McCarthy et al classified patients as having fulminant myocarditis based on the criteria of Lieberman et al. The authors are from the Johns Hopkins Hospital and Hershey Medical Center in Hershey, Pennsylvania.


Criteria for fulminant myocarditis:

(1) borderline or active myocarditis on endomyocardial biopsy using the Dallas criteria

(2) severe hemodynamic compromise

(3) requirement for high doses of vasopressors (to maintain renal perfusion) or ventricular assist device

(4) at least 2 of the following

(4a) fever

(4b) distinct onset of symptoms of heart failure

(4c) history consistent with a viral infection within 2 weeks prior to hospitalization



• High dose of vasopressors was >= 5 µg per kg body weight per minute of dopamine or dobutamine

• Symptoms of heart failure: fatigue, dyspnea on exertion, dyspnea at rest, edema.

• Distinct onset = dated specifically to a 1 or 2 day period


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