Materiały źródłowe

• #1 Treatment and prognosis of myocarditis in adults – UpToDate

  https://www.uptodate.com/contents/treatment-and-prognosis-of-myocarditis-in-adults

  Treatment of myocarditis consists of both specific therapy aimed at the cause of the myocarditis and nonspecific therapy aimed at the clinical manifestations such as HF and arrhythmias. […] Overview of therapy for lymphocytic myocarditis. […] Antiviral therapy. […] Immunosuppressive therapy. […] Intravenous immune globulin.

• #2 Current Treatment and Immunomodulation Strategies in Acute Myocarditis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11067867/

  Myocarditis is an inflammatory disease of the myocardium characterized by a great heterogeneity of presentation and evolution. Treatment of myocarditis is often supportive, and the evidence for immunosuppression is scarce and debated. Conventional treatment is based on clinical presentation, ranging from conservative to advanced mechanical assist devices. In this setting, immunosuppression and immunomodulation therapies are mostly reserved for patients presenting with major clinical syndromes. In this review, we will summarize the current evidence and strategies for conventional and immunosuppressive treatments for patients presenting with acute myocarditis. […] Supportive management is the mainstay of therapy for patients presenting with AM. Further management of myocarditis may include immunosuppression with steroids. Empirical immunosuppression has, so far, failed to demonstrate a strong clinical benefit and is only recommended in patients with GCM or after exclusion of active viral replication at EMB in the most severe patients. Risk stratification in AM is important. Indeed, studies investigating the role of immunosuppression in myocarditis were generally small and conducted in selected high-risk populations. Other anti-inflammatory therapies that have been investigated for use in myocarditis include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, monoclonal antibodies, and other immunosuppressants such as azathioprine (AZA) and methotrexate (MTX). This review aims to summarize available treatments for myocarditis, discuss challenges with the existing evidence base, and review emerging novel therapies.

• #3 Myocarditis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocarditis/diagnosis-treatment/drc-20352544

  Often, myocarditis gets better on its own or with treatment. Myocarditis treatment focuses on the cause and the symptoms, such as heart failure. […] Myocarditis treatment may include: Medicine. Medical devices. Surgery. […] People with mild myocarditis may only need rest and medicine. If myocarditis is severe, medicines may be given through an IV at a hospital to quickly improve the heart’s ability to pump blood. […] Medicine to treat myocarditis may include: Corticosteroids. These medicines may be used to treat some rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis. […] Medicines to prevent blood clots. If myocarditis is causing severe heart failure or irregular heartbeats, medicine may be given to reduce the risk of blood clots in the heart. […] Heart medicines. Medicines may be used to remove extra fluid from the body and reduce the strain on the heart. Some types of medicines that may be used to treat myocarditis symptoms are diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin 2 receptor blockers (ARBs).

• #4 Myocarditis: Symptoms & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/myocarditis

  In cases of mild myocarditis, medication, rest, and recovery may be all that is needed for it to go away on its own. Antibiotics are often prescribed if an infection is the suspected cause of myocarditis. Most cases improve with this standard medical therapy and need no further intervention for the heart to return to its normal function and rhythm. […] In addition to treating an infection, doctors often prescribe other medications such as ACE inhibitors for lowering blood pressure, corticosteroids for reducing inflammation, and diuretics to decrease fluid buildup. Beta blockers may also be used to help restore the natural heart rhythm. […] Surgery may be necessary in rare cases when the myocarditis has led to heart failure or an abnormal heart rhythm. Inserting a pacemaker or another device could be an option. If myocarditis does not improve and heart failure continues to worsen, even with previous treatments, a patient may be evaluated for a heart transplant.

• #5 Current Treatment and Immunomodulation Strategies in Acute Myocarditis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11067867/

  Myocarditis is an inflammatory disease of the myocardium characterized by a great heterogeneity of presentation and evolution. Treatment of myocarditis is often supportive, and the evidence for immunosuppression is scarce and debated. Conventional treatment is based on clinical presentation, ranging from conservative to advanced mechanical assist devices. In this setting, immunosuppression and immunomodulation therapies are mostly reserved for patients presenting with major clinical syndromes. In this review, we will summarize the current evidence and strategies for conventional and immunosuppressive treatments for patients presenting with acute myocarditis. […] Supportive management is the mainstay of therapy for patients presenting with AM. Further management of myocarditis may include immunosuppression with steroids. Empirical immunosuppression has, so far, failed to demonstrate a strong clinical benefit and is only recommended in patients with GCM or after exclusion of active viral replication at EMB in the most severe patients. Risk stratification in AM is important. Indeed, studies investigating the role of immunosuppression in myocarditis were generally small and conducted in selected high-risk populations. Other anti-inflammatory therapies that have been investigated for use in myocarditis include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, monoclonal antibodies, and other immunosuppressants such as azathioprine (AZA) and methotrexate (MTX). This review aims to summarize available treatments for myocarditis, discuss challenges with the existing evidence base, and review emerging novel therapies.

• #6

  https://journals.lww.com/cardiovascularpharm/fulltext/2024/05000/current_treatment_and_immunomodulation_strategies.2.aspx

  Myocarditis is an inflammatory disease of the myocardium characterized by a great heterogeneity of presentation and evolution. Treatment of myocarditis is often supportive, and the evidence for immunosuppression is scarce and debated. Conventional treatment is based on clinical presentation, ranging from conservative to advanced mechanical assist devices. In this setting, immunosuppression and immunomodulation therapies are mostly reserved for patients presenting with major clinical syndromes. In this review, we will summarize the current evidence and strategies for conventional and immunosuppressive treatments for patients presenting with acute myocarditis. […] Supportive management is the mainstay of therapy for patients presenting with AM. Further management of myocarditis may include immunosuppression with steroids. Empirical immunosuppression has, so far, failed to demonstrate a strong clinical benefit and is only recommended in patients with GCM or after exclusion of active viral replication at EMB in the most severe patients. Risk stratification in AM is important. Indeed, studies investigating the role of immunosuppression in myocarditis were generally small and conducted in selected high-risk populations. Other anti-inflammatory therapies that have been investigated for use in myocarditis include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, monoclonal antibodies, and other immunosuppressants such as azathioprine (AZA) and methotrexate (MTX). This review aims to summarize available treatments for myocarditis, discuss challenges with the existing evidence base, and review emerging novel therapies.

• #7 Understanding Myocarditis – Myocarditis Foundation

  https://www.myocarditisfoundation.org/about-myocarditis/

  Myocarditis is classified as a rare disease but is estimated to affect thousands of adults and children in the U.S. and around the world each year. […] Here, we’ll review the disease’s causes, symptoms, treatment and more to answer your most pressing questions. […] While there is no known treatment for viral myocarditis, the physician will treat the symptoms (known as symptomatic treatment) caused from the effects of myocarditis. […] If there is an element of weakened heart function, they will treat that with various cardiac medications, dependent on the specific case. […] Avoiding sustained and strenuous exercise can prevent further heart damage. […] The usual period-of-time of cardiac rest, is from 3 to 6 months, but each case is different. […] After treatment, many patients live long, full lives free from the effects of myocarditis.

• #8 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Myocarditis-Therapy.aspx

  A majority of patients with acute myocarditis do not require therapy. […] Individuals with left ventricular dysfunction or symptomatic heart failure should adhere to current heart failure therapy guidelines. […] Supportive care is the first line of treatment for myocarditis; therefore, every patient with active myocarditis should avoid physical activity for at least six months even in cases of early recovery. […] Treatment options for acute myocarditis generally follow the heart-failure regimen for systolic heart failure, as described in the current guidelines of the European Society of Cardiology. […] In patients whose condition gets worse despite optimal medical management, mechanical circulatory support can be instituted in the form of ventricular assist devices or extracorporeal membrane oxygenation, for example.

• #9 Pediatric Viral Myocarditis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/890740-treatment

  Extracorporeal membrane oxygenation (ECMO) has been used as an interim treatment to provide rest to the heart and as a bridge for transplant in selected patients with good results. Left ventricular assist devices may also be utilized in those patients with poor left ventricular function that does not recover and as a bridge to transplantation. […] A low-salt diet is recommended for patients with congestive heart failure. Bed rest is necessary during the acute phase of the illness and may slow the intramyocardial replication of the virus. Activity is permitted as partial or complete recovery is achieved. Restrict patient activity based on performance after the acute phase. […] Monitor medication doses and adverse effects. Serial echocardiography is useful in monitoring ventricular function. Avoid negative inotropes. Be aware of the possibility of a further decrease in ventricular function.

• #10 Pediatric Viral Myocarditis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/890740-treatment

  Extracorporeal membrane oxygenation (ECMO) has been used as an interim treatment to provide rest to the heart and as a bridge for transplant in selected patients with good results. Left ventricular assist devices may also be utilized in those patients with poor left ventricular function that does not recover and as a bridge to transplantation. […] A low-salt diet is recommended for patients with congestive heart failure. Bed rest is necessary during the acute phase of the illness and may slow the intramyocardial replication of the virus. Activity is permitted as partial or complete recovery is achieved. Restrict patient activity based on performance after the acute phase. […] Monitor medication doses and adverse effects. Serial echocardiography is useful in monitoring ventricular function. Avoid negative inotropes. Be aware of the possibility of a further decrease in ventricular function.

• #11 Myocarditis | Heart Condition – Heart Foundation NZ

  https://www.heartfoundation.org.nz/your-heart/heart-conditions/myocarditis

  Treatment will vary for each person and depends on your symptoms. […] If you have mild myocarditis, you may need to stay home, rest, and take medication. […] If you have severe myocarditis, this will most likely require a stay in hospital. […] You may need medication to help: prevent blood clots, keep your heart pumping normally and reduce the amount of work it’s doing, reduce excess fluid, help you with your breathing, reduce inflammation. […] It is very important not to drink alcohol while you have myocarditis. This is because it can cause more damage to your heart. […] It is usually treated with anti-inflammatory medication, resting and avoiding physical activity for six months.

