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cardio.cardiogenic-shock.giant-cell-myocarditis.v1PRODUCTION
cardio.cardiogenic-shock.giant-cell-myocarditis.v1

Cardiogenic shock — giant cell myocarditis (GCM)

cardiologyacuteadult
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11/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Suspect GCM in previously healthy young-to-middle-aged adult with rapid progression of acute HF to CS, especially with sustained VT/VF storm or new high-grade AV block; EMB is the gateway diagnostic — multidisciplinary alignment for emergent biopsy

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GCM clinical suspicion stated and EMB pathway engaged

Patient inputs (18)

Mandatory rule-out of obstructive CAD (myocarditis is an MI mimic); typically clean coronaries in GCM

Lake Louise Criteria 2018 (Ferreira PMID 30025572); patchy or extensive transmural LGE possible in GCM

Hilar / mediastinal lymphadenopathy screen for sarcoidosis differential; thymoma screen for paraneoplastic GCM

GOLD STANDARD per AHA/ACC/ESC 2007 EMB consensus (Cooper PMID 17998456) — Class IIa for unexplained new-onset HF <2 wks with hemodynamic compromise + ventricular arrhythmia or AV block; multinucleated giant cells + lymphocyte infiltrate + myocyte necrosis WITHOUT non-caseating granulomas (vs sarcoidosis)

GCM mean age ~42-43 yo per Cooper 1997 + Kandolin 2013; younger than typical AMI-CS; informs prognosis + transplant candidacy

Sustained VT/VF storm + AV block both common in GCM; informs telemetry and arrhythmia management

End-organ damage marker + cyclosporine renal dose adjustment + gadolinium contrast safety for CMR

Markedly elevated typical; persistent elevation reflects ongoing myocyte injury despite immunosuppression

Acute HF marker; trend tracks LV recovery on combined immunosuppression

Baseline cytopenias + ATG / cyclosporine + steroid bone marrow surveillance

Cyclosporine + ATG hepatotoxicity surveillance; baseline before immunosuppression

Biventricular dysfunction; effusion screen; no regional wall motion crossing single coronary territory

AV block (15-50% of GCM cases) — high diagnostic value; diffuse ST/T-wave changes

SCAI 2022 staging baseline; gates vasopressor escalation

SCAI 2022 staging + CardShock prognostication (Harjola EHJ 2015 PMID 26333869)

Autoimmune thyroid disease association with GCM (Cooper 1997)

Autoimmune disease screen; thymoma association

Metabolic activity assessment; differential vs cardiac sarcoidosis (Birnie HRS 2014 PMID 24682272)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (5)

