From the Guidelines
Myocarditis treatment should focus on managing symptoms and preventing complications while the heart heals, with an emphasis on rest, avoiding strenuous physical activity for 3-6 months, and medications such as ACE inhibitors and beta-blockers to support cardiac function, as recommended by the most recent guidelines 1. The treatment approach for myocarditis is multifaceted and depends on the severity of the condition. Key aspects of treatment include:
- Rest and avoidance of strenuous physical activity for 3-6 months to allow the heart to recover
- Medications to manage symptoms and prevent complications, such as:
- ACE inhibitors like lisinopril (5-40mg daily) to support cardiac function and reduce inflammation
- Beta-blockers like metoprolol (12.5-200mg daily) to manage heart rate and reduce the risk of arrhythmias
- Diuretics like furosemide (20-40mg daily) to manage heart failure symptoms
- Hospitalization for severe cases, with IV medications, supplemental oxygen, or mechanical circulatory support as needed
- Regular cardiac monitoring through ECGs, echocardiograms, and blood tests to track recovery and adjust treatment as needed It is essential to note that the use of NSAIDs, such as ibuprofen, should be avoided due to the risk of increased inflammation and mortality, as highlighted in the guidelines 1. Additionally, immunosuppression may be considered in specific cases, such as giant cell myocarditis or cardiac sarcoidosis, but its use is not generally recommended for acute lymphocytic myocarditis in adults 1. The goal of treatment is to reduce cardiac inflammation, prevent heart damage, and support cardiac function while the body's immune response resolves, ultimately improving morbidity, mortality, and quality of life outcomes for patients with myocarditis.
From the Research
Treatment Options for Myocarditis
The treatment for myocarditis depends on the acuity, severity, clinical presentation, and etiology of the disease. Some of the treatment options include:
- Supportive care, which is the first-line therapy for most patients 2
- Immunosuppression, such as corticosteroids, which is appropriate for patients with eosinophilic or giant cell myocardial infiltrations or due to systemic autoimmune disorders 2, 3
- Intravenous immunoglobulin (IVIG) therapy, which has been shown to be effective in resolving inflammation in fulminant, acute, and chronic autoreactive myocarditis, as well as viral cardiomyopathy and myocarditis 4, 5, 3
- Antiviral treatments, which may be effective in treating viral myocarditis 5, 6
- Immunomodulatory therapies, which have shown potential benefit in randomized, controlled trials 6
Specific Treatment Approaches
Some specific treatment approaches for myocarditis include:
- High-dose IVIG therapy, which has been shown to be effective in treating fulminant myocarditis and acute inflammatory cardiomyopathy 4, 5
- Immunosuppressive treatment, which has proven to be beneficial in the TIMIC and ESETCID trials for fulminant, acute, and chronic autoreactive myocarditis 3
- Polyvalent intravenous immunoglobulins, which can frequently resolve inflammation in viral cardiomyopathy and myocarditis 3
Future Directions
Future research is needed to elucidate the pharmacokinetics and side-effects of promising constituents of herbal remedies, as well as to develop new treatments that target deleterious arms of the immune response, such as Th17 cells 5. Additionally, advances in our understanding of the function of Matrix Metalloproteinases may yield another target for altering disease progression in myocarditis 5.