Nipah virus infection can manifest through several severe syndromic presentations. Myocarditis is one of these recognised complications and carries acute haemodynamic risk that requires targeted management alongside general supportive care.

Clinical Scenario

This protocol applies to patients with confirmed or suspected Nipah virus infection who develop myocarditis — a serious cardiac complication reported alongside ARDS and encephalitis as a syndromic presentation of the disease. The myocarditis presentation creates an acute heart failure picture requiring specific haemodynamic intervention.

Treatment Approach (overview)

Management is supportive and focuses on the haemodynamic consequences of acute heart failure. The approach involves a combination of agents targeting preload, afterload, and cardiac output, with agent selection and titration determined by the patient's blood pressure status and evolving clinical response.

Agent selection criteria, titration thresholds, combination strategies, and escalation guidance are detailed in the full structured protocol.

References

The syndromic presentations are ARDS, Myocarditis and Encephalitis.
Supportive therapy for symptoms of acute heart failure with use of diuretics, nitroprusside, ACE inhibitors.
Inotropes — Dobutamine: 2–5 micrograms/kg/min, titrated up to 20 micrograms/kg/min — inotrope and potential vasodilator; lowers blood pressure; give as individual agent as long as systolic blood pressure (SBP) ≥90. Can use with dopamine.
Dopamine: 3–5 micrograms/kg/min, titrated up to 20 micrograms/kg/min as needed — inotrope and vasoconstrictor; increases left ventricular end-diastolic pressure and causes tachycardia. Can be used with dobutamine.
Norepinephrine: 2–50 micrograms/min (0.02–2 micrograms/kg/minute), titrate to response — vasoconstrictor and inotrope; preferred as a single agent over dobutamine if SBP <70. Can use combined with dobutamine.

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Treatment of Nipah Virus Infection in Myocarditis

References