Welcome to the Emergency Medicine Cases podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.

EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute, the nonprofit organization dedicated to improving EM care through research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice and qualified practicing physician. In part one of our two-parts series with Walter Himmel and Paul Dorian on pericarditis, mild carditis, and COVID, we discussed the recognition and management of paracarditis.

In this part two, we're going to dive into the oh-so-elusive diagnosis of myocarditis,

how to treat it in the ED, and then when to suspect myocarditis or pericarditis in the patient

with COVID infection or the patient who has had a recent COVID vaccine.

Now, we've separated pericarditis from myocarditis in the podcast, but it's important

to realize that these entities can overlap and exist at the same time, i.e. myoperycarditis.

So pretty much everything we said about pericarditis in the last episode will probably apply to the myocarditis patient and vice versa.

The other thing that's important to understand before we dive in is that myocarditis is just one of the very many types of cardiomyopathy out there.

So just please keep that in mind throughout this podcast.

Let's dive into a case. You're on a late night shift and you're called overhead to the

resuscitation room for a young woman in respiratory distress and shock.

She's a 22-year-old otherwise healthy woman who's had a week-long history of several bouts

of non-bloody diarrhea.

Earlier that day, just a few hours ago, she developed shortness of breath at rest,

which soon followed with chest pain and palpitations,

which have been constant and severe.

She called 911 when the shortness of breath got rapidly worse.

She reports no fever or chills, no cough, no belly pain, and she doesn't think that she's pregnant.

She has no cardiac or thromomabolic risk factors, and she doesn't think that she's pregnant. She has no cardiac or thromomobolic risk factors, and on exam, she looks sick. Her GCS is 13, she's all clammy, heart rate is 140,

and irregular, blood pressure is 80 over 40, respiratory rate is 36, oxygen saturation is 90% on a

...