Fulminant myocarditis is a rare and severe presentation of acute myocarditis. When it precipitates cardiogenic shock, it constitutes a haemodynamic emergency requiring immediate, structured management to restore perfusion and prevent end-organ failure.
This protocol targets patients with acute myocarditis presenting as fulminant myocarditis complicated by cardiogenic shock — defined by haemodynamic instability and evidence of inadequate end-organ perfusion.
Immediate circulatory support is the cornerstone of management. Mechanical support of the failing heart is central, with a defined first-line device strategy and clear criteria for escalation. In specific subtypes — where an underlying non-infectious aetiology is established — additional disease-modifying therapy is part of the approach. The complete algorithm, escalation thresholds, and subtype-specific options are in the full protocol.
DOI: 10.1093/eurheartj/ehaf192
Fulminant myocarditis is a rare and severe presentation of myocarditis and a cause of cardiogenic shock, and should be treated accordingly with inotropic or vasopressor support or, if needed, MCS (see Section 6.3).
An intra-aortic balloon pump (IABP) should be considered in cardiogenic shock as first-line MCS with prompt escalation to more powerful MCS if haemodynamic and end-organ perfusion improvement is not observed within a short time (1 h maximum).
Corticosteroids should be considered in patients with fulminant, non-infectious forms of myocarditis to stabilize the patients.
Specific subtypes of FM (e.g. biopsy-proven non-infectious forms) may respond to immunosuppressive therapy in addition to guideline-directed medical care.
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