Myocarditis In the Western world, myocarditis is most commonly associated with cardiotropic viruses. In other regions, Chagas disease, Borrelia infection and diphtheria may be the underlying cause. Myocarditis may present acutely, with typical chest pain symptoms or with more severe symptoms of heart failure and arrhythmia. In these cases, diagnosis is based on serum troponin measurements, TTE and CMR, and will also often involve coronary angiography to rule out CAD. It may be missed due to its subtle symptoms or be detected on CMR as an incidental finding following an asymptomatic episode. Progression from myocarditis to DCM occurs in approximately a fifth of those affected. SCD is a well-recognised association with acute myocarditis, most commonly in younger patients and in association with strenuous physical exertion, with the highest risk being in the 6 months following diagnosis.

The clinical presentation of myocarditis and acute coronary syndromes maybe similar; however, the occupational ramifications of these two diagnoses in aircrew differ substantially and mandate optimal assessment to discriminate between them. The use of CMR to look for myocarditis, either using T2-weighted sequences to look for oedema, or using LGE to look for fibrosis, is strongly encouraged. There are some data to suggest that the presence of LGE in myocarditis is associated with a worse prognosis,43 which further supports its use in aircrew. CMR imaging may be useful for the follow-up of aircrew with myocarditis, to assess LV function and fibrosis burden.

Although full recovery from myocarditis is thought to occur in approximately 80% of those with myocarditis, there are no clinical measures that have proven useful in predicting outcomes in these patients. Even those with fulminant disease, with rapid onset of symptoms and haemodynamic compromise may have an excellent outcome.44 General features of postviral syndromes and reduced exercise capacity may persist for many months following an episode of myocarditis, and this should also be borne in mind when considering returning aircrew to flying duties. Therefore, a cautious approach, with initial restriction to flying duties and close follow-up over a period of time is required in aircrew.


https://heart.bmj.com/content/105/Suppl_1/s50