• #12 Myocarditis Treatment & Management: Approach Considerations, Emergency Department Care, Medical Care

  https://emedicine.medscape.com/article/156330-treatment

  Guideline-directed medical therapy (GDMT) is recommended for all patients with acute myocarditis, particularly in the setting of heart failure (HF) and/or arrhythmias. The general principles of therapy for congestive HF (CHF) are applicable to patients with myocarditis. These principles include the manipulation of preload, afterload, and contractility. Therefore, fluid restriction and diuretics, inotropic support to optimize contractility with continuous intravenous (IV) inotropic agents, and IV vasodilator agents, are all important potential interventions for CHF caused by myocarditis of a nonviral origin. […] Overall, neurohormonal agents are given in a similar manner as in patients presenting with new-onset HF. Serial assessment is needed to determine the potential resolution of acute myocarditis, and during the early recovery period, strenuous exercise and digoxin should be avoided. Data regarding the risks of relapse with drug withdrawal following recovery are not available, so it is generally not recommended in practice.

• #13 Myocarditis Treatment & Management: Approach Considerations, Emergency Department Care, Medical Care

  https://emedicine.medscape.com/article/156330-treatment

  Following stabilization, it is recommended that all patients with fulminant myocarditis and contractile dysfunction regardless of the disease pathogenesis be treated with evidence-based neurohormonal antagonist therapy. […] Treatment of myocarditis includes supportive therapy for symptoms of acute HF with use of diuretics, nitroglycerin/nitroprusside, and angiotensin-converting enzyme (ACE) inhibitors. Inotropic drugs (eg, dobutamine, milrinone) may be necessary for severe decompensation, although they are highly arrhythmogenic. Long-term treatment follows the same medical regimen, including ACE inhibitors, beta blockers, and aldosterone receptor antagonists. However, in some instances, some of these drugs cannot be implemented initially because of hemodynamic instability. […] The American Heart Association indicates that in those with fulminant myocarditis and sinus tachycardia, avoid the use of rate control agents (in particular, those with negative inotropic properties: metoprolol, diltiazem, verapamil, etc). Also, avoid the use of NSAIDs to avoid increasing sodium retention, myocardial harm, and exacerbation of renal hypoperfusion.

• #14 Myocarditis: Symptoms and Causes

  https://my.clevelandclinic.org/health/diseases/22129-myocarditis

  Myocarditis is inflammation of the heart muscle, or myocardium. This inflammation weakens your heart muscle, making it harder for your heart to pump. This can be caused by viral infections or inflammatory conditions. […] If you have a mild case, it may go away on its own. If not, your provider can order medicines for you. […] To treat myocarditis, your healthcare provider may want you to take medication. These include: Medicines for heart failure, Corticosteroids, Intravenous (IV) immunoglobulin. […] If your myocarditis led to heart failure or an abnormal heart rhythm and your case is serious, you may need surgery to implant a: LVAD (left ventricular assist device), Pacemaker, Donor heart.

• #15 Myocarditis: Causes, Symptoms, Treatment & Tests You May Need

  https://www.webmd.com/heart-disease/myocarditis

  Sometimes, mild myocarditis gets better on its own. But other times, you might need medical treatment. […] If possible, your doctor will treat the cause of the myocarditis (for example, by prescribing medications for lupus). […] Usually, you’ll be given medicines to help your heart work better. Examples include: ACE inhibitors. These lower your blood pressure so your heart doesn’t have to work as hard. […] Beta-blockers. These slow down your heart rate and lower blood pressure. […] Corticosteroids. These calm down inflammation in the heart. […] Diuretics. These can help decrease fluid build-up caused by a weakened heart. […] Intravenous immunoglobulin. These are antibodies, or infection-fighting proteins, delivered through an IV. […] Your doctor will probably suggest rest or reduced activity. They might put you on a low-salt diet to keep fluid from building up. If you have mild myocarditis, it will often get better with just medication and rest.

• #16 Myocarditis: Causes, Symptoms, Treatment & Tests You May Need

  https://www.webmd.com/heart-disease/myocarditis

  Sometimes, mild myocarditis gets better on its own. But other times, you might need medical treatment. […] If possible, your doctor will treat the cause of the myocarditis (for example, by prescribing medications for lupus). […] Usually, you’ll be given medicines to help your heart work better. Examples include: ACE inhibitors. These lower your blood pressure so your heart doesn’t have to work as hard. […] Beta-blockers. These slow down your heart rate and lower blood pressure. […] Corticosteroids. These calm down inflammation in the heart. […] Diuretics. These can help decrease fluid build-up caused by a weakened heart. […] Intravenous immunoglobulin. These are antibodies, or infection-fighting proteins, delivered through an IV. […] Your doctor will probably suggest rest or reduced activity. They might put you on a low-salt diet to keep fluid from building up. If you have mild myocarditis, it will often get better with just medication and rest.

• #17 Myocarditis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocarditis/diagnosis-treatment/drc-20352544

  Often, myocarditis gets better on its own or with treatment. Myocarditis treatment focuses on the cause and the symptoms, such as heart failure. […] Myocarditis treatment may include: Medicine. Medical devices. Surgery. […] People with mild myocarditis may only need rest and medicine. If myocarditis is severe, medicines may be given through an IV at a hospital to quickly improve the heart’s ability to pump blood. […] Medicine to treat myocarditis may include: Corticosteroids. These medicines may be used to treat some rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis. […] Medicines to prevent blood clots. If myocarditis is causing severe heart failure or irregular heartbeats, medicine may be given to reduce the risk of blood clots in the heart. […] Heart medicines. Medicines may be used to remove extra fluid from the body and reduce the strain on the heart. Some types of medicines that may be used to treat myocarditis symptoms are diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin 2 receptor blockers (ARBs).

• #18

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Myocarditis%20Background%20PEDs

  Myocarditis: Treatment […] Initial/Prep/Goals […] Primarily focuses on supportive care, monitoring, and management of heart failure […] Treatment is tailored by disease severity […] Maintain ABC and manage cardiac emergencies according to PALS […] Stabilize the patient hemodynamically […] Manage heart failure and its complication […] Manage arrhythmia and its complication […] For patients with pulmonary edema positive pressure ventilation may be required […] If the patient presents with cardiogenic shock, decrease metabolic demand by sedation, intubation and mechanical ventilation […] Severe and unresponsive cases may be managed by extracorporeal membrane oxygenation (ECMO) or a ventricular assist device. […] Medical/Pharmaceutical […] If the patient presents with congestive heart failure give diuretics, after load reducing agents, inotropic agents (Dopamine, Dobutamine, Milrinone) […] If the patient develops chronic heart failure give diuretics, angiotensin inhibitors […] Beta blockers have shown mixed studies (i.e., poor outcomes) […] Combination ACE-I and B-Blockers has shown survival (78%) for heart failure hospitalization […] Digoxin (not recommended for acute myocarditis) […] Spironolactone […] Combination of ACE-I and Beta-blockade + selective use of aldosterone antagonists in symptomatic heart failure […] For example: Carvedilol (Limited data; 0.2-0.4 mg/kg/dose PO BID) + Lisinopril + Spironolactone […] Cardiogenic shock/Refractory to medical treatment use of inotropic agents with mechanical ventilatory or circulatory support (Dopamine, Dobutamine, Milrinone) […] Immunosuppressive therapy benefit not established […] IVIG (Intravenous immunoglobulins) doesn’t impact survival […] Antiarrhythmics should be given accordingly in consultation with a pediatric cardiologist. […] Surgical/Procedural […] Heart transplantation remains the final therapeutic option for children with myocarditis and intractable severe heart failure […] ECMO […] Pacing […] Ventricular assist devices.

• #19 Myocarditis – Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/myocarditis-diagnosis-and-treatment/

  Myocarditis – Diagnosis and Treatment […] Treatment should be tailored around the etiology of the myocarditis, risk stratification, and clinical presentation. […] For hemodynamically unstable patients, may require inotropic support, diuresis, and ventilator support. Norepinephrine is the preferred vasopressor in myocarditis. Avoid excessive IV fluids which may worsen symptoms. […] For hemodynamically stable patients, if heart failure is present, standard heart failure therapy may be used including ACEi/ARB and beta blocker with consideration of MRA. […] Immunosuppressive agents should only be considered for subgroups of patients with specific etiologies of myocarditis including giant cell myocarditis, sarcoidosis, or other systemic autoimmune diseases, which require EMB. […] Immunotherapy is not recommended as it has not been shown to affect outcomes and may have significant side effects.

• #20 Advances in myocarditis management in the light of the latest research and recent guidelines of the European Society of Cardiology | Chabior | Cardiology Journal

  https://journals.viamedica.pl/cardiology_journal/article/view/95175

  The main goal of treatment is the optimal management of HF and arrhythmias according to standard recommendations from appropriate guidelines. According to the ESC guidelines, standard HF therapy with angiotensin converting enzyme inhibitors or angiotensin receptor neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists and sodium glucose co-transporter type 2 inhibitors should be initiated when baseline LVEF is decreased [6]. […] Moreover, hemodynamically unstable patients with acute/fulminant myocarditis (FM) should be treated in experienced intensive cardiac care units with respiratory and mechanical circulatory support, if necessary [6]. Patients with FM and deteriorating cardiac function may require diuretics, inotropes, and vasopressors. In case of cardiogenic shock unresponsive to initial treatment, temporary mechanical ventilation, veno-arterial extracorporeal membrane oxygenation or the Impella heart pump should be considered [44]. Heart transplant or left ventricular assist device implantation should be under consideration when transient mechanical circulatory support must be continued for more than 2 or 3 weeks [45, 46].

• #21 Current Treatment and Immunomodulation Strategies in Acute Myocarditis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11067867/

  Myocarditis is an inflammatory disease of the myocardium characterized by a great heterogeneity of presentation and evolution. Treatment of myocarditis is often supportive, and the evidence for immunosuppression is scarce and debated. Conventional treatment is based on clinical presentation, ranging from conservative to advanced mechanical assist devices. In this setting, immunosuppression and immunomodulation therapies are mostly reserved for patients presenting with major clinical syndromes. In this review, we will summarize the current evidence and strategies for conventional and immunosuppressive treatments for patients presenting with acute myocarditis. […] Supportive management is the mainstay of therapy for patients presenting with AM. Further management of myocarditis may include immunosuppression with steroids. Empirical immunosuppression has, so far, failed to demonstrate a strong clinical benefit and is only recommended in patients with GCM or after exclusion of active viral replication at EMB in the most severe patients. Risk stratification in AM is important. Indeed, studies investigating the role of immunosuppression in myocarditis were generally small and conducted in selected high-risk populations. Other anti-inflammatory therapies that have been investigated for use in myocarditis include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, monoclonal antibodies, and other immunosuppressants such as azathioprine (AZA) and methotrexate (MTX). This review aims to summarize available treatments for myocarditis, discuss challenges with the existing evidence base, and review emerging novel therapies.