5 need judgement
  • informationallife_threateningrecurrent_vt_vf_storm_requiring_icd_in_gcm
    Recurrent VT/VF storm in GCM (50-60% of cases per Cooper 1997 + Kandolin 2013) — amiodarone + EP consult + ICD implantation given high recurrent arrhythmia risk; refractory cases → catheter ablation; transplant escalation
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningtransplant_listing_priority_unos_1a_in_gcm
    GCM with refractory CS on optimal therapy OR refractory VT/VF on optimal therapy OR MCS-dependent — UNOS 1A transplant listing priority; high recurrence in graft (20-25%) but transplant remains best option given dismal medical mortality
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningmcs_bridge_to_immunosuppression_response_in_gcm
    Refractory CS in GCM despite cautious vasopressor / inotrope — escalate to MCS (IABP / Impella / VA-ECMO) early; bridge to combined immunosuppression response, recovery, or transplant; recovery possible with combined immunosuppression in 40-50% per Cooper GIANT-2
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverehigh_grade_av_block_requiring_permanent_pacing_in_gcm
    New high-grade AV block (Mobitz II / complete heart block) in GCM (15-50% of cases per Kandolin 2013) — transvenous pacemaker → permanent pacemaker (often biventricular if HFrEF); AV block is the major diagnostic clue distinguishing GCM from viral myocarditis
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveregraft_gcm_recurrence_after_transplant
    GCM recurrence in transplanted graft on surveillance EMB (20-25% per Kandolin 2013 + Ekström 2024) — re-escalate immunosuppression intensity (steroid pulse + cyclosporine trough increase + add MMF if not already + consider abatacept/ATG re-induction); selected patients may require re-transplant
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Giant cell myocarditis CS — combined immunosuppression per Cooper GIANT-2 protocol (methylprednisolone + cyclosporine + IL-2RA + ATG induction; chronic maintenance with cyclosporine + low-dose steroids + AZA/MMF) + early MCS bridge + transplant listing priority
axis: gcm_combined_immunosuppression_phenotype
Selected axis "Giant cell myocarditis CS — combined immunosuppression per Cooper GIANT-2 protocol (methylprednisolone + cyclosporine + IL-2RA + ATG induction; chronic maintenance with cyclosporine + low-dose steroids + AZA/MMF) + early MCS bridge + transplant listing priority" by default fallback (first axis)
  • norepinephrine
    first line
    vasopressor_alpha
    0.05–0.5 µg/kg/min titrate MAP ≥65 • IV • continuous
    triggers: gcm_cs_with_sbp_lt_90, cs_scai_c_or_higher
    SOAP-II PMID 20200382 — NE first-line in CS
    rxcui 7512
  • dobutamine
    second line
    inotrope_beta1
    2.5 µg/kg/min CAUTIOUS titration; AVOID in ventricular electrical storm • IV • continuous
    triggers: low_cardiac_output_despite_NE, no_active_VT_or_VF
    DOREMI PMID 33704937; CAUTION in GCM given high VT/VF risk; escalate to MCS over higher inotrope doses
    rxcui 3616
  • methylprednisolone
    first line
    corticosteroid_systemic
    1000 mg IV daily × 3-5 days then prednisone 1 mg/kg/d taper over months • IV • daily
    triggers: gcm_emb_confirmed_or_strongly_suspected
    Cooper Multicenter GCM Registry NEJM 1997 (PMID 9197214) + GIANT-2 protocol (PMID 18369191) — cornerstone of combined immunosuppression
    rxcui 6902
  • cyclosporine
    first line
    calcineurin_inhibitor
    3-5 mg/kg/d divided BID; trough target 200-300 ng/mL acute then 100-200 ng/mL maintenance • PO/IV • BID
    triggers: gcm_emb_confirmed
    Cooper NEJM 1997 + GIANT-2 — combination cyclosporine + steroids markedly improves transplant-free survival from ~10% to ~70%; ESC 2013 myocarditis position paper
    rxcui 3008
  • basiliximab
    add on
    il2_receptor_antagonist
    20 mg IV day 0 + day 4 (induction) • IV • q4d × 2 doses
    triggers: gcm_emb_confirmed_severe, transplant_listed
    GIANT-2 protocol PMID 18369191 — IL-2RA induction in GCM; transplant immunology precedent (basiliximab is standard induction in solid organ transplant)
    rxcui 196102
  • rabbit anti-thymocyte globulin
    add on
    polyclonal_anti_t_cell
    1.5 mg/kg/d IV × 5-14 days (induction); replaces historical OKT3 (muromonab) which is no longer available • IV • daily × 5-14 d
    triggers: gcm_severe_emb_confirmed, transplant_listed, ventricular_arrhythmia_storm_in_gcm
    Cooper GIANT-2 protocol PMID 18369191 — anti-T-cell induction in GCM; historically OKT3 (muromonab) used but no longer manufactured; ATG is contemporary equivalent
    rxcui 107044
  • azathioprine
    add on
    antimetabolite_purine
    1-2 mg/kg/d PO daily (chronic maintenance) • PO • daily
    triggers: gcm_chronic_maintenance_phase
    GIANT-2 protocol PMID 18369191 — chronic maintenance after acute phase; purine antimetabolite
    rxcui 1256
  • mycophenolate mofetil
    add on
    antimetabolite_imp_dh
    1000 mg PO BID (chronic maintenance alternative to AZA) • PO • BID
    triggers: gcm_chronic_maintenance_alternative_to_aza, aza_intolerant
    Solid organ transplant precedent + GIANT-2 — alternative to AZA
    rxcui 68149
  • amiodarone
    first line
    class_iii_antiarrhythmic
    150 mg IV bolus then 1 mg/min × 6 h then 0.5 mg/min • IV • continuous
    triggers: ventricular_electrical_storm_in_gcm, sustained_vt_or_vf
    AHA 2020 ACLS Class IIb for refractory VT/VF; high baseline arrhythmia risk in GCM (50-60%); consider catheter ablation if refractory
    rxcui 703
  • lidocaine
    add on
    class_ib_antiarrhythmic
    1-1.5 mg/kg IV bolus then 1-4 mg/min infusion • IV • continuous
    triggers: vt_vf_refractory_to_amiodarone
    AHA 2020 ACLS alternative for refractory VT/VF
    rxcui 6387
  • magnesium sulfate
    add on
    electrolyte_repletion
    2 g IV bolus over 5-15 min then maintenance to keep Mg ≥2.0 • IV • as needed
    triggers: vt_vf_torsades, mg_lt_2
    AHA 2020 ACLS for torsades; standard electrolyte repletion
    rxcui 6585
  • sulfamethoxazole-trimethoprim
    add on
    pjp_prophylaxis
    1 SS tab PO daily or 1 DS tab PO MWF • PO • daily/MWF
    triggers: chronic_immunosuppression_in_gcm
    PJP prophylaxis on chronic high-dose steroid + cyclosporine; standard transplant immunology
    rxcui 10831
  • valganciclovir
    add on
    cmv_prophylaxis
    900 mg PO daily × 3-6 mo per CMV serostatus • PO • daily
    triggers: gcm_post_transplant, high_intensity_immunosuppression
    CMV prophylaxis on ATG / IL-2RA / chronic immunosuppression; standard transplant immunology
    rxcui 275891

