Very ill pt with potential myocarditis

  My sincere appreciation for fielding my question.  My loved-one is a 52 y.o. WM with a family history of heart disease, but no personal past history of cardiac problems. PMHX includes gall stones, DVT (years ago).
  Approx 2 months ago he begin experiencing mild fatigue, pedal edema nocturnal dyspnea and orthopnea.  Intermittent CP with radiation into the left arm in also noted.  Current meds include Lidocaine, Dig, Dopamine Drip Vasotec.
  He was evaluated 7/25 with significant finding to include elevated HR (ranges from 100 to 130),  BP 140/90 RR 20.  There is a servere S3 gallop and decreased breath sounds bilat. ECG reveal a normal sinus rhythm, incomplete RBBB, diffuse nonspecific ST-T segment changes and PVC's. CXR (-). Echocardiogram revealed a 30% EF. Cardiac Cath 7/26 revealed no stenosis or blockage (no biopsy was conducted.)
  He is currently being transferred to Jackson Memorial in Miami for further evaluation. The best diagnosis I could muster from the physician might be a viral myocarditis. Apparently he is a potential transplant candidate.
  Do you think he might improve with conservative care?  Any prognostic ideas or intelligent questions for the next physician team would be appreciated.

[Cleveland Clinic, MD]

Dear Kirk,
Topic Area: Heart Failure
Thank you for your question.  Viral myocarditis is a infection of the heart that leads to heart failure.  The mode of transmission is unknown and in the majority of cases the viral agent is also unknown.  In order to make this diagnosis there must be no significant blockages of the coronary arteries on coronary angiogram to exclude ischemic (lack of blood flow) myocarditis.
About a third of patients with viral myocarditis get worse, a third stay the same and a third get better.  There is no way to tell what group an individual is in except to wait and see.  There is no treatment of viral myocarditis per se.  The symptoms and the heart failure are treated with ACE inhibitors, diuretics, and digoxin.  Pressor agents (i.e dopamine, dobutamine, milrinone, nitroprusside) are used in seriously ill individuals.  Cardiac transplant is an option for some individuals.  
Hope this information helps you.  Let us know how things turn out.
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.