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Myocarditis is ‘inflammation of the myocardium’ and is most commonly due to viral infection in Europe and North America, although other pathogens, toxins and immunological conditions are also associated with the condition. Active myocarditis is characterised by infiltration of the myocardium with inflammatory cells that cause local tissue damage and myocardial oedema. Categorisation of myocarditis according to the mode of clinical presentation1 and by histological findings2 has been proposed but these techniques are rarely used. The utility of endomyocardial biopsy histology is particularly questionable given that only 10% of clinical cases of myocarditis are biopsy positive.3 In the acute phase of myocarditis additional clinical features and investigations may be used to help make the diagnosis and there may be evidence of active inflammation (increased C-reactive …