• #22

  https://journals.lww.com/cardiovascularpharm/fulltext/2024/05000/current_treatment_and_immunomodulation_strategies.2.aspx

  Myocarditis is an inflammatory disease of the myocardium characterized by a great heterogeneity of presentation and evolution. Treatment of myocarditis is often supportive, and the evidence for immunosuppression is scarce and debated. Conventional treatment is based on clinical presentation, ranging from conservative to advanced mechanical assist devices. In this setting, immunosuppression and immunomodulation therapies are mostly reserved for patients presenting with major clinical syndromes. In this review, we will summarize the current evidence and strategies for conventional and immunosuppressive treatments for patients presenting with acute myocarditis. […] Supportive management is the mainstay of therapy for patients presenting with AM. Further management of myocarditis may include immunosuppression with steroids. Empirical immunosuppression has, so far, failed to demonstrate a strong clinical benefit and is only recommended in patients with GCM or after exclusion of active viral replication at EMB in the most severe patients. Risk stratification in AM is important. Indeed, studies investigating the role of immunosuppression in myocarditis were generally small and conducted in selected high-risk populations. Other anti-inflammatory therapies that have been investigated for use in myocarditis include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, monoclonal antibodies, and other immunosuppressants such as azathioprine (AZA) and methotrexate (MTX). This review aims to summarize available treatments for myocarditis, discuss challenges with the existing evidence base, and review emerging novel therapies.

• #23 Myocarditis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocarditis/diagnosis-treatment/drc-20352544

  Often, myocarditis gets better on its own or with treatment. Myocarditis treatment focuses on the cause and the symptoms, such as heart failure. […] Myocarditis treatment may include: Medicine. Medical devices. Surgery. […] People with mild myocarditis may only need rest and medicine. If myocarditis is severe, medicines may be given through an IV at a hospital to quickly improve the heart’s ability to pump blood. […] Medicine to treat myocarditis may include: Corticosteroids. These medicines may be used to treat some rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis. […] Medicines to prevent blood clots. If myocarditis is causing severe heart failure or irregular heartbeats, medicine may be given to reduce the risk of blood clots in the heart. […] Heart medicines. Medicines may be used to remove extra fluid from the body and reduce the strain on the heart. Some types of medicines that may be used to treat myocarditis symptoms are diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin 2 receptor blockers (ARBs).

• #24 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Arrhythmias Recommendation. Arrhythmias may be reversible in the acute stages of myocarditis, and this possibility should be considered when taking decisions. Sarcoidosis and giant cell myocarditis are the most likely diagnoses in patients with myocarditis and ventricular arrhythmias. […] Acute lymphocytic myocarditis Recommendation. Corticosteroids should only be used to treat fulminant lymphocytic myocarditis or complicated acute myocarditis in patients awaiting EMB, the results of which should dictate treatment. […] Giant cell myocarditis Recommendation. Giant cell myocarditis should be treated aggressively and rapidly using combination immunosuppressive therapy: access to circulatory support must be ensured given the uncertain course of this disease. […] Immune checkpoint inhibitor-associated myocarditis Recommendation. When immune checkpoint inhibitor-myocarditis is suspected, immunotherapy should be discontinued and corticosteroids initiated promptly.

• #25 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  Patients diagnosed with giant cell myocarditis (GCM) should receive prompt treatment with immunosuppressive therapy. Combined treatment with anti-T-lymphocyte-based therapy, such as antithymocyte globulin, and calcineurin inhibitor therapy can lead to remission in approximately two-thirds of patients. […] Patients with fulminant myocarditis in the setting of GCM should receive antithymocyte globulin and pulse high-dose corticosteroids, with the addition of cyclosporine a few days after antithymocyte globulin administration. Corticosteroid treatment is continued for approximately 1 year, and cyclosporine treatment typically is continued for at least 2 years. Azathioprine or mycophenolate could be added during this period. […] Because patients with GCM are at a high risk for ventricular arrhythmias, implantable cardiac defibrillator (ICD) placement generally is recommended for all patients, including those who recovered heart function after treatment. Heart transplant is an effective option for patients with GCM.

• #26 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  Experts generally recommend corticosteroid therapy to treat cardiac sarcoidosis, although it is unclear whether all patients should receive this treatment, or just those who are symptomatic. Methotrexate is a second-line treatment option for patients who do not respond to corticosteroids or cannot tolerate the adverse effects of corticosteroids.

• #27

  https://journals.lww.com/cardiovascularpharm/fulltext/2024/05000/current_treatment_and_immunomodulation_strategies.2.aspx

  The role of corticosteroids in AM is controversial. Only 1 randomized clinical trial has assessed the efficacy of immunosuppression for AM. In this trial, Mason et al studied the effect of prednisone with either cyclosporine or AZA in 111 patients with a histopathological diagnosis of myocarditis and a LV ejection fraction less than 45%. The immunosuppressive protocol did not significantly improve mortality compared with conventional HF therapy. However, the treatment was administered between 2 weeks and 2 years after the clinical presentation, resulting in the potential inclusion of cases of long-standing chronic nonischaemic cardiomyopathy secondary to myocarditis. […] While immunosuppression is strongly recommended in specific noninfectious myocarditis settings, such as GCM, EM, cardiac sarcoidosis (CS), and immune checkpoint inhibitor-associated myocarditis, the role of steroids is debated in the other scenarios. The most recent expert consensus document on management of AM and chronic inflammatory cardiomyopathy suggests consideration of empirical intravenous (IV) corticosteroids in cases of fulminant myocarditis or complicated AM, tailoring the therapy according to EMB results. However, considerable divergence remains between official recommendations and clinical practice, including the possibility of starting immunosuppressive therapy empirically, without knowing viral polymerase chain reaction results on EMB.

• #28 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Arrhythmias Recommendation. Arrhythmias may be reversible in the acute stages of myocarditis, and this possibility should be considered when taking decisions. Sarcoidosis and giant cell myocarditis are the most likely diagnoses in patients with myocarditis and ventricular arrhythmias. […] Acute lymphocytic myocarditis Recommendation. Corticosteroids should only be used to treat fulminant lymphocytic myocarditis or complicated acute myocarditis in patients awaiting EMB, the results of which should dictate treatment. […] Giant cell myocarditis Recommendation. Giant cell myocarditis should be treated aggressively and rapidly using combination immunosuppressive therapy: access to circulatory support must be ensured given the uncertain course of this disease. […] Immune checkpoint inhibitor-associated myocarditis Recommendation. When immune checkpoint inhibitor-myocarditis is suspected, immunotherapy should be discontinued and corticosteroids initiated promptly.

• #29 Advances in myocarditis management in the light of the latest research and recent guidelines of the European Society of Cardiology | Chabior | Cardiology Journal

  https://journals.viamedica.pl/cardiology_journal/article/view/95175

  In patients with myocarditis, it is recommended to assess individually the indications for ICD or cardiac resynchronization therapy (CRT). ICD implantation in primary SCD prevention is not advised in the acute phase of myocarditis. The decision should be delayed for 3 to 6 months. Of note, in patients with a high risk of arrhythmias and/or serious left ventricular dysfunction a wearable cardioverter defibrillator may be beneficial as a bridge to an implanted device, cardiac transplantation, or resolution after immunosuppressive treatment [6]. […] For the first time, the new ESC HF guidelines have suggested considering immunosuppressive treatment in EMB-proven cases. Immunosuppression with duration tailored to the disease activity (usually for at least 612 months) is recommended in EMB-proven myocarditis, particularly giant cell or eosinophilic myocarditis, cardiac sarcoidosis, and myocarditis (especially FM) triggered by systemic autoimmune diseases [6].

• #30 Current Treatment and Immunomodulation Strategies in Acute Myocarditis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11067867/

  Several nonconventional forms of immunosuppression have been proposed or are under investigation to determine their potential benefits in the context of AM. These include recombinant cytokine receptor antagonists such as anakinra or lymphocyte components involved in the inflammatory process in myocarditis. Noncorticosteroid immunosuppressants including AZA, MTX, and cyclosporine have also been proposed for use in the management of myocarditis.

• #31

  https://journals.lww.com/cardiovascularpharm/fulltext/2024/05000/current_treatment_and_immunomodulation_strategies.2.aspx

  Several nonconventional forms of immunosuppression have been proposed or are under investigation to determine their potential benefits in the context of AM. These include recombinant cytokine receptor antagonists such as anakinra or lymphocyte components involved in the inflammatory process in myocarditis. Noncorticosteroid immunosuppressants including AZA, MTX, and cyclosporine have also been proposed for use in the management of myocarditis.

• #32 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Arrhythmias Recommendation. Arrhythmias may be reversible in the acute stages of myocarditis, and this possibility should be considered when taking decisions. Sarcoidosis and giant cell myocarditis are the most likely diagnoses in patients with myocarditis and ventricular arrhythmias. […] Acute lymphocytic myocarditis Recommendation. Corticosteroids should only be used to treat fulminant lymphocytic myocarditis or complicated acute myocarditis in patients awaiting EMB, the results of which should dictate treatment. […] Giant cell myocarditis Recommendation. Giant cell myocarditis should be treated aggressively and rapidly using combination immunosuppressive therapy: access to circulatory support must be ensured given the uncertain course of this disease. […] Immune checkpoint inhibitor-associated myocarditis Recommendation. When immune checkpoint inhibitor-myocarditis is suspected, immunotherapy should be discontinued and corticosteroids initiated promptly.

