Acute Myocarditis, the Dilemma in the General Practice Setting in the Years of the Coronavirus Pandemic Era: An Italian Experience

Myocarditis is inflammation of the muscle tissue of the heart (myocardium) and unlike most heart disease it tends to affect young people more often. Myocarditis can go almost unnoticed, frequently heals without results, but can sometimes be very serious and life threatening. However, many symptoms are non-specific and difficult to evaluate in the general practice setting. In order to diagnose myocarditis it is necessary to carry out some instrumental tests, too. Very important are the EKG and the dosage of cardiac markers in the blood. The echocardiogram allows you to highlight the valvular and muscle alterations that occur during inflammation and the same thing can be done by myocardial magnetic resonance. For those reasons, myocarditis is difficult to diagnose in the setting of General Practitioner (GP) and therefore it is underdiagnosed or misdiagnosed. The presence of nonspecific symptoms, fatigue and dyspnea, especially in a young person, it can lead the GP to suspect a myocarditis. We present a case of myocarditis in a young person. The patient, without a clinical history of important pathologies, presented asthenic and respiratory symptoms with progressive worsening of the clinical picture. We described the reasons of the diagnostic and therapeutic procedures. The general medicine setting is currently unsuitable for taking care of patients of this type, as the waiting times for the necessary examinations. The evaluation and follow-up are not within the reach of local doctors in Italy or with too long waiting times, so monitoring and optimizing therapies remain difficult outside the hospital.