outpatient playbook — drug actions (5)

  1. 1. continue or up-titrate GDMT 4-pillar if persistent EF<40
    lisinopril or sac/val + carvedilol + MRA + SGLT2i • PO • daily/BID
    trigger: Persistent EF<40
    AHA/ACC/HFSA 2022 HF Guideline (PMID 35363499)
  2. 2. continue combined immunosuppression LIFE-LONG OR until transplant
    rxcui 3008
    cyclosporine trough 100-200 ng/mL chronic; prednisone 5-10 mg/d; AZA / MMF maintenance • PO • daily
    trigger: GCM chronic maintenance / post-transplant
    Cooper NEJM 1997 — chronic combined immunosuppression maintains transplant-free survival; recurrence in graft 20-25% per Kandolin 2013 + Ekström 2024
  3. 3. continue opportunistic prophylaxis
    rxcui 8163
    TMP-SMX + valganciclovir per intensity • PO • daily
    trigger: Chronic immunosuppression
    Standard transplant immunology
  4. 4. AVOID NSAIDs lifelong
    do not give • n/a • n/a
    trigger: GCM history
    ESC 2013
  5. 5. AVOID live vaccines lifelong on immunosuppression
    inactivated only • n/a • n/a
    trigger: Chronic immunosuppression
    Standard transplant immunology

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Previously healthy young-to-middle-aged adult with rapid (days-to-weeks) progression of acute HF to cardiogenic shock — high suspicion for GCM, especially if associated with VT/VF storm or AV block; Sustained VT/VF storm (≥3 episodes in 24 h) in setting of acute myocarditis — GCM until proven otherwise (50-60% of GCM cases per Cooper 1997 + Kandolin 2013); emergent EMB indication; New high-grade AV block (Mobitz II / complete heart block) in acute myocarditis — GCM is the leading clue (15-50% per Kandolin 2013); emergent EMB indication.

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Cardiogenic shock — giant cell myocarditis (GCM)** (cardio.cardiogenic-shock.giant-cell-myocarditis.v1).
Scope: Suspect GCM in previously healthy young-to-middle-aged adult with rapid progression of acute HF to CS, especially with sustained VT/VF storm or new high-grade AV block; EMB is the gateway diagnostic — multidisciplinary alignment for emergent biopsy

No severity triggers fired against current inputs.

