From the Guidelines
Treatment for myocarditis should be based on the underlying cause and severity of the condition, with hospitalization recommended for patients with definite myocarditis that is either mild or moderate in severity, ideally at an advanced heart failure center, as stated in the 2022 ACC expert consensus decision pathway 1. The treatment approach for myocarditis involves both supportive care and targeted therapies. For patients with myocarditis and COVID-19 pneumonia with an ongoing need for supplemental oxygen, treatment with corticosteroids is recommended 1.
- Key considerations in the treatment of myocarditis include:
- Hospitalization for patients with definite myocarditis that is either mild or moderate in severity, ideally at an advanced heart failure center 1
- Treatment with corticosteroids for patients with myocarditis and COVID-19 pneumonia with an ongoing need for supplemental oxygen 1
- Use of nonsteroidal anti-inflammatory drugs, colchicine, and/or prednisone for patients with associated pericardial involvement 1
- Initiation of guideline-directed medical therapy for heart failure before discharge and titration as appropriate in the outpatient setting 1
- Avoidance of strenuous physical activity for 3-6 months to prevent worsening inflammation and increase the risk of sudden cardiac death 1 The goal of treatment is to reduce inflammation, prevent further cardiac damage, and support heart function while the heart heals.
- Medications that may be used in the treatment of myocarditis include:
- Corticosteroids, such as prednisone, for autoimmune causes or severe myocardial inflammatory infiltrates 1
- ACE inhibitors, such as lisinopril, beta-blockers, such as metoprolol, and diuretics, such as furosemide, for heart failure symptoms 1
- Antiarrhythmic medications or devices for arrhythmias 1 It is essential to note that the treatment approach may vary depending on the underlying cause and severity of the condition, and consultation with a cardiologist is crucial in making decisions about treatment 1.
From the Research
Myocarditis Treatment Overview
- The treatment of myocarditis depends on the severity of symptoms and the specific etiology of the condition 2, 3, 4, 5.
- For patients with mild symptoms, treatment may focus on supportive care, such as respiratory and hemodynamic support 4, 5.
- In cases of fulminant, acute, and chronic autoreactive myocarditis, immunosuppressive treatment has proven to be beneficial 3.
- Intravenous immunoglobulin (IVIG) can be used to treat viral cardiomyopathy and myocarditis, and may help resolve inflammation 3.
Treatment Options
- Initial hemodynamic management may include vasopressors and inotropes, while more severe cases may require an intra-aortic balloon pump, extracorporeal membrane oxygenation, or a ventricular assist device 4.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in patients with myocarditis 4.
- Corticosteroids may be used to treat specific forms of myocarditis, such as eosinophilic or giant cell infiltrations, or in cases of systemic autoimmune disorders 5.
- Oral doxycycline has been used to successfully treat Lyme carditis with isolated left bundle branch block and myocarditis 6.
Etiology-Specific Treatment
- The treatment of myocarditis should be tailored to the underlying cause of the condition 2, 3, 5.
- For example, in cases of viral myocarditis, antiviral therapy may be used, while in cases of autoimmune myocarditis, immunosuppressive therapy may be necessary 3, 5.
- The use of IVIG has been shown to be effective in treating viral cardiomyopathy and myocarditis, and may help resolve inflammation 3.