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Immunotherapy-Related Myocarditis

A rare but often fatal cardiac side effect of immunotherapy agents, especially checkpoint inhibitors.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kardiyoloji department. Book Appointment →

What is Immunotherapy-Related Myocarditis?

Immunotherapy-related myocarditis is a rare immune-related adverse event in patients treated with immune checkpoint inhibitors (anti-PD-1, anti-PD-L1, anti-CTLA-4). It carries high mortality due to effector T-cell mediated myocardial injury.

It usually appears within the first 3 months of therapy, with a median onset around 30 days. Diagnostic criteria include elevated troponin, ECG changes, cardiac MRI and endomyocardial biopsy. Risk is higher with combination immunotherapy.

Early recognition and high-dose corticosteroids can reduce mortality. Severe cases may require immunoglobulin, anti-thymocyte globulin or plasmapheresis. Discontinuation of immunotherapy is mandatory.

Symptoms

Chest pain and pressure
Fatigue and exercise intolerance
Dyspnea
Palpitations and arrhythmia
Myalgia and fever
Syncope and presyncope
Signs of acute heart failure

Risk Factors

Combination checkpoint inhibitor therapy
Pre-existing cardiac disease
History of autoimmune disease
Advanced age
Cardiovascular risk factors
Tumor type (melanoma, lung)
Concurrent myositis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Chest pain after immunotherapy
  • New palpitations
  • Unexplained dyspnea
  • Elevated troponin
  • New ECG changes
  • Muscle pain with cardiac symptoms

Treatment Methods

01
Immediate discontinuation of immunotherapy
02
High-dose corticosteroids (1–2 mg/kg methylprednisolone)
03
Intravenous immunoglobulin (IVIG)
04
Anti-thymocyte globulin in refractory cases
05
Abatacept for CTLA-4-related cases
06
Arrhythmia management and hemodynamic support
07
Multidisciplinary cardio-oncology follow-up

Which Department to Visit?

You can visit our Kardiyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.