Myocarditis: treatment of myocarditis

Myocarditis is an inflammatory condition of the myocardium causing dilated cardiomyopathy and threatening arrhythmias. It typically results from cardiotropic viral infection followed by an inflammatory destruction of the myocardium. Characterization of myocarditis has been hampered by its heterogeneous clinical presentations and diverse aetiologies. Clinical and non-invasive investigations—including magnetic resonance imaging—are fundamental for the identification of cases of suspected myocarditis. However, the definite diagnosis of myocarditis is provided by histological, immunohistological, and virological analyses of myocardial tissue samples obtained by endomyocardial biopsies. This is the gold standard for the definite diagnosis and the basis for a tailored treatment strategy oriented to the pathophysiological mechanisms. For every clinical decision concerning therapy, one needs an exact knowledge of the quality and intensity of the inflammatory process and/or the type and activity of the viral infection. The evidence-based treatment strategies cover immunosuppressive, immune-modulating, and antiviral strategies. The specific, causal, and personalized treatment adapted to pathophysiological clearly characterized disease forms lead to a significant clinical improvement.