Plan

Regimen axis: **Giant cell myocarditis CS — combined immunosuppression per Cooper GIANT-2 protocol (methylprednisolone + cyclosporine + IL-2RA + ATG induction; chronic maintenance with cyclosporine + low-dose steroids + AZA/MMF) + early MCS bridge + transplant listing priority**.
1. norepinephrine 0.05–0.5 µg/kg/min titrate MAP ≥65 IV continuous (vasopressor_alpha, first line) — SOAP-II PMID 20200382 — NE first-line in CS
2. dobutamine 2.5 µg/kg/min CAUTIOUS titration; AVOID in ventricular electrical storm IV continuous (inotrope_beta1, second line) — DOREMI PMID 33704937; CAUTION in GCM given high VT/VF risk; escalate to MCS over higher inotrope doses
3. methylprednisolone 1000 mg IV daily × 3-5 days then prednisone 1 mg/kg/d taper over months IV daily (corticosteroid_systemic, first line) — Cooper Multicenter GCM Registry NEJM 1997 (PMID 9197214) + GIANT-2 protocol (PMID 18369191) — cornerstone of combined immunosuppression
4. cyclosporine 3-5 mg/kg/d divided BID; trough target 200-300 ng/mL acute then 100-200 ng/mL maintenance PO/IV BID (calcineurin_inhibitor, first line) — Cooper NEJM 1997 + GIANT-2 — combination cyclosporine + steroids markedly improves transplant-free survival from ~10% to ~70%; ESC 2013 myocarditis position paper
5. basiliximab 20 mg IV day 0 + day 4 (induction) IV q4d × 2 doses (il2_receptor_antagonist, add on) — GIANT-2 protocol PMID 18369191 — IL-2RA induction in GCM; transplant immunology precedent (basiliximab is standard induction in solid organ transplant)
6. rabbit anti-thymocyte globulin 1.5 mg/kg/d IV × 5-14 days (induction); replaces historical OKT3 (muromonab) which is no longer available IV daily × 5-14 d (polyclonal_anti_t_cell, add on) — Cooper GIANT-2 protocol PMID 18369191 — anti-T-cell induction in GCM; historically OKT3 (muromonab) used but no longer manufactured; ATG is contemporary equivalent
7. azathioprine 1-2 mg/kg/d PO daily (chronic maintenance) PO daily (antimetabolite_purine, add on) — GIANT-2 protocol PMID 18369191 — chronic maintenance after acute phase; purine antimetabolite
8. mycophenolate mofetil 1000 mg PO BID (chronic maintenance alternative to AZA) PO BID (antimetabolite_imp_dh, add on) — Solid organ transplant precedent + GIANT-2 — alternative to AZA
9. amiodarone 150 mg IV bolus then 1 mg/min × 6 h then 0.5 mg/min IV continuous (class_iii_antiarrhythmic, first line) — AHA 2020 ACLS Class IIb for refractory VT/VF; high baseline arrhythmia risk in GCM (50-60%); consider catheter ablation if refractory
10. lidocaine 1-1.5 mg/kg IV bolus then 1-4 mg/min infusion IV continuous (class_ib_antiarrhythmic, add on) — AHA 2020 ACLS alternative for refractory VT/VF
11. magnesium sulfate 2 g IV bolus over 5-15 min then maintenance to keep Mg ≥2.0 IV as needed (electrolyte_repletion, add on) — AHA 2020 ACLS for torsades; standard electrolyte repletion
12. sulfamethoxazole-trimethoprim 1 SS tab PO daily or 1 DS tab PO MWF PO daily/MWF (pjp_prophylaxis, add on) — PJP prophylaxis on chronic high-dose steroid + cyclosporine; standard transplant immunology
13. valganciclovir 900 mg PO daily × 3-6 mo per CMV serostatus PO daily (cmv_prophylaxis, add on) — CMV prophylaxis on ATG / IL-2RA / chronic immunosuppression; standard transplant immunology