• #33 Advances in myocarditis management in the light of the latest research and recent guidelines of the European Society of Cardiology | Chabior | Cardiology Journal

  https://journals.viamedica.pl/cardiology_journal/article/view/95175

  Despite the growing doubts about the role and importance of viruses in myocarditis, it is still not recommended to start immunosuppression in patients without ruling out the presence of a virus in EMB [6, 52]. However, in case of acute HF and/or life-threatening arrhythmias during FM, some experts suggest that empirical therapy with intravenous corticosteroids may be considered without delay when immune etiology is suspected [53]. […] There is also promising data on immunosuppressive therapy with prednisone and azathioprine in chronic lymphocytic myocarditis [56]. A significant increase in LVEF and a decrease in LV dimensions and volumes was observed in some single-center studies [57]. Recently, Chimenti et al. [58] published a 20-year follow up of the TIMIC (Tailored IMmunosuppression in virus-negative Inflammatory Cardiomyopathy) trial that confirmed the lasting benefit of immunosuppressive therapy. However, further, randomized controlled studies are needed to explain the efficacy and safety of the immunosuppressive therapy in myocarditis. At present a multicenter, double blind randomized trial (IMPROVE-MC) on combined 12-month therapy of azathioprine with prednisone is ongoing in Poland [59, 60].

• #34 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  Patients diagnosed with giant cell myocarditis (GCM) should receive prompt treatment with immunosuppressive therapy. Combined treatment with anti-T-lymphocyte-based therapy, such as antithymocyte globulin, and calcineurin inhibitor therapy can lead to remission in approximately two-thirds of patients. […] Patients with fulminant myocarditis in the setting of GCM should receive antithymocyte globulin and pulse high-dose corticosteroids, with the addition of cyclosporine a few days after antithymocyte globulin administration. Corticosteroid treatment is continued for approximately 1 year, and cyclosporine treatment typically is continued for at least 2 years. Azathioprine or mycophenolate could be added during this period. […] Because patients with GCM are at a high risk for ventricular arrhythmias, implantable cardiac defibrillator (ICD) placement generally is recommended for all patients, including those who recovered heart function after treatment. Heart transplant is an effective option for patients with GCM.

• #35 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  Patients diagnosed with giant cell myocarditis (GCM) should receive prompt treatment with immunosuppressive therapy. Combined treatment with anti-T-lymphocyte-based therapy, such as antithymocyte globulin, and calcineurin inhibitor therapy can lead to remission in approximately two-thirds of patients. […] Patients with fulminant myocarditis in the setting of GCM should receive antithymocyte globulin and pulse high-dose corticosteroids, with the addition of cyclosporine a few days after antithymocyte globulin administration. Corticosteroid treatment is continued for approximately 1 year, and cyclosporine treatment typically is continued for at least 2 years. Azathioprine or mycophenolate could be added during this period. […] Because patients with GCM are at a high risk for ventricular arrhythmias, implantable cardiac defibrillator (ICD) placement generally is recommended for all patients, including those who recovered heart function after treatment. Heart transplant is an effective option for patients with GCM.

• #36 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  First-line treatment of myocarditis associated with the use of immune checkpoint inhibitor (ICIs) is intravenous corticosteroids and withdrawal of the ICI. Proposed second-line treatment options are alemtuzumab, antithymocyte globulin, and abatacept. More research is needed to understand the mechanism of ICI-associated cardiovascular disease and to define treatment options. […] Treating eosinophilic myocarditis depends on its underlying etiology. If eosinophilic myocarditis is a hypersensitivity reaction to a drug or toxin, withdrawing the offending agent is essential. Albendazole and corticosteroids can be used to treat eosinophilic myocarditis associated with Toxocara canis infection. Patients with myeloproliferative variants of hypereosinophilic syndrome should receive imatinib. Eosinophilic myocarditis associated with eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome could be treated with corticosteroids combined with immunosuppressive therapy (cyclophosphamide, azathioprine, or methotrexate).

• #37 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Sarcoidosis Recommendation. Corticosteroids are the treatment of choice for sarcoidosis. Treatment response and disease course (in particular the appearance of ventricular arrhythmias) should be closely monitored to assess the need for other immunosuppressive agents or ICD placement. […] Eosinophilic myocarditis A definitive diagnosis of eosinophilic myocarditis requires confirmation of characteristic histological findings, namely, a diffuse inflammatory infiltrate with predominant eosinophils and extensive necrosis, and, on occasions, mural and intravascular thrombi. Corticosteroids are the mainstay of treatment. […] Myocarditis associated with COVID-19 and SARS-CoV-2 vaccination Recommendation. Myocarditis associated with isolated cases of nonsevere SARS-CoV-2 infection or vaccination-induced symptoms does not require any specific treatment other than standard COVID-19 treatment or the recommendation to avoid another vaccine dose.

• #38 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Sarcoidosis Recommendation. Corticosteroids are the treatment of choice for sarcoidosis. Treatment response and disease course (in particular the appearance of ventricular arrhythmias) should be closely monitored to assess the need for other immunosuppressive agents or ICD placement. […] Eosinophilic myocarditis A definitive diagnosis of eosinophilic myocarditis requires confirmation of characteristic histological findings, namely, a diffuse inflammatory infiltrate with predominant eosinophils and extensive necrosis, and, on occasions, mural and intravascular thrombi. Corticosteroids are the mainstay of treatment. […] Myocarditis associated with COVID-19 and SARS-CoV-2 vaccination Recommendation. Myocarditis associated with isolated cases of nonsevere SARS-CoV-2 infection or vaccination-induced symptoms does not require any specific treatment other than standard COVID-19 treatment or the recommendation to avoid another vaccine dose.

• #39 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  Experts generally recommend corticosteroid therapy to treat cardiac sarcoidosis, although it is unclear whether all patients should receive this treatment, or just those who are symptomatic. Methotrexate is a second-line treatment option for patients who do not respond to corticosteroids or cannot tolerate the adverse effects of corticosteroids.

• #40 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Arrhythmias Recommendation. Arrhythmias may be reversible in the acute stages of myocarditis, and this possibility should be considered when taking decisions. Sarcoidosis and giant cell myocarditis are the most likely diagnoses in patients with myocarditis and ventricular arrhythmias. […] Acute lymphocytic myocarditis Recommendation. Corticosteroids should only be used to treat fulminant lymphocytic myocarditis or complicated acute myocarditis in patients awaiting EMB, the results of which should dictate treatment. […] Giant cell myocarditis Recommendation. Giant cell myocarditis should be treated aggressively and rapidly using combination immunosuppressive therapy: access to circulatory support must be ensured given the uncertain course of this disease. […] Immune checkpoint inhibitor-associated myocarditis Recommendation. When immune checkpoint inhibitor-myocarditis is suspected, immunotherapy should be discontinued and corticosteroids initiated promptly.

• #41 Diagnosis and Treatment of Immune Checkpoint Inhibitor-Associated Myocarditis and ACS

  https://www.acc.org/Latest-in-Cardiology/Articles/2020/10/30/15/06/Diagnosis-and-Treatment-of-Immune-Checkpoint-Inhibitor-Associated-Myocarditis-and-ACS

  Immune checkpoint inhibitor myocarditis is rare but has a high mortality, and early diagnosis and treatment is important. […] Treatment of immune checkpoint inhibitor-associated myocarditis requires a team approach with involvement of at least a cardiologist and an oncologist. […] American Society of Clinical Oncology Clinical Practice Guidelines recommend holding immune checkpoint inhibitor therapy starting with Grade 1 cardiotoxicity (asymptomatic biomarker elevation or imaging abnormality) and permanently discontinuing for Grade 2 or higher. […] In patients with no immediate response to this regimen, 1 g daily intravenous methylprednisolone with addition of mycophenolate, infliximab, or anti-thymocyte globulin is recommended. […] In steroid refractory cases as assessed by clinical course, abnormal biomarkers, and electrocardiography, alemtuzumab, infliximab, tocilizumab, or rituximab can be considered.

• #42 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Treatment of complications Treatment of ventricular dysfunction and heart failure Recommendation. There is insufficient evidence to guide specific recommendations on the treatment of heart failure in myocarditis. Guideline recommendations for heart failure due to other causes should be followed. […] Cardiogenic shock Recommendation. Rapid access to circulatory support should be available for patients with early signs of cardiogenic shock. There is no evidence supporting the use of any specific treatments for cardiogenic shock in myocarditis. Patients with severe heart failure requiring inotropic agents should receive early care in an acute care unit with immediate access to mechanical circulatory support systems, such as ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO).

• #43 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-treatment-myocarditis-inflammatory-cardiomyopathy–articulo-S1885585724001567

  Treatment of complications Treatment of ventricular dysfunction and heart failure Recommendation. There is insufficient evidence to guide specific recommendations on the treatment of heart failure in myocarditis. Guideline recommendations for heart failure due to other causes should be followed. […] Cardiogenic shock Recommendation. Rapid access to circulatory support should be available for patients with early signs of cardiogenic shock. There is no evidence supporting the use of any specific treatments for cardiogenic shock in myocarditis. Patients with severe heart failure requiring inotropic agents should receive early care in an acute care unit with immediate access to mechanical circulatory support systems, such as ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO).

• #44 Myocarditis in Adults: ED Presentations, Evaluation, and Management – emDocs

  https://www.emdocs.net/myocarditis-in-adults-ed-presentations-evaluation-and-management/

  Aggressive stabilization with intraaortic balloon pumps, extracorporeal membrane oxygenation (ECMO), and/or ventricular assist devices (VAD’s) may be necessary for patients who present with cardiovascular collapse. While VAD’s are more often used in non-acute presentations while preparing for definitive heart transplantation, ECMO has been used successfully in patients with fulminant presentations who require either continuous CPR or those with either persistent hypotension or high vasopressor or inotrope requirements. Growing evidence suggests that ECMO is more successful for said patients when started earlier in their resuscitations. A 2014 meta-analysis looking at the use of ECMO for a total of 170 patients with severe myocarditis showed survival to discharge rates of 46% for patients in whom ECMO was initiated after the onset of cardiac arrest versus 66% for those in whom ECMO was initiated prior to arrest.

