Fulminant myocarditis (FM) is an uncommon syndrome characterized by sudden and severe diffuse cardiac inflammation often leading to death resulting from cardiogenic shock, ventricular arrhythmias, or multiorgan system failure. Historically, FM was almost exclusively diagnosed at autopsy. By definition, all patients with FM will need some form of inotropic or mechanical circulatory support to maintain end-organ perfusion until transplantation or recovery. Specific subtypes of FM may respond to immunomodulatory therapy in addition to guideline-directed medical care. Despite the increasing availability of circulatory support, orthotopic heart transplantation, and disease-specific treatments, patients with FM experience significant morbidity and mortality as a result of a delay in diagnosis and initiation of circulatory support and lack of appropriately trained specialists to manage the condition. This scientific statement outlines the resources necessary to manage the spectrum of FM, including extracorporeal life support, percutaneous and durable ventricular assist devices, transplantation capabilities, and specialists in advanced heart failure, cardiothoracic surgery, cardiac pathology, immunology, and infectious disease. Education of frontline providers who are most likely to encounter FM first is essential to increase timely access to appropriately resourced facilities, to prevent multiorgan system failure, and to tailor disease-specific therapy as early as possible in the disease process.

中文翻译：

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恶性心肌炎的认识和初步处理：美国心脏协会的科学声明。

暴发性心肌炎（FM）是一种罕见的综合症，其特征是突发性和严重性弥漫性心脏炎症，通常会因心源性休克，室性心律不齐或多器官系统衰竭而导致死亡。从历史上看，FM几乎完全是在尸检时诊断出来的。根据定义，所有FM患者都需要某种形式的正性肌力或机械循环支持，以维持终末器官灌注直至移植或恢复。FM的特定亚型除了针对指南的医疗服务外，可能还会对免疫调节疗法产生反应。尽管循环支持，原位心脏移植和针对疾病的治疗方法的可用性不断提高，由于诊断和循环支持的延迟以及缺乏适当培训的专家来管理该病，FM病人的发病率和死亡率都很高。该科学陈述概述了管理FM频谱所需的资源，包括体外生命支持，经皮和耐用的心室辅助设备，移植能力以及晚期心力衰竭，心胸外科，心脏病理学，免疫学和传染病的专家。对最有可能首先遇到FM的一线医务人员进行教育对于增加及时使用适当资源的设施，防止多器官系统衰竭以及在疾病过程中尽早进行针对疾病的治疗至关重要。