Article Text

Download PDFPDF
Diagnosis, risk stratification and management of myocarditis
  1. Melina Müller1,
  2. Leslie T Cooper2,
  3. Bettina Heidecker1
  1. 1 Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
  2. 2 Department of Cardiology, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Bettina Heidecker, Department of Cardiology, Charité Universitätsmedizin Berlin, 12203 Berlin, Germany; bettina.heidecker{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Learning objectives

  • To provide knowledge about the aetiology of myocarditis.

  • To improve diagnostic and therapeutic skills iof physicians taking care of patients with myocarditis.

  • To provide knowledge about follow-up care of patients after myocarditis.


Myocarditis is defined as an inflammation of the myocardium resulting from various infectious and non-infectious causes, such as viruses, adverse drug reactions or toxins. The condition can present with a subacute, acute, fulminant or chronic course. Inflammation of the myocardium in the context of organ dysfunction is referred to as inflammatory cardiomyopathy.1 Infectious causes are most commonly viruses, while non-infectious causes may result from hypersensitivity to drugs, toxic agents or systemic autoimmune conditions.2

Clinically, the presentation of myocardial inflammation may range from asymptomatic, self-resolving and potentially undiagnosed, acute coronary syndrome (ACS)-like to a fulminant form, requiring urgent mechanical circulatory support (MCS) (table 1).

View this table:
Table 1

Main definitions

Heart failure (HF) symptoms, chest pain, troponin elevation and electrocardiographic (ECG) abnormalities after a recent influenza-like illness are red flags for myocarditis. With the development of new modalities of cardiac magnetic resonance (CMR) imaging and more standardised diagnostic guidelines, the value of non-invasive diagnosis of myocarditis continues to increase. Confirmation of myocarditis can be accomplished by histological investigation of an endomyocardial biopsy (EMB) specimen. However, there remains a need for therapy guidelines as consensus recommendations are mostly based on small clinical studies and expert opinion.

Risk stratification of patients with myocarditis is important since it is a common cause of sudden cardiac death (SCD) in young adults.3 Long-term complications of myocarditis most frequently include dilated cardiomyopathy (DCM).4 This article aims to provide an overview of the condition of myocarditis and its management by outlining current expert recommendations.


In 2019, the estimated prevalence of myocarditis was 712 780 cases globally.5 6 In the 35–39 years age group, this is equal …

View Full Text


  • Contributors All authors have contributed to writing and revising this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BH is an inventor on patents that use RNA for the diagnosis of myocarditis.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.