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8 Inflammatory myopericardial

syndrome overlapping types: myopericarditis and perimyocarditis

IMPS includes a spectrum of inflammatory diseases from isolated myocarditis to isolated pericarditis through a combination of both. IMPS should be used as an umbrella term, also covering overlapping forms of myocarditis and pericarditis.1 The diagnosis of predominant pericarditis with myocardial involvement, or ‘myopericarditis’, can be clinically established if patients with definite criteria for AP show elevated biomarkers of myocardial injury, without newly developed focal or diffuse impairment of LV function on TTE or CMR. The term myopericarditis indicates a primarily pericarditic syndrome with minor myocardial involvement, which describes the majority of combined pericarditis and myocarditis cases encountered in clinical practice. On the other hand, evidence of new-onset focal or diffuse reduction of LV function in patients with elevated myocardial biomarkers, and clinical criteria for AP, suggests predominant myocarditis with pericardial involvement,

 


     
	




 



 


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Figure 17 Follow-up and risk stratification after acute myocarditis with arrhythmic presentation. ICD, implantable cardioverter-defibrillator; LGE, late gadolinium enhancement; LV, left ventricle; LVEF, left ventricular ejection fraction; NSVT, non-sustained ventricular tachycardia; PVS, programmed ventricular stimulation; WCD, wearable cardioverter-defibrillator. Rarely for a high risk, cardioverter-defibrillator implantation may be considered before discharge (see text for detailed discussion). aAdditional risk factors (at least 1, increasing risk and indication with >1 or more): NSVT, extensive LGE, unexplained syncope, positive PVS, reduced LVEF of <50%.327–329

Table 16 Indicators of non-viral aetiologies and complications (high-risk features or red flags in acute pericarditis)

Major

Fever >38°C (HR 3.56) Subacute onset (HR 3.97) Large pericardial effusion (>20 mm on echocardiography) (HR 2.15) Cardiac tamponade (HR 2.15) Lack of response to aspirin or NSAID after at least 1 week of therapy (HR 2.50)

Minor

Pericarditis associated with myocarditis Immunodepression Trauma Oral anticoagulant therapy © ESC 2025

HR, hazard ratio; NSAID, non-steroidal anti-inflammatory drug. Major features have been validated in multivariable analysis in a prospective cohort study of patients with acute pericarditis.105

ESC Guidelines                                                                                                                                                                                          3999

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