Introduction

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).

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.