From the Guidelines
Myocarditis treatment primarily involves supportive care and management of heart failure symptoms.
Treatment Overview
- The treatment of myocarditis should be based on standard pathways for heart failure, with a focus on managing symptoms and preventing further complications [ 1 ].
- Immunosuppression is generally not indicated for acute lymphocytic myocarditis in adults, but may be considered in cases of giant cell myocarditis, cardiac sarcoidosis, or eosinophilic myocarditis [ 1 ].
- Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided due to the risk of increased inflammation and mortality [ 1 ].
Management of Specific Conditions
- In patients with fulminant myocarditis, management of heart failure and potentially fatal arrhythmias is the main clinical challenge [ 2 ].
- Giant cell myocarditis is a severe form of myocarditis with a dramatic clinical course, frequently affecting young patients, and may require placement of temporary or permanent pacemakers [ 2 ].
- In patients with COVID-19 myocarditis, treatment may involve corticosteroids, low-dose aldosterone system inhibitors, and beta-blockers, depending on the severity of symptoms and presence of concurrent pneumonia [ 3 ].
Additional Considerations
- Competitive sport participation should be avoided for 3 to 6 months after diagnosis of myocarditis to prevent increased mortality [ 1 ].
- Mechanical circulatory support (MCS) may be required in patients with myocarditis who develop cardiogenic shock despite optimal medical management [ 1 ].
- Cardiac transplantation may be considered in patients with severe myocarditis who do not respond to medical therapy [ 1 ].
From the Research
Treatment Options for Myocarditis
The treatment for myocarditis is often supportive and depends on the clinical presentation, severity, and etiology of the disease. The following are some of the treatment options:
- Supportive care, which includes rest and management of symptoms such as chest pain and dyspnea 4
- Heart failure therapy, which may include the use of diuretics, angiotensin-converting enzyme inhibitors, and beta-blockers 5, 4
- Antiarrhythmic therapy, which may be necessary to manage arrhythmias that can occur in patients with myocarditis 5, 6
- Immunosuppressive therapy, which may be used in patients with certain forms of myocarditis, such as eosinophilic or giant cell myocardial infiltrations, or in patients with systemic autoimmune disorders 7, 4
- Intravenous immunoglobulin (IVIG) therapy, which has been shown to be effective in resolving inflammation in patients with viral cardiomyopathy and myocarditis 5, 8
Specific Treatment Approaches
Some studies have investigated the use of specific treatment approaches for myocarditis, including:
- Immunomodulation therapies, which aim to modulate the immune response and reduce inflammation 7, 8
- Antiviral treatments, which may be necessary to manage viral infections that can cause myocarditis 5, 8
- Heart rate-lowering treatments, such as beta-blockers, which may be used to manage heart failure and arrhythmias in patients with myocarditis 6
Emerging Therapies
There are also emerging therapies that are being investigated for the treatment of myocarditis, including:
- Humanized monoclonal antibodies, which may be used to target specific immune cells and reduce inflammation 8
- Herbal remedies, which may have anti-inflammatory properties and may be used to treat myocarditis 8
- Matrix metalloproteinase inhibitors, which may be used to reduce fibrosis and improve outcomes in patients with myocarditis 8