Highly variable, ranging from incidental dx based on labs/imaging to fulminant HF w/ shock
Can present as ACS-like syndrome (chest pain, ECG Δs, ↑ Tn), acute HF, arrhythmias
Diagnostic studies and workup
Echo: systolic dysfxn (typically global but can be regional); ± ↑ LV wall thickness due to edema; LV size may be small in fulminant and dilated in chronic; ± pericardial effusion
Cardiac MRI: can show hyperemia, edema, and scar (JACC 2009;53:1475)
Endomyocardial biopsy: useful in GCM & eosinophilic; ∴ consider if rapidly progressive HF, high-grade AVB or sustained VT, suspected allergic rxn or eosinophilia
Treatment
Standard HF Rx if LV dysfxn (but do not start if e/o shock); temporary MCS as needed
Immunosuppression: for GCM (high-dose steroids + CsA or tacrolimus ± AZA), collagen vascular disease, peripartum (? IVIg), & eosinophilic;