Setting playbook (outpatient) — 4-8 wk recovery echo + CMR — confirm LV recovery (variable in GCM, often partial); long-term GDMT if persistent HFrEF; LIFE-LONG combined immunosuppression maintenance; transplant waitlist management or post-transplant immunosuppression with surveillance for graft GCM recurrence (20-25% per Kandolin 2013 + Ekström 2024); EP follow-up — most GCM patients receive ICD given high arrhythmic recurrence risk
14. continue or up-titrate GDMT 4-pillar if persistent EF<40 lisinopril or sac/val + carvedilol + MRA + SGLT2i PO daily/BID — Persistent EF<40 (AHA/ACC/HFSA 2022 HF Guideline (PMID 35363499))
15. continue combined immunosuppression LIFE-LONG OR until transplant cyclosporine trough 100-200 ng/mL chronic; prednisone 5-10 mg/d; AZA / MMF maintenance PO daily — GCM chronic maintenance / post-transplant (Cooper NEJM 1997 — chronic combined immunosuppression maintains transplant-free survival; recurrence in graft 20-25% per Kandolin 2013 + Ekström 2024)
16. continue opportunistic prophylaxis TMP-SMX + valganciclovir per intensity PO daily — Chronic immunosuppression (Standard transplant immunology)
17. AVOID NSAIDs lifelong do not give n/a n/a — GCM history (ESC 2013)
18. AVOID live vaccines lifelong on immunosuppression inactivated only n/a n/a — Chronic immunosuppression (Standard transplant immunology)

Non-pharmacologic actions:
- No competitive sports × 6+ mo per AHA 2015 / ESC 2020 / Drezner JACC 2022 (often lifelong restriction in GCM)
- Cardiac rehab
- EP referral for ICD per AHA 2017 VA/SCD guideline (most GCM patients eligible)
- Ongoing transplant waitlist or post-transplant care
- Annual flu (inactivated) + indicated inactivated vaccines

AVOID / contraindication checks:
- Nsaids_AVOID_in_gcm_myocarditis (worsen myocarditis per ESC 2013)
- High_dose_dobutamine_minimize_in_gcm (very high VT/VF risk; escalate to MCS instead)
- Digoxin_AVOID_in_acute_myocarditis (toxicity threshold lowered per ESC 2013)
- Gadolinium_caution_if_egfr_lt_30 (NSF risk; group II macrocyclic agents safer)
- Cyclosporine_renal_adjust + trough monitoring 200 300 ng/mL acute then 100 200 ng/mL maintenance (calcineurin nephrotoxicity)
- Cyclosporine_drug_interactions (CYP3A4: avoid concurrent strong inhibitors / inducers)
- Aza_check_TPMT_genotype_before_initiation (myelosuppression risk if TPMT deficient)
- Atg_premedicate_with_acetaminophen_diphenhydramine_methylprednisolone (cytokine release syndrome)
- Basiliximab_anaphylaxis_risk (rare but reported; have epinephrine ready)
- Opportunistic_infection_prophylaxis_required (PJP, CMV, anti fungal per immunosuppression intensity)

Monitoring

Regimen monitoring:
- arterial line continuous BP (ACC/AHA 2022 Class I)
- central venous access (ACC/AHA 2022)
- lactate q1-2h (CardShock, Harjola EHJ 2015)
- UOP hourly (SCAI 2019 end-organ perfusion marker)
- serial echo q24h for recovery trajectory
- continuous telemetry for arrhythmia (extreme VT/VF risk in GCM)
- daily troponin and bnp (trend tracks recovery)
- cyclosporine trough q24h (200-300 acute, 100-200 maintenance)
- daily CBC LFT BMP for immunosuppression toxicity
- CMV PCR weekly during high intensity immunosuppression
- PJP prophylaxis TMP-SMX or atovaquone
- opportunistic fungal surveillance if neutropenic

Setting (outpatient) monitoring:
- Echo at 6 mo and 12 mo
- CMR at 6 mo if persistent LGE
- Surveillance EMB per protocol (some centers q3-6 mo for first year)
- Cyclosporine trough monthly
- CBC + LFT + BMP + lipid + HbA1c monthly initially
- Skin cancer surveillance (chronic immunosuppression risk)

Follow-up plan: Repeat echo + CMR at 4-8 wks; continued combined immunosuppression LIFE-LONG OR until transplant; transplant evaluation completion if not yet listed; cardiac rehab; EP follow-up for ICD eligibility per AHA 2017 VA/SCD guideline (high arrhythmic recurrence — most GCM patients receive ICD after acute phase); post-transplant immunosuppression maintained with surveillance for graft GCM recurrence (20-25% per Kandolin 2013 + Ekström 2024)
- Close-out criterion: Recovery echo, CMR, continued immunosuppression, transplant evaluation, ICD pathway booked

