Chest pain 1 If ischemia ruled out and pain is pleuritic or underlying inflammation present e g costochondritis Consider 1 to 2 wk NSAID trial w low dose colchicine added prn If sx worsen w NSAID consider esophagitis esophageal spasm If suspected endothel

By rray, 3 June, 2024
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Mild moderate myocarditis Manage in hospital w advanced cardiac expertise If concurrent lung injury steroids If pericardial involvement NSAIDs colchicine or prednisone If reduced LVEF Treat HF Avoid vigorous physical activity x3 6mo repeat cardiac testing
Severe myocarditis Manage in hospital w advanced cardiac expertise If severe concurrent lung injury hemodynamic compromise MIS A or severe myocardial infiltrates fulminant myocarditis on bx steroids balanced against infection risk If reduced LVEF Treat HF
Suspected pericardial involvement w o myocarditis Can likely manage as out pt if chest pain is only sx LV systolic function preserved no ventricular arrhythmias If pericardial involvement NSAIDs colchicine or prednisone Monitor closely Consider repeat car
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<b>Chest pain:<sup>1</sup></b> If ischemia ruled out, and pain is pleuritic or underlying inflammation present (e.g., costochondritis): Consider 1- to 2-wk NSAID trial, w/ low-dose <a href=https://online.epocrates.com/e/deeplink/drugs/10a97/colchicine><u>colchicine</u></a> added prn. If sx worsen w/ NSAID, consider esophagitis, esophageal spasm. If suspected endothelial dysfunction: Consider CCB, long-acting nitrate, or <a href=https://online.epocrates.com/e/deeplink/drugs/10a4343/ranolazine><u>ranolazine</u></a>. For underlying ASCVD: aspirin and high-intensity statin. If persistent chest pain refractory to other tx or if microvascular dysfunction suspected: Some supplements may help. Beetroot extract taken 1h before exercise for max vasodilation, or L-arginine 4 mg bid.