R, et al. Myocarditis-associated necrotizing coronary vasculitis: incidence, cause, and outcome. Eur Heart J. 2021;42(16):1609-17. doi:10.1093/eurheartj/ehaa973.
2. Arutyunov GP, Paleev FN, Moiseeva OM, et al. 2020 Clinical practice guidelines for Myocarditis in adults. Russian Journal of Cardiology. 2021;26(11):4790. (In Russ.) doi:10.15829/1560-4071-2021-4790.
3. Johnson DB, Balko JM, Compton ML, et al. Fulminant Myocarditis with Combination Immune Checkpoint Blockade. N Engl J Med. 2016;375(18):1749-55. doi:10.1056/NEJMoa1609214.
4. Varricchi G, Galdiero MR, Marone G, et al. Cardiotoxicity of immune checkpoint inhibitors. ESMO Open. 2017;2(4):e000247. doi:10.1136/esmoopen-2017-000247.
5. Błyszczuk P. Myocarditis in Humans and in Experimental Animal Models. Front Cardiovasc Med. 2019;6:64. doi:10.3389/fcvm.2019.00064.
6. Palaskas N, Lopez-Mattei J, Durand JB, et al. Immune Checkpoint Inhibitor Myocarditis: Pathophysiological Characteristics, Diagnosis, and Treatment. J Am Heart Assoc. 2020;9(2): e013757. doi:10.1161/JAHA.119.013757.
7. Zotova L. Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases. Diagnostics (Basel). 2023;13(7):1243. doi:10.3390/diagnostics13071243.
8. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48. doi:10.1093/eurheartj/eht210.
9. Drazner MH, Bozkurt B, Cooper LT, et al. 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2025;85(4):391-431. doi:10.1016/j.jacc.2024.10.080.
10. Butorova EA, Stukalova OV. Case report: role of cardiac MRI in the diagnosis of myocarditis. Eurasian heart journal. 2023;(3):90-4. (In Russ.) doi:10.38109/22251685-2023-3-90-94.
11. Kushnareva EA, Moiseeva OM. Immune checkpoint inhibitor myocarditis: a systematic case study. Russian Journal of Cardiology. 2020;25(11):3910. (In Russ.) doi:10.15829/29/1560-4071-2020-3910.
12. Jyothi Ramachandran Nair DP, Zachariah S, Scollan D, et al. Myocarditis: A Rare Complication of Immune Checkpoint Inhibitor Therapy. Cureus. 2024;16(5):e60459. doi:10.7759/cureus.60459.
13. Khidirova LD, Latsvieva AE, Vederin AV. Cardiotoxicity mechanisms of antitumor therapy with immune checkpoint inhibitors: new achievements. Rational Pharmacotherapy in Cardiology. 2024;20(2):265-74. (In Russ.) doi:10.20996/1819-6446-2024-3022.
Supplementary files
- In the first case, the patient had suggested bacterial myocarditis, complicated by atrial fibrillation, cardiogenic shock, and circulatory arrest.
- In the second case, the patient’s myocarditis simulated acute coronary syndrome.
- In both cases, endomyocardial biopsy was not performed, and the diagnosis and appropriate treatment were made based on clinical data and ruling out other cardiomyopathy causes.
Review
For citations:
Lebedeva A.Yu., Kurenkov D.A., Ilchenko R.S., Drogashevskaya D.V., Balan V.M., Baidaev M.A. Diagnostics and approaches to therapy of acute heart failure caused by myocarditis of various origin: a case series. Russian Journal of Cardiology. 2025;30(10S):6311. (In Russ.) https://doi.org/10.15829/1560-4071-2025-6311. EDN: FOWZRX







