Monitoring phase: A-line, central line, lactate clearance, urine output; continuous telemetry (high VT/VF risk); serial echo q24h for LV recovery; daily troponin and BNP; cyclosporine trough q24h to maintain 200-300 ng/mL acute then 100-200 ng/mL maintenance; daily CBC + LFT for immunosuppression toxicity; opportunistic infection surveillance (CMV, PJP prophylaxis)

Disposition

Current setting: outpatient — 4-8 wk recovery echo + CMR — confirm LV recovery (variable in GCM, often partial); long-term GDMT if persistent HFrEF; LIFE-LONG combined immunosuppression maintenance; transplant waitlist management or post-transplant immunosuppression with surveillance for graft GCM recurrence (20-25% per Kandolin 2013 + Ekström 2024); EP follow-up — most GCM patients receive ICD given high arrhythmic recurrence risk

Disposition criteria:
- Stable on chronic immunosuppression + GDMT + opportunistic prophylaxis + ICD if eligible → routine surveillance
- Persistent HFrEF beyond 6 mo → transplant escalation if not yet listed

Escalation triggers (move to higher acuity):
- Sustained VT / syncope / ICD shock → EP urgent consult; transplant escalation
- Persistent severe LV dysfunction → expedite transplant
- Recurrent GCM on surveillance EMB → escalate immunosuppression OR expedite transplant
- Opportunistic infection → ID urgent consult
- Post-transplant graft GCM recurrence → re-escalate immunosuppression; consider re-transplant in selected cases
- Skin cancer / PTLD → oncology + transplant team

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Recurrent VT/VF storm in GCM (50-60% of cases per Cooper 1997 + Kandolin 2013) — amiodarone + EP consult + ICD implantation given high recurrent arrhythmia risk; refractory cases → catheter ablation; transplant escalation
- [LIFE_THREATENING] GCM with refractory CS on optimal therapy OR refractory VT/VF on optimal therapy OR MCS-dependent — UNOS 1A transplant listing priority; high recurrence in graft (20-25%) but transplant remains best option given dismal medical mortality
- [LIFE_THREATENING] Refractory CS in GCM despite cautious vasopressor / inotrope — escalate to MCS (IABP / Impella / VA-ECMO) early; bridge to combined immunosuppression response, recovery, or transplant; recovery possible with combined immunosuppression in 40-50% per Cooper GIANT-2

Citations

- Cooper Multicenter Giant Cell Myocarditis Registry NEJM 1997 (PMID 9197214); Cooper GIANT-2 trial protocol (PMID 18369191); Caforio ESC 2013 myocarditis position paper (PMID 23824828); Tschöpe AHA 2020 myocarditis scientific statement (PMID 32200645); Cooper AHA/ACC/ESC 2007 EMB consensus (PMID 17998456); Birnie HRS 2014 cardiac sarcoidosis (PMID 24682272) — differential [PMID:9197214](https://pubmed.ncbi.nlm.nih.gov/9197214/)
- Cited evidence (PMID 18369191) [PMID:18369191](https://pubmed.ncbi.nlm.nih.gov/18369191/)
- Cited evidence (PMID 17998456) [PMID:17998456](https://pubmed.ncbi.nlm.nih.gov/17998456/)
- Cited evidence (PMID 23824828) [PMID:23824828](https://pubmed.ncbi.nlm.nih.gov/23824828/)
- Cited evidence (PMID 32200645) [PMID:32200645](https://pubmed.ncbi.nlm.nih.gov/32200645/)

Last reconciled with current guidelines: 2026-05-15.
References
  • Cooper Multicenter Giant Cell Myocarditis Registry NEJM 1997 (PMID 9197214); Cooper GIANT-2 trial protocol (PMID 18369191); Caforio ESC 2013 myocarditis position paper (PMID 23824828); Tschöpe AHA 2020 myocarditis scientific statement (PMID 32200645); Cooper AHA/ACC/ESC 2007 EMB consensus (PMID 17998456); Birnie HRS 2014 cardiac sarcoidosis (PMID 24682272) — differential — PMID:9197214
  • Cited evidence (PMID 18369191) — PMID:18369191
  • Cited evidence (PMID 17998456) — PMID:17998456
  • Cited evidence (PMID 23824828) — PMID:23824828
  • Cited evidence (PMID 32200645) — PMID:32200645