theMednet - For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?

Topics: Gynecologic Cancers • Pediatric Oncology • Medical Oncology • Cardiology • Cardio-Oncology • Multispecialty Spotlight

For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?

Answer from: at Academic Institution

This question raises an important point that the clinical presentation of ICI-associated myocarditis often overlaps with other cardiovascular disorders, including acute coronary syndrome, chronic CAD, congestive heart failure, and other nonischemic cardiomyopathies. Therefore, prompt initiation of w...

Comments

at FibroFighters Foundation
Do you use tocilizumab? Or only if steroids fail? ...

Answer from: at Academic Institution

Where there is high clinical suspicion for ICI myocarditis, it is reasonable to empirically start high doses of steroids for the treatment of ICI myocarditis while awaiting confirmatory testing. Such situations include significantly elevated troponin and/or BNP, new heart block or ventricular tachyc...

Related Questions