Management of myocarditis

Myocarditis refers to inflammation of the myocardium, which can result in chest pain, arrhythmias and dilated cardiomyopathy. The presenting symptoms are non specific and diverse triggers, most commonly viruses, can lead to the common clinical presentations. The pathogenesis of myocarditis can be simplified into a phase of acute injury resulting in an innate and adaptive immunological response, which downregulates in most patients leading to myocardial recovery. In a minority of cases, extensive scar form the initial injury or persistent inflammation results in chronic dilated cardiomyopathy. Cardiac magnetic resonance imaging is used in the diagnosis, with endomyocardial biopsy being reserved for cases in which the result will significantly alter prognosis or therapy. The management of myocarditis in patients with cardiomyopathy depends on the presence of infection and inflammation; if there is no evidence of either then patients are treated with standard guideline-based heart failure therapy. Emerging therapeutic strategies focus on modulating patient-specific immune reactions. Patients who fail to respond to medical therapy and have advanced heart failure may require mechanical circulatory support or heart transplantation.