• #45 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-and-treatment-of-myocarditis-a-articulo-S1885585724001567

  Arrhythmias Recommendation. Arrhythmias may be reversible in the acute stages of myocarditis, and this possibility should be considered when taking decisions. Sarcoidosis and giant cell myocarditis are the most likely diagnoses in patients with myocarditis and ventricular arrhythmias. […] Acute lymphocytic myocarditis Recommendation. Corticosteroids should only be used to treat fulminant lymphocytic myocarditis or complicated acute myocarditis in patients awaiting EMB, the results of which should dictate treatment. […] Giant cell myocarditis Recommendation. Giant cell myocarditis should be treated aggressively and rapidly using combination immunosuppressive therapy: access to circulatory support must be ensured given the uncertain course of this disease. […] Immune checkpoint inhibitor-associated myocarditis Recommendation. When immune checkpoint inhibitor-myocarditis is suspected, immunotherapy should be discontinued and corticosteroids initiated promptly.

• #46 Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-treatment-myocarditis-inflammatory-cardiomyopathy–articulo-S1885585724001567

  Arrhythmias Recommendation. Arrhythmias may be reversible in the acute stages of myocarditis, and this possibility should be considered when taking decisions. Sarcoidosis and giant cell myocarditis are the most likely diagnoses in patients with myocarditis and ventricular arrhythmias. […] Acute lymphocytic myocarditis Recommendation. Corticosteroids should only be used to treat fulminant lymphocytic myocarditis or complicated acute myocarditis in patients awaiting EMB, the results of which should dictate treatment. […] Giant cell myocarditis Recommendation. Giant cell myocarditis should be treated aggressively and rapidly using combination immunosuppressive therapy: access to circulatory support must be ensured given the uncertain course of this disease. […] Immune checkpoint inhibitor-associated myocarditis Recommendation. When immune checkpoint inhibitor-myocarditis is suspected, immunotherapy should be discontinued and corticosteroids initiated promptly.

• #47 Advances in myocarditis management in the light of the latest research and recent guidelines of the European Society of Cardiology | Chabior | Cardiology Journal

  https://journals.viamedica.pl/cardiology_journal/article/view/95175

  In patients with myocarditis, it is recommended to assess individually the indications for ICD or cardiac resynchronization therapy (CRT). ICD implantation in primary SCD prevention is not advised in the acute phase of myocarditis. The decision should be delayed for 3 to 6 months. Of note, in patients with a high risk of arrhythmias and/or serious left ventricular dysfunction a wearable cardioverter defibrillator may be beneficial as a bridge to an implanted device, cardiac transplantation, or resolution after immunosuppressive treatment [6]. […] For the first time, the new ESC HF guidelines have suggested considering immunosuppressive treatment in EMB-proven cases. Immunosuppression with duration tailored to the disease activity (usually for at least 612 months) is recommended in EMB-proven myocarditis, particularly giant cell or eosinophilic myocarditis, cardiac sarcoidosis, and myocarditis (especially FM) triggered by systemic autoimmune diseases [6].

• #48 Myocarditis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocarditis/diagnosis-treatment/drc-20352544

  Medicines to treat chronic conditions. Sometimes another health condition, such as lupus, causes myocarditis. Treating this underlying condition may help reduce heart muscle inflammation. […] A treatment called extracorporeal membrane oxygenation (ECMO) may be used to help the heart to recover or while waiting for other treatments, such as a heart transplant. […] Severe myocarditis needs aggressive treatment. Treatment may include: Ventricular assist device (VAD). A VAD helps pump blood from the lower chambers of the heart to the rest of the body. […] Heart transplant. An urgent heart transplant may be needed for those who have very severe myocarditis.

• #49 Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-020-00360-y

  Fulminant myocarditis (FM) is characterized by a rapid progressive decline in cardiac function and a high mortality rate. […] The development of mechanical circulation support (MCS) devices and progress in our understanding of the pathophysiological mechanisms underlying FM, treatment regimens have evolved from simple symptomatic treatment to a life support-based comprehensive treatment approach. […] Recent improvements in FM treatments have resulted in decreased mortality rates from over 50% to 5% in distinct clinical centers. […] Once FM is suspected or diagnosed, use of modern life support devices is highly recommended to prevent loss of life. […] Immediate immunosuppressive treatment with glucocorticoids and subsequent tapering to low maintenance dose may be initiated based on evidence of giant cell FM, cardiac sarcoidosis, and eosinophil myocarditis resulting in better outcomes.

• #50 Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-020-00360-y

  However, the application of glucocorticoids in the treatment of lymphocyte FM remains debatable, notably, disease caused by viral infections. […] The application of MCS will immediately improve heart function, however the lack of control of cytokines costs more time to wean out MCS devices or eventually lead to death. […] The combination of immunomodulation and MCS, which is the core of the life support-based comprehensive treatment regimen, supports dysfunctional circulation and attenuates an overwhelming cytokine storm. […] Our increased knowledge about the underlying pathophysiology of FM, revealed it is a severe disease characterized by acute heart failure and the occurrence of a serious inflammatory response. […] The core concept of the life support-based comprehensive treatment regimen is to modulate the immune response and provide circulation support to the deteriorated hemodynamic state via MCS.

• #51 Myocarditis: Causes, Symptoms, Treatment & Tests You May Need

  https://www.webmd.com/heart-disease/myocarditis

  Your doctor also might take steps to prevent or control complications (such as blood clots). If you have complications, you might be hospitalized. Serious cases of myocarditis may require other treatments, such as: Extracorporeal membrane oxygenation (ECMO). For this treatment, a machine removes carbon dioxide from and adds oxygen to your blood. […] Implantable cardioverter-defibrillator (ICD). A surgeon implants this device near your heart. When your heart beats irregularly, the device restores its normal rhythm by delivering a small shock. […] Intra-aortic balloon pump. This device uses a tiny balloon to help the heart pump more blood. […] Pacemaker. This device, similar to an ICD, helps regulate your heartbeat. […] Ventricular assist device (VAD). This machine helps a weakened heart to pump blood.

• #52 Myocarditis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/heart-inflammation/myocarditis/treatment

  IABP – also known as an intra-aortic balloon pump. A doctor feeds a catheter (a thin, flexible tube) into a blood vessel and guides it to the heart. A small balloon at the end of the catheter is inserted into the aorta (the main artery that carries blood out of the heart), which inflates and deflates as the heart contracts, to increasing blood flow and reduce stress being placed on the heart. […] ECMO – also known as extracorporeal membrane oxygenation, this involves pumping blood to a heart-lung machine to remove carbon dioxide from the blood and return oxygenated blood back into the body. This can be used to assist your heart and lungs in delivering oxygen to your tissues. […] VAD – a ventricular assist device, assists a weak or failing heart by pumping blood from the lower chambers of the heart to the rest of the body. This can be used to reduce the strain on the heart while a patient awaits other treatments or procedures, including a heart transplant.

• #53 Myocarditis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/heart-inflammation/myocarditis/treatment

  IABP – also known as an intra-aortic balloon pump. A doctor feeds a catheter (a thin, flexible tube) into a blood vessel and guides it to the heart. A small balloon at the end of the catheter is inserted into the aorta (the main artery that carries blood out of the heart), which inflates and deflates as the heart contracts, to increasing blood flow and reduce stress being placed on the heart. […] ECMO – also known as extracorporeal membrane oxygenation, this involves pumping blood to a heart-lung machine to remove carbon dioxide from the blood and return oxygenated blood back into the body. This can be used to assist your heart and lungs in delivering oxygen to your tissues. […] VAD – a ventricular assist device, assists a weak or failing heart by pumping blood from the lower chambers of the heart to the rest of the body. This can be used to reduce the strain on the heart while a patient awaits other treatments or procedures, including a heart transplant.

• #54 Lymphocytic Myocarditis – Diagnosis, Treatment and Care

  https://www.uchealth.com/en/conditions/lymphocytic-myocarditis

  Immunosuppressive Therapy: For cases linked to autoimmune reactions, immunosuppressive medications can be effective in reducing heart inflammation. […] In more severe cases, such as fulminant myocarditis, treatment may require more aggressive interventions: Hospitalization: For close monitoring and management of heart function. Intravenous Medications: To stabilize heart function and blood pressure. Mechanical Circulatory Support: In cases of severe heart failure, devices like ventricular assist devices (VADs) or extracorporeal membrane oxygenation (ECMO) may be necessary. Heart Transplant: In rare cases where the heart is severely damaged and other treatments are ineffective, a heart transplant may be considered. […] For patients with chronic myocarditis or those who have recovered from an acute episode, long-term management focuses on preventing recurrence and preserving heart function: Regular Monitoring: Including follow-up appointments and periodic imaging tests. Lifestyle Modifications: Such as dietary changes, exercise, and stress management to support overall heart health. Patient Education: Empowering patients with knowledge about their condition, treatment plan, and how to recognize signs of worsening symptoms.

• #55 Myocarditis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/heart-inflammation/myocarditis/treatment

  IABP – also known as an intra-aortic balloon pump. A doctor feeds a catheter (a thin, flexible tube) into a blood vessel and guides it to the heart. A small balloon at the end of the catheter is inserted into the aorta (the main artery that carries blood out of the heart), which inflates and deflates as the heart contracts, to increasing blood flow and reduce stress being placed on the heart. […] ECMO – also known as extracorporeal membrane oxygenation, this involves pumping blood to a heart-lung machine to remove carbon dioxide from the blood and return oxygenated blood back into the body. This can be used to assist your heart and lungs in delivering oxygen to your tissues. […] VAD – a ventricular assist device, assists a weak or failing heart by pumping blood from the lower chambers of the heart to the rest of the body. This can be used to reduce the strain on the heart while a patient awaits other treatments or procedures, including a heart transplant.

• #56 Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-020-00360-y

  Fulminant myocarditis (FM) is characterized by a rapid progressive decline in cardiac function and a high mortality rate. […] The development of mechanical circulation support (MCS) devices and progress in our understanding of the pathophysiological mechanisms underlying FM, treatment regimens have evolved from simple symptomatic treatment to a life support-based comprehensive treatment approach. […] Recent improvements in FM treatments have resulted in decreased mortality rates from over 50% to 5% in distinct clinical centers. […] Once FM is suspected or diagnosed, use of modern life support devices is highly recommended to prevent loss of life. […] Immediate immunosuppressive treatment with glucocorticoids and subsequent tapering to low maintenance dose may be initiated based on evidence of giant cell FM, cardiac sarcoidosis, and eosinophil myocarditis resulting in better outcomes.

