From the Guidelines
Treatment for myocarditis should be guided by current guidelines for systolic heart failure, with individualized consideration for immunosuppression in specific cases.
General Treatment Principles
- Treatment of myocarditis that presents as dilated cardiomyopathy (DCM) should follow current guidelines for systolic heart failure 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.
Specific Considerations
- Competitive sport participation should be avoided for 3 to 6 months after diagnosis, with reassessment before resuming activity 1.
- Cardiac troponin levels, 12-lead ECG, and standard transthoracic echocardiogram should be obtained in patients with clinically suspected myocarditis 1.
- Endomyocardial biopsy (EMB) may be performed in patients with unexplained acute myocarditis who require inotropic support or mechanical circulatory support (MCS), or those with high-degree heart block or ventricular tachycardia 1.
- Intravenous corticosteroids may be considered in patients with COVID-19 myocarditis and hemodynamic compromise or multisystem inflammatory syndrome (MIS-A) 1.
- Guideline-directed medical therapy for heart failure should be initiated and continued after discharge 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 treatment of heart failure and antiarrhythmic therapy 2
- Immunosuppressive treatment, which has been shown to be beneficial in certain cases, such as fulminant, acute, and chronic autoreactive myocarditis 2
- Intravenous immunoglobulin (IVIG) therapy, which can help resolve inflammation in viral cardiomyopathy and myocarditis 2, 3
- Corticosteroids, which are often used for specific forms of myocarditis, such as eosinophilic or giant cell infiltrations 4
- Mechanical circulatory devices, such as extracorporeal life support, which may be necessary for patients with hemodynamic instability 4
Immunomodulation Therapies
Immunomodulation therapies, such as immunosuppression and immunoadsorption, have been investigated for the treatment of myocarditis. These therapies aim to modulate the immune response and reduce inflammation in the heart. Some studies have shown promising results with these therapies, but further research is needed to fully understand their effectiveness 5, 3, 6.
Emerging Pharmacologic Targets
Recent studies have identified new pharmacologic targets for the treatment of myocarditis, including:
- Regulatory T cells, which can help mitigate the detrimental effects of autoimmunity in the heart 3
- Th17 T cells, which can drive autoimmunity in the heart and may be targeted with humanized monoclonal antibodies 3
- Matrix Metalloproteinases, which play a role in the development of fibrosis during dilated cardiomyopathy and may be targeted with new therapies 3