Myocarditis Management Guidelines

Diagnosis and Treatment

The American College of Cardiology recommends hospitalization for patients with definite myocarditis that is either mild or moderate in severity, ideally at an advanced heart failure center 1, 2
Initial testing for suspected myocarditis should include ECG, cardiac troponin, and echocardiogram, according to the American College of Cardiology 3
Cardiac MRI is recommended in hemodynamically stable patients to confirm the diagnosis and assess the extent of ventricular dysfunction and inflammation, as suggested by the American College of Cardiology 1, 3
The American Heart Association recommends treating patients with myocarditis presenting as dilated cardiomyopathy according to standard heart failure guidelines 4, 5
For patients with mildly reduced left ventricular function and stable hemodynamics, the American College of Cardiology considers low-dose aldosterone system inhibitors and beta-blockers for patients with supraventricular arrhythmias, if hemodynamically stable 1, 2
Guideline-directed medical therapy for heart failure should be initiated before discharge and titrated appropriately in the outpatient setting, according to the American College of Cardiology 1, 2

Patients with fulminant myocarditis should be managed at centers with expertise in advanced heart failure, as recommended by the American College of Cardiology 1, 2
Mechanical circulatory support may be required for patients who develop cardiogenic shock despite optimal medical management, according to the American Heart Association 4, 5, 2
Patients with myocarditis and COVID-19 pneumonia requiring supplemental oxygen should be treated with corticosteroids, as suggested by the American College of Cardiology 1, 2
Nonsteroidal anti-inflammatory drugs may be used to alleviate chest pain and inflammation in patients with pericardial involvement, according to the American College of Cardiology 1, 2

Immunosuppression is generally not indicated for the management of acute lymphocytic myocarditis in adults, as stated by the American Heart Association 4, 5
Immunosuppressive therapy should be considered in specific forms of myocarditis, such as giant cell myocarditis and cardiac sarcoidosis, according to the American Heart Association 4, 5
Empiric use of corticosteroids may be considered in patients with biopsy evidence of severe myocardial inflammatory infiltrates or fulminant myocarditis, as suggested by the American College of Cardiology 1, 2

Competitive sport participation should be avoided for 3-6 months after the diagnosis of myocarditis, as recommended by the American Heart Association 4, 5, 3
Follow-up surveillance testing should be performed 3-6 months after presentation to gauge recovery of cardiac function and inflammation, according to the American College of Cardiology 1, 2
The overall rate of survival after cardiac transplantation for adult patients with myocarditis is similar to that for other causes of cardiac failure, as stated by the American Heart Association 4, 5