• #57 Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-020-00360-y

  However, the application of glucocorticoids in the treatment of lymphocyte FM remains debatable, notably, disease caused by viral infections. […] The application of MCS will immediately improve heart function, however the lack of control of cytokines costs more time to wean out MCS devices or eventually lead to death. […] The combination of immunomodulation and MCS, which is the core of the life support-based comprehensive treatment regimen, supports dysfunctional circulation and attenuates an overwhelming cytokine storm. […] Our increased knowledge about the underlying pathophysiology of FM, revealed it is a severe disease characterized by acute heart failure and the occurrence of a serious inflammatory response. […] The core concept of the life support-based comprehensive treatment regimen is to modulate the immune response and provide circulation support to the deteriorated hemodynamic state via MCS.

• #58 Myocarditis: Causes, Symptoms, Treatment & Tests You May Need

  https://www.webmd.com/heart-disease/myocarditis

  Your doctor also might take steps to prevent or control complications (such as blood clots). If you have complications, you might be hospitalized. Serious cases of myocarditis may require other treatments, such as: Extracorporeal membrane oxygenation (ECMO). For this treatment, a machine removes carbon dioxide from and adds oxygen to your blood. […] Implantable cardioverter-defibrillator (ICD). A surgeon implants this device near your heart. When your heart beats irregularly, the device restores its normal rhythm by delivering a small shock. […] Intra-aortic balloon pump. This device uses a tiny balloon to help the heart pump more blood. […] Pacemaker. This device, similar to an ICD, helps regulate your heartbeat. […] Ventricular assist device (VAD). This machine helps a weakened heart to pump blood.

• #59 Myocarditis: Causes, Symptoms, Treatment & Tests You May Need

  https://www.webmd.com/heart-disease/myocarditis

  Your doctor also might take steps to prevent or control complications (such as blood clots). If you have complications, you might be hospitalized. Serious cases of myocarditis may require other treatments, such as: Extracorporeal membrane oxygenation (ECMO). For this treatment, a machine removes carbon dioxide from and adds oxygen to your blood. […] Implantable cardioverter-defibrillator (ICD). A surgeon implants this device near your heart. When your heart beats irregularly, the device restores its normal rhythm by delivering a small shock. […] Intra-aortic balloon pump. This device uses a tiny balloon to help the heart pump more blood. […] Pacemaker. This device, similar to an ICD, helps regulate your heartbeat. […] Ventricular assist device (VAD). This machine helps a weakened heart to pump blood.

• #60 Myocarditis: Causes, Symptoms, Treatment & Tests You May Need

  https://www.webmd.com/heart-disease/myocarditis

  Your doctor also might take steps to prevent or control complications (such as blood clots). If you have complications, you might be hospitalized. Serious cases of myocarditis may require other treatments, such as: Extracorporeal membrane oxygenation (ECMO). For this treatment, a machine removes carbon dioxide from and adds oxygen to your blood. […] Implantable cardioverter-defibrillator (ICD). A surgeon implants this device near your heart. When your heart beats irregularly, the device restores its normal rhythm by delivering a small shock. […] Intra-aortic balloon pump. This device uses a tiny balloon to help the heart pump more blood. […] Pacemaker. This device, similar to an ICD, helps regulate your heartbeat. […] Ventricular assist device (VAD). This machine helps a weakened heart to pump blood.

• #61 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  Patients diagnosed with giant cell myocarditis (GCM) should receive prompt treatment with immunosuppressive therapy. Combined treatment with anti-T-lymphocyte-based therapy, such as antithymocyte globulin, and calcineurin inhibitor therapy can lead to remission in approximately two-thirds of patients. […] Patients with fulminant myocarditis in the setting of GCM should receive antithymocyte globulin and pulse high-dose corticosteroids, with the addition of cyclosporine a few days after antithymocyte globulin administration. Corticosteroid treatment is continued for approximately 1 year, and cyclosporine treatment typically is continued for at least 2 years. Azathioprine or mycophenolate could be added during this period. […] Because patients with GCM are at a high risk for ventricular arrhythmias, implantable cardiac defibrillator (ICD) placement generally is recommended for all patients, including those who recovered heart function after treatment. Heart transplant is an effective option for patients with GCM.

• #62 Myocarditis | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/myocarditis/

  Patients diagnosed with giant cell myocarditis (GCM) should receive prompt treatment with immunosuppressive therapy. Combined treatment with anti-T-lymphocyte-based therapy, such as antithymocyte globulin, and calcineurin inhibitor therapy can lead to remission in approximately two-thirds of patients. […] Patients with fulminant myocarditis in the setting of GCM should receive antithymocyte globulin and pulse high-dose corticosteroids, with the addition of cyclosporine a few days after antithymocyte globulin administration. Corticosteroid treatment is continued for approximately 1 year, and cyclosporine treatment typically is continued for at least 2 years. Azathioprine or mycophenolate could be added during this period. […] Because patients with GCM are at a high risk for ventricular arrhythmias, implantable cardiac defibrillator (ICD) placement generally is recommended for all patients, including those who recovered heart function after treatment. Heart transplant is an effective option for patients with GCM.

• #63 Myocarditis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/heart-inflammation/myocarditis/treatment

  Heart Transplant – this option is often reserved for individuals with severe case that have caused serious heart damage and other treatment methods were ineffective. […] At NewYork-Presbyterian, our experienced team of heart care specialists provide comprehensive care for myocarditis and its symptoms. We offer the latest diagnostic testing and approaches to treatment. Schedule an appointment today to learn about our approach to myocarditis care and to avoid complications.

• #64 Myocarditis: Symptoms & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/myocarditis

  In cases of mild myocarditis, medication, rest, and recovery may be all that is needed for it to go away on its own. Antibiotics are often prescribed if an infection is the suspected cause of myocarditis. Most cases improve with this standard medical therapy and need no further intervention for the heart to return to its normal function and rhythm. […] In addition to treating an infection, doctors often prescribe other medications such as ACE inhibitors for lowering blood pressure, corticosteroids for reducing inflammation, and diuretics to decrease fluid buildup. Beta blockers may also be used to help restore the natural heart rhythm. […] Surgery may be necessary in rare cases when the myocarditis has led to heart failure or an abnormal heart rhythm. Inserting a pacemaker or another device could be an option. If myocarditis does not improve and heart failure continues to worsen, even with previous treatments, a patient may be evaluated for a heart transplant.

• #65 Understanding Myocarditis – Myocarditis Foundation

  https://www.myocarditisfoundation.org/about-myocarditis/

  Myocarditis is classified as a rare disease but is estimated to affect thousands of adults and children in the U.S. and around the world each year. […] Here, we’ll review the disease’s causes, symptoms, treatment and more to answer your most pressing questions. […] While there is no known treatment for viral myocarditis, the physician will treat the symptoms (known as symptomatic treatment) caused from the effects of myocarditis. […] If there is an element of weakened heart function, they will treat that with various cardiac medications, dependent on the specific case. […] Avoiding sustained and strenuous exercise can prevent further heart damage. […] The usual period-of-time of cardiac rest, is from 3 to 6 months, but each case is different. […] After treatment, many patients live long, full lives free from the effects of myocarditis.

• #66 Advances in myocarditis management in the light of the latest research and recent guidelines of the European Society of Cardiology | Chabior | Cardiology Journal

  https://journals.viamedica.pl/cardiology_journal/article/view/95175

  The main goal of treatment is the optimal management of HF and arrhythmias according to standard recommendations from appropriate guidelines. According to the ESC guidelines, standard HF therapy with angiotensin converting enzyme inhibitors or angiotensin receptor neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists and sodium glucose co-transporter type 2 inhibitors should be initiated when baseline LVEF is decreased [6]. […] Moreover, hemodynamically unstable patients with acute/fulminant myocarditis (FM) should be treated in experienced intensive cardiac care units with respiratory and mechanical circulatory support, if necessary [6]. Patients with FM and deteriorating cardiac function may require diuretics, inotropes, and vasopressors. In case of cardiogenic shock unresponsive to initial treatment, temporary mechanical ventilation, veno-arterial extracorporeal membrane oxygenation or the Impella heart pump should be considered [44]. Heart transplant or left ventricular assist device implantation should be under consideration when transient mechanical circulatory support must be continued for more than 2 or 3 weeks [45, 46].

• #67 Diet and Exercise Following Myocarditis Diagnosis: Recovery Tips

  https://www.myocarditisfoundation.org/diet-exercise-myocarditis-diagnosis/

  A diagnosis of myocarditis can be life-changing, but the right approach to diet and exercise can significantly support heart health during recovery. Myocarditis is an inflammation of the heart muscle, often caused by viral infections or immune system disorders. While treatment varies, adopting a healthy lifestyle can help manage symptoms and reduce the risk of complications. This guide provides actionable steps for optimizing diet and exercise after a myocarditis diagnosis. […] Whether you’re recovering from a mild case or facing long-term management of the condition, working closely with healthcare professionals is crucial. A personalized approach to diet and exercise can improve your quality of life, support heart function, and aid in preventing future cardiac issues. […] Before making any changes to your diet or exercise routine, it is essential to consult healthcare professionals. A cardiologist can evaluate the severity of your myocarditis and recommend safe levels of physical activity.

• #68 Diet and Exercise Following Myocarditis Diagnosis: Recovery Tips

  https://www.myocarditisfoundation.org/diet-exercise-myocarditis-diagnosis/

  Similarly, consulting a nutritionist or dietitian can help you develop a personalized meal plan that supports your recovery. […] Medications play a critical role in the treatment and management of myocarditis. These medications may help control inflammation, reduce symptoms, and support heart function. […] It’s essential to follow your doctor’s prescribed medication regimen closely. Skipping doses or stopping medication prematurely can lead to complications or worsen your condition. […] Recovering from myocarditis requires a personalized approach to diet and exercise. Always work closely with your healthcare team to develop a plan that is safe and tailored to your specific needs. […] By adopting heart-healthy habits, managing your weight, and following appropriate exercise guidelines, you can support your heart’s recovery and reduce the risk of future complications. […] Additionally, adhering to medication, monitoring symptoms, and seeking psychosocial support are critical components of managing myocarditis.

