Outcome-Based Clinical Training on Myocarditis for Physicians from Residents to Board-Certified Pediatric Cardiologists

Abstract

Here we describe outcome-based clinical training on myocarditis based on the achievement level of the physicians as follows: epidemiology, symptoms, blood examinations, imaging, pharmacotherapy, treatment devices, and prognosis. The mortality rate of fatal myocarditis is 0.46 per 10 million patients. Fulminant myocarditis should be considered based on the clinical findings, including any neurological or gastric symptoms. It is useful in the identification of advanced myocarditis to observe temporal changes from electrocardiography or blood examinations. Echocardiography sometimes demonstrates poor systolic function or pericardial effusion, which are specific findings in advanced myocarditis, and are also easy findings for residents to understand. Magnetic resonance imaging and nuclear medicine are minimally invasive diagnostic modalities and are available for the evaluation of impaired myocardium during the clinical course after the acute phase. Electrophysiological studies can be performed on patients if they still have arrhythmias during the convalescent phase. Venoatrial extracorporeal membrane oxygenation should be initiated using clear criteria from each institution for weaning off the device if the patients suffer from low output or fatal arrhythmias. The utility of intraaortic balloon pumping for children is still controversial. We have no clear consensus concerning the usefulness of steroid or immunoglobulin therapy. Patients who develop fulminant myocarditis do not always have an unfavorable prognosis if they can survive sudden terrible disease in acute phase.