1. Fulminant Myocarditis Guideline
2. Myocarditis Treatment
3. Myocarditis Diagnosis
4. Chinese Society of Cardiology
5. Inflammatory Heart Diseases

In a significant advancement for the medical community, the Chinese Society of Cardiology under the Chinese Medical Association has released a comprehensive guide focused on the management of fulminant myocarditis in adults. Published on January 24, 2024, in the Zhonghua Xin Xue Guan Bing Za Zhi (Chinese Journal of Cardiology), the guidelines are set out to revolutionize the prognosis and treatment of this acute and often fatal condition.

DOI: 10.3760/cma.j.cn112148-20231108-00421


Fulminant myocarditis represents an acute, diffuse inflammatory heart disease characterized by a sudden onset, rapidly progressive course, and a high risk of mortality. With advancements in understanding the immunological underpinning of the disease, this new guideline offers a life-support-based comprehensive treatment plan that aims to significantly enhance patient survival rates and improve long-term outcomes.

Background and Significance

Historically, the management of fulminant myocarditis has posed a notable challenge to clinicians due to its abrupt onset and swift clinical deterioration. The pathogenesis of fulminant myocarditis involves hyperactivation of the cardiac innate immune response and the development of an inflammatory storm, which can lead to severe cardiac dysfunction, arrhythmias, and even sudden death.

The guidelines emerged from rigorous discussions and contributions by experts across the nation, tasked and entrusted by the Chinese Society of Cardiology. Such initiatives reflect the continued efforts and commitment of professional bodies to address urgent clinical needs through evidence-based recommendations.

Elaboration of the Guidelines

Early Recognition and Diagnosis
One of the key emphases of the new guideline is on the ultra-early recognition, diagnosis, and treatment of fulminant myocarditis. The document underscores the importance of timely action, given the rapidity of disease progression, which severely limits the window for effective intervention.

In highlighting the clinical features that warrant immediate attention, the guideline provides a crucial framework for healthcare providers to identify potential cases at the earliest possible stage. This includes the recognition of signs such as chest pain, shortness of breath, palpitations, and in severe cases, cardiogenic shock, which should prompt an urgent cardiac evaluation.

Risk Assessment and Treatment Optimization

The treatment plan outlined in the guideline is anchored on life-support measures and integrates a multi-faceted approach to care. Given the high mortality risk associated with fulminant myocarditis, thorough risk factor assessment is deemed essential to tailor the intervention strategies and escalate care appropriately.

Apart from conventional treatments that focus on the suppression of inflammation, the guideline introduces advanced therapeutic interventions which are based on recent clinical evidence and practice experience within China. These include the use of mechanical circulatory support devices such as ECMO (Extracorporeal Membrane Oxygenation) when indicated, to maintain hemodynamic stability and organ perfusion in critically ill patients.

The comprehensive care pathway encourages a collaboration between cardiologists, intensive care specialists, and other multidisciplinary teams, ensuring a coordinated response to manage the complex nature of fulminant myocarditis.

Research Evidence and Outcomes

The guideline draws upon a rich body of research and clinical data accumulated over recent years, reflecting substantial progress in understanding and treating fulminant myocarditis. Studies cited in the guideline show a significant correlation between the adoption of the recommended protocols and positive clinical outcomes, including reduced mortality and improved cardiac function recovery.


1. Chinese Society of Cardiology, Chinese Medical Association. (2024). Chinese guideline on the diagnosis and treatment of fulminant myocarditis in adults. Zhonghua Xin Xue Guan Bing Za Zhi, 52(1), 10-33. DOI: 10.3760/cma.j.cn112148-20231108-00421
2. Cooper, L. T., Keren, A., Sliwa, K., Matsumori, A., & Mensah, G. A. (2020). The global burden of myocarditis: Part 1: A systematic review. Global Heart, 15(1), 71.
3. Kindermann, I., Barth, C., Mahfoud, F., Ukena, C., Lenski, M., Yilmaz, A., … & Bohm, M. (2012). Update on Myocarditis. Journal of the American College of Cardiology, 59(9), 779-792.
4. Feldman, A. M., & McNamara, D. (2000). Myocarditis. New England Journal of Medicine, 343(19), 1388–1398.
5. Narula, J., Khaw, B. A., Dec, G. W., & Palacios, I. F. (1993). Recognition and management of myocarditis. Drugs, 46(3), 367–383.

Long-Term Management and Rehabilitation

The guideline further extends into the realm of post-acute management and rehabilitation, recognizing the chronic nature and potential for relapse inherent to autoimmune and inflammatory cardiac diseases. Recommendations for follow-up and monitoring are provided to ensure sustained recovery and to minimize the chances of myocardial scarring and chronic heart failure.


The publication of this guideline marks a watershed moment for the cardiology field, particularly within China. There is an inherent promise that with increased awareness and the adoption of these recommendations, the tide will turn on the devastating impact fulminant myocarditis has had on adult patients.

By focusing on early detection, risk management, robust intervention strategies, and long-term follow-up, the Chinese Society of Cardiology aims not only to save lives in the immediate crisis but also to improve the quality of life for survivors of this formidable disease. The global medical community will be watching closely, with anticipation that such evidence-based protocols might be adopted and adapted to suit diverse clinical settings across the world.

As healthcare systems integrate these guidelines into clinical practice, they stand as a testament to the power of research, collaboration, and evidence-based medicine in combating one of the most challenging inflammatory heart diseases today.