• #69 Understanding Myocarditis – Myocarditis Foundation

  https://www.myocarditisfoundation.org/about-myocarditis/

  Myocarditis is classified as a rare disease but is estimated to affect thousands of adults and children in the U.S. and around the world each year. […] Here, we’ll review the disease’s causes, symptoms, treatment and more to answer your most pressing questions. […] While there is no known treatment for viral myocarditis, the physician will treat the symptoms (known as symptomatic treatment) caused from the effects of myocarditis. […] If there is an element of weakened heart function, they will treat that with various cardiac medications, dependent on the specific case. […] Avoiding sustained and strenuous exercise can prevent further heart damage. […] The usual period-of-time of cardiac rest, is from 3 to 6 months, but each case is different. […] After treatment, many patients live long, full lives free from the effects of myocarditis.

• #70 Understanding Myocarditis – Myocarditis Foundation

  https://www.myocarditisfoundation.org/about-myocarditis/

  For others, however, ongoing cardiovascular medication or even a heart transplant may be needed. […] Overall, dilated cardiomyopathy which can result from myocarditis accounts for up to 45 percent of heart transplants in the U.S. today. […] Healthy lifestyle changes can also support proper heart function. […] It’s also generally advised that you avoid competitive sports and other rigorous exercise for a period after diagnosis, to be determined by the cardiologist. […] Yes, myocarditis can recur, and in some cases can lead to a chronically enlarged heart (called dilated cardiomyopathy). […] There is no known way to prevent recurrence of myocarditis. […] However, the risk of recurrence is low (probably about 10 to 15 percent). […] No lifestyle changes or medical treatments are known to prevent viral myocarditis. […] Today’s patients and healthcare providers have more information than ever about myocarditis. […] Still, there are many discoveries yet to be made, and the Myocarditis Foundation is dedicated to supporting researchers and physicians in the search for a cure.

• #71 Myocarditis: Causes, Symptoms and Treatment of Inflammation in the Heart | Brown University Health

  https://www.brownhealth.org/be-well/myocarditis-causes-symptoms-and-treatment-inflammation-heart

  Myocarditis treatment is based on the severity of symptoms and test results. Treatment ranges from simple observation to medications that reduce inflammation or treat the infection that is causing the symptoms. […] Depending on severity, hospitalization and even ICU admission may be necessary during the acute phase of illness. Medications are available to help the heart pump blood more efficiently, and other medications can be used to prevent or treat arrhythmias. […] Hospitalization, when necessary, ranges from several days to weeks, and should be followed by several months of exercise restriction after hospital discharge. This allows for complete myocardial healing prior to restarting exercise and athletics. […] Patients with vaccine-associated myocarditis typically respond very well, with minimal treatments and a full recovery.

• #72 Understanding Myocarditis – Myocarditis Foundation

  https://www.myocarditisfoundation.org/about-myocarditis/

  For others, however, ongoing cardiovascular medication or even a heart transplant may be needed. […] Overall, dilated cardiomyopathy which can result from myocarditis accounts for up to 45 percent of heart transplants in the U.S. today. […] Healthy lifestyle changes can also support proper heart function. […] It’s also generally advised that you avoid competitive sports and other rigorous exercise for a period after diagnosis, to be determined by the cardiologist. […] Yes, myocarditis can recur, and in some cases can lead to a chronically enlarged heart (called dilated cardiomyopathy). […] There is no known way to prevent recurrence of myocarditis. […] However, the risk of recurrence is low (probably about 10 to 15 percent). […] No lifestyle changes or medical treatments are known to prevent viral myocarditis. […] Today’s patients and healthcare providers have more information than ever about myocarditis. […] Still, there are many discoveries yet to be made, and the Myocarditis Foundation is dedicated to supporting researchers and physicians in the search for a cure.

• #73 Myocarditis Recovery and Rehabilitation | LifeMD

  https://lifemd.com/learn/myocarditis-recovery-and-rehabilitation

  Proper hydration can help the heart muscle to function and pump blood more effectively. […] Those recovering from myocarditis should focus on a diet rich in fruits and vegetables, which provide essential nutrients needed for healing and recovery. […] Resting is crucial for recovery from myocarditis, as it reduces the heart’s workload and aids in healing. […] Keep track of your myocarditis symptoms. […] Joining a support group can make you feel less alone in your journey to recovery. […] You may want to see a therapist while you are in recovery.

• #74 Myocarditis: Causes, Symptoms, Treatment & Tests You May Need

  https://www.webmd.com/heart-disease/myocarditis

  Sometimes, mild myocarditis gets better on its own. But other times, you might need medical treatment. […] If possible, your doctor will treat the cause of the myocarditis (for example, by prescribing medications for lupus). […] Usually, you’ll be given medicines to help your heart work better. Examples include: ACE inhibitors. These lower your blood pressure so your heart doesn’t have to work as hard. […] Beta-blockers. These slow down your heart rate and lower blood pressure. […] Corticosteroids. These calm down inflammation in the heart. […] Diuretics. These can help decrease fluid build-up caused by a weakened heart. […] Intravenous immunoglobulin. These are antibodies, or infection-fighting proteins, delivered through an IV. […] Your doctor will probably suggest rest or reduced activity. They might put you on a low-salt diet to keep fluid from building up. If you have mild myocarditis, it will often get better with just medication and rest.

• #75 Myocarditis Recovery and Rehabilitation | LifeMD

  https://lifemd.com/learn/myocarditis-recovery-and-rehabilitation

  Proper hydration can help the heart muscle to function and pump blood more effectively. […] Those recovering from myocarditis should focus on a diet rich in fruits and vegetables, which provide essential nutrients needed for healing and recovery. […] Resting is crucial for recovery from myocarditis, as it reduces the heart’s workload and aids in healing. […] Keep track of your myocarditis symptoms. […] Joining a support group can make you feel less alone in your journey to recovery. […] You may want to see a therapist while you are in recovery.

• #76 Myocarditis | Heart Condition – Heart Foundation NZ

  https://www.heartfoundation.org.nz/your-heart/heart-conditions/myocarditis

  Treatment will vary for each person and depends on your symptoms. […] If you have mild myocarditis, you may need to stay home, rest, and take medication. […] If you have severe myocarditis, this will most likely require a stay in hospital. […] You may need medication to help: prevent blood clots, keep your heart pumping normally and reduce the amount of work it’s doing, reduce excess fluid, help you with your breathing, reduce inflammation. […] It is very important not to drink alcohol while you have myocarditis. This is because it can cause more damage to your heart. […] It is usually treated with anti-inflammatory medication, resting and avoiding physical activity for six months.

• #77 Myocarditis Recovery and Rehabilitation | LifeMD

  https://lifemd.com/learn/myocarditis-recovery-and-rehabilitation

  Most patients successfully recover from myocarditis, but it may take up to seven years for a complete recovery. […] Patients can aid their recovery by staying hydrated, getting plenty of rest, and following a low-sodium diet. […] Physical therapy or cardiac rehabilitation programs can help you recover effectively. […] If you have severe myocarditis that weakens the heart muscle and affects your physical function, you may need to work with a physical therapist during your recovery. […] There are also cardiac rehabilitation programs that your doctor may recommend. […] Before resuming exercise, you should consult your doctor, as physical activity strains the heart muscle. […] If you are receiving myocarditis treatment, such as medications to lower your blood pressure and reduce heart muscle inflammation, you must continue your treatment as prescribed.

• #78 Lymphocytic Myocarditis – Diagnosis, Treatment and Care

  https://www.uchealth.com/en/conditions/lymphocytic-myocarditis

  Immunosuppressive Therapy: For cases linked to autoimmune reactions, immunosuppressive medications can be effective in reducing heart inflammation. […] In more severe cases, such as fulminant myocarditis, treatment may require more aggressive interventions: Hospitalization: For close monitoring and management of heart function. Intravenous Medications: To stabilize heart function and blood pressure. Mechanical Circulatory Support: In cases of severe heart failure, devices like ventricular assist devices (VADs) or extracorporeal membrane oxygenation (ECMO) may be necessary. Heart Transplant: In rare cases where the heart is severely damaged and other treatments are ineffective, a heart transplant may be considered. […] For patients with chronic myocarditis or those who have recovered from an acute episode, long-term management focuses on preventing recurrence and preserving heart function: Regular Monitoring: Including follow-up appointments and periodic imaging tests. Lifestyle Modifications: Such as dietary changes, exercise, and stress management to support overall heart health. Patient Education: Empowering patients with knowledge about their condition, treatment plan, and how to recognize signs of worsening symptoms.

• #79 Lymphocytic Myocarditis – Diagnosis, Treatment and Care

  https://www.uchealth.com/en/conditions/lymphocytic-myocarditis

  Recovery and management of myocarditis also involve patient support and rehabilitation programs. These can include cardiac rehabilitation, psychological support, and patient education programs to help individuals adjust to lifestyle changes and cope with the emotional aspects of living with a heart condition. […] Ongoing research is crucial in enhancing our understanding and treatment of myocarditis. Recent advances include: New Diagnostic Tools: Emerging technologies and biomarkers are being explored to improve the accuracy and ease of diagnosing myocarditis. Innovative Treatments: Research into new medications and therapies, including advanced immunosuppressive treatments, is ongoing, offering hope for more effective management of myocarditis in the future.

• #80 Myocarditis – causes, symptoms & treatments – BHF

  https://www.bhf.org.uk/informationsupport/conditions/myocarditis

  Your treatment will depend on your symptoms and the cause of them. Your doctor will discuss the best treatment options with you. […] Treatment can include: painkillers/analgesia for the chest pain, medication to calm the inflammation, (your doctor will discuss suitable anti-inflammatory medicines with you), antibiotics, if a bacterial infection is the cause, rest, general remedies if you feel unwell, such as plenty of fluids, rest and painkillers. […] Yes most people will have one episode of myocarditis and will get better with rest, medication and avoiding high intensity exercise while their heart recovers. Doctors will follow your progress closely at first, and then you may be offered a yearly follow up appointment depending on your circumstances. […] For some people myocarditis will last longer, or return. If your heart is damaged (scarred) by the inflammation, doctors will check your progress closely, with follow-up appointments at least every few months.

