ABSTRACT
Myocarditis is a challenging inflammatory disorder of the heart with unpredictable clinical course and outcome. Although myocarditis is self-limited in half of the cases, the main concern is its established association with sudden cardiac death even in oligosymptomatic or asymptomatic patients and its potential progression to dilated cardiomyopathy, heart failure, and need for transplantation. Thus, particular emphasis should be given in the early recognition and treatment of this condition. Myocarditis may appear after a viral infection with a cardiotropic virus in genetically predisposed subjects or complicate a systemic autoimmune or autoinflammatory disorder, hypersensitivity, or exposure to toxins, among others. Although endomyocardial biopsy is still the gold standard for diagnosis and treatment guidance, cardiac magnetic resonance imaging has emerged as a noninvasive alternative for diagnostic and prognostic purposes. The treatment of myocarditis should be tailored to the individual patient according to the underlying etiology and clinical presentation. In more severely ill patients, the threshold for endomyocardial biopsy should be rather low, as novel specific treatments may be offered in addition to standard heart failure treatment, based on the detection of viral genome and/or inflammation. In the near future, better understanding of pathogenesis is expected to improve the management of myocarditis.