• #81 Lymphocytic Myocarditis – Diagnosis, Treatment and Care

  https://www.uchealth.com/en/conditions/lymphocytic-myocarditis

  Immunosuppressive Therapy: For cases linked to autoimmune reactions, immunosuppressive medications can be effective in reducing heart inflammation. […] In more severe cases, such as fulminant myocarditis, treatment may require more aggressive interventions: Hospitalization: For close monitoring and management of heart function. Intravenous Medications: To stabilize heart function and blood pressure. Mechanical Circulatory Support: In cases of severe heart failure, devices like ventricular assist devices (VADs) or extracorporeal membrane oxygenation (ECMO) may be necessary. Heart Transplant: In rare cases where the heart is severely damaged and other treatments are ineffective, a heart transplant may be considered. […] For patients with chronic myocarditis or those who have recovered from an acute episode, long-term management focuses on preventing recurrence and preserving heart function: Regular Monitoring: Including follow-up appointments and periodic imaging tests. Lifestyle Modifications: Such as dietary changes, exercise, and stress management to support overall heart health. Patient Education: Empowering patients with knowledge about their condition, treatment plan, and how to recognize signs of worsening symptoms.

• #82 Pediatric Viral Myocarditis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/890740-treatment

  Extracorporeal membrane oxygenation (ECMO) has been used as an interim treatment to provide rest to the heart and as a bridge for transplant in selected patients with good results. Left ventricular assist devices may also be utilized in those patients with poor left ventricular function that does not recover and as a bridge to transplantation. […] A low-salt diet is recommended for patients with congestive heart failure. Bed rest is necessary during the acute phase of the illness and may slow the intramyocardial replication of the virus. Activity is permitted as partial or complete recovery is achieved. Restrict patient activity based on performance after the acute phase. […] Monitor medication doses and adverse effects. Serial echocardiography is useful in monitoring ventricular function. Avoid negative inotropes. Be aware of the possibility of a further decrease in ventricular function.

• #83 Myocarditis Recovery and Rehabilitation | LifeMD

  https://lifemd.com/learn/myocarditis-recovery-and-rehabilitation

  Proper hydration can help the heart muscle to function and pump blood more effectively. […] Those recovering from myocarditis should focus on a diet rich in fruits and vegetables, which provide essential nutrients needed for healing and recovery. […] Resting is crucial for recovery from myocarditis, as it reduces the heart’s workload and aids in healing. […] Keep track of your myocarditis symptoms. […] Joining a support group can make you feel less alone in your journey to recovery. […] You may want to see a therapist while you are in recovery.

• #84 Myocarditis Recovery and Rehabilitation | LifeMD

  https://lifemd.com/learn/myocarditis-recovery-and-rehabilitation

  Most patients successfully recover from myocarditis, but it may take up to seven years for a complete recovery. […] Patients can aid their recovery by staying hydrated, getting plenty of rest, and following a low-sodium diet. […] Physical therapy or cardiac rehabilitation programs can help you recover effectively. […] If you have severe myocarditis that weakens the heart muscle and affects your physical function, you may need to work with a physical therapist during your recovery. […] There are also cardiac rehabilitation programs that your doctor may recommend. […] Before resuming exercise, you should consult your doctor, as physical activity strains the heart muscle. […] If you are receiving myocarditis treatment, such as medications to lower your blood pressure and reduce heart muscle inflammation, you must continue your treatment as prescribed.

• #85 Myocarditis – causes, symptoms & treatments – BHF

  https://www.bhf.org.uk/informationsupport/conditions/myocarditis

  Your treatment will depend on your symptoms and the cause of them. Your doctor will discuss the best treatment options with you. […] Treatment can include: painkillers/analgesia for the chest pain, medication to calm the inflammation, (your doctor will discuss suitable anti-inflammatory medicines with you), antibiotics, if a bacterial infection is the cause, rest, general remedies if you feel unwell, such as plenty of fluids, rest and painkillers. […] Yes most people will have one episode of myocarditis and will get better with rest, medication and avoiding high intensity exercise while their heart recovers. Doctors will follow your progress closely at first, and then you may be offered a yearly follow up appointment depending on your circumstances. […] For some people myocarditis will last longer, or return. If your heart is damaged (scarred) by the inflammation, doctors will check your progress closely, with follow-up appointments at least every few months.

• #86 Myocarditis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/244?locale=ko

  Myocarditis describes a heterogeneous group of disorders characterised by myocardial inflammation in the absence of predominant acute or chronic ischaemia. […] Treatment is usually supportive care and conventional heart failure therapy. More severe presentations may need aggressive pharmacological treatment with escalation to mechanical circulatory support. Occasionally, some cases do not respond to conventional therapy and progress to heart transplantation or death. […] Prognosis is variable but is related to presentation and underlying aetiology. Most cases of viral myocarditis are asymptomatic and spontaneously resolve. Patients who present with mild to moderate heart failure tend to improve or recover but may progress to chronic severe heart failure. Surprisingly, patients who present with fulminant, acutely decompensated heart failure almost universally recover back to baseline function, if death is prevented through management in the acute phase.

• #87 Myocarditis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/244?locale=ko

  Myocarditis describes a heterogeneous group of disorders characterised by myocardial inflammation in the absence of predominant acute or chronic ischaemia. […] Treatment is usually supportive care and conventional heart failure therapy. More severe presentations may need aggressive pharmacological treatment with escalation to mechanical circulatory support. Occasionally, some cases do not respond to conventional therapy and progress to heart transplantation or death. […] Prognosis is variable but is related to presentation and underlying aetiology. Most cases of viral myocarditis are asymptomatic and spontaneously resolve. Patients who present with mild to moderate heart failure tend to improve or recover but may progress to chronic severe heart failure. Surprisingly, patients who present with fulminant, acutely decompensated heart failure almost universally recover back to baseline function, if death is prevented through management in the acute phase.

• #88 Myocarditis – Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/myocarditis-diagnosis-and-treatment/

  Antiviral therapy should not routinely be used. […] NSAIDs not recommended as it may worsen mortality in myocarditis, as seen in experimental models, although clinical trial data is lacking. […] Physical exercise should be restricted in the acute phase, which will require follow-up 6 months after onset of the disease (expert opinion). […] All patients with suspected acute myocarditis should be admitted to hospital and those requiring vasopressors or ventilator support require ICU admission. […] 50% recover fully. […] 30% will decompensate. […] 20% require transplantation.

• #89 Myocarditis in Children | Symptoms, Causes, Treatment & Prognosis

  https://www.cincinnatichildrens.org/health/m/myocarditis

  Most children diagnosed with myocarditis are admitted to an intensive care unit for initial management. It is important for the child to be placed on bed rest. There is evidence to suggest that strenuous activity may be harmful to the heart during the recovery period. Depending upon the severity of the myocarditis, this may mean that physical activity is restricted for weeks to months. The child’s physical activity should be slowly increased over time. […] The good news is that about two-thirds of the children, with the right medical management, will have a complete recovery. […] If untreated, only 10 percent to 20 percent will have recovery on their own, and 80 percent will develop chronic heart disease. For most children, recovery usually occurs within two to three months from the onset of the illness.

• #90 Myocarditis in Children | Symptoms, Causes, Treatment & Prognosis

  https://www.cincinnatichildrens.org/health/m/myocarditis

  Of the remaining one-third who are treated, 10 percent to 20 percent will improve but have chronic residual heart problems called dilated cardiomyopathy. […] In this case, the child will need long-term follow-up by a cardiologist. Sometimes these children will develop progressive heart failure and need a heart transplant. […] Other children may be at risk for having heart rhythm problems. These can often be treated with medicine.

• #91 Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment

  https://www.mdpi.com/2075-4418/13/19/3073

  Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment […] Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. […] The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunosuppressive therapy, methods of mechanical circulatory support, and heart transplantation. […] The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high. […] Spontaneous recovery of left ventricular function is common in patients with acute myocarditis. It is necessary to treat such patients symptomatically because specific treatment options have not yet been found. Autoimmune myocarditis (large cell myocarditis) is treated with immunosuppressive therapy. A smaller number of patients require mechanical circulatory support or heart transplantation within a year. The prognosis of patients treated for myocarditis is variable, with a five-year survival rate of 60–90%.

• #92 Myocarditis Recovery and Rehabilitation | LifeMD

  https://lifemd.com/learn/myocarditis-recovery-and-rehabilitation

  Most patients successfully recover from myocarditis, but it may take up to seven years for a complete recovery. […] Patients can aid their recovery by staying hydrated, getting plenty of rest, and following a low-sodium diet. […] Physical therapy or cardiac rehabilitation programs can help you recover effectively. […] If you have severe myocarditis that weakens the heart muscle and affects your physical function, you may need to work with a physical therapist during your recovery. […] There are also cardiac rehabilitation programs that your doctor may recommend. […] Before resuming exercise, you should consult your doctor, as physical activity strains the heart muscle. […] If you are receiving myocarditis treatment, such as medications to lower your blood pressure and reduce heart muscle inflammation, you must continue your treatment as prescribed.

• #93 Understanding Myocarditis – Myocarditis Foundation

  https://www.myocarditisfoundation.org/about-myocarditis/

  For others, however, ongoing cardiovascular medication or even a heart transplant may be needed. […] Overall, dilated cardiomyopathy which can result from myocarditis accounts for up to 45 percent of heart transplants in the U.S. today. […] Healthy lifestyle changes can also support proper heart function. […] It’s also generally advised that you avoid competitive sports and other rigorous exercise for a period after diagnosis, to be determined by the cardiologist. […] Yes, myocarditis can recur, and in some cases can lead to a chronically enlarged heart (called dilated cardiomyopathy). […] There is no known way to prevent recurrence of myocarditis. […] However, the risk of recurrence is low (probably about 10 to 15 percent). […] No lifestyle changes or medical treatments are known to prevent viral myocarditis. […] Today’s patients and healthcare providers have more information than ever about myocarditis. […] Still, there are many discoveries yet to be made, and the Myocarditis Foundation is dedicated to supporting researchers and physicians in the search for a cure.

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