Myocarditis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S.; Maliha Shakil, M.D. [2] Homa Najafi, M.D.[3]

Overview

Symptomatic treatment is the mainstay of therapy for patients with viral myocarditis. Supportive therapy includes diuretics and inotropes for left ventricular failure. ACE inhibitor therapy may aid in left ventricular remodeling. Among patients with fulminant myocarditis, placement of either an intra-aortic balloon pump or a left ventricular assist device may be necessary as bridge to recovery. Administration of antimicrobial therapy is recommended for bacterial myocarditis. Immunosuppressive therapy may be effective in the management of giant cell myocarditis, autoimmune myocarditis, and eosinophilic myocarditis. In patients with arrythmias, treatment should be initiated only if arrhythmias are symptomatic or sustained. Myocarditis patients presenting with conduction abnormalities, particularly Mobitz type II and complete heart block require temporary pacemaker usually during the acute phase.

Medical Therapy

Lymphocytic/Viral Myocarditis

Giant Cell Myocarditis

Eosinophilic Myocarditis

Autoimmune Myocarditis

Treatment of Heart Failure

  • Heart failure complicating myocarditis should be managed in accordance with guideline-directed medical therapy (GDMT). The 2024 ACC Expert Consensus Decision Pathway explicitly endorses the evidence-based approach to heart failure management recommended in the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure for all patients with myocarditis-associated cardiac dysfunction.[6]
  • Current GDMT for heart failure with reduced ejection fraction (HFrEF, defined as LVEF ≤40%) comprises four evidence-based medication classes.[39]
    • Angiotensin receptor-neprilysin inhibitors (ARNi): Sacubitril-valsartan is the preferred renin-angiotensin system agent in eligible patients with HFrEF (Class I, Level of Evidence A). Where ARNi is not feasible, an ACE inhibitor or angiotensin receptor blocker (ARB) remains appropriate.[39]
    • Beta-blockers: Carvedilol, metoprolol succinate, or bisoprolol are recommended in stable patients with HFrEF. Beta-blockers should be used with caution or avoided during the acutely decompensated phase of myocarditis.[39]
    • Mineralocorticoid receptor antagonists (MRA): Spironolactone or eplerenone are recommended in patients with HFrEF without contraindications.[39]
    • Sodium-glucose cotransporter-2 inhibitors (SGLT2i): Dapagliflozin or empagliflozin are now a Class I, Level of Evidence A recommendation for HFrEF, providing reduction in cardiovascular mortality and HF hospitalization independent of diabetes status. SGLT2 inhibitors also carry a Class IIa recommendation in heart failure with mildly reduced ejection fraction ( LVEF 41–49%) and a Class IIa recommendation in heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%).[39]
    • Diuretics remain important for relief of congestive symptoms and volume overload but do not independently reduce mortality.[39]
    • Digoxin should be avoided in viral myocarditis, as animal studies have demonstrated a higher mortality rate with digoxin compared to beta-blocker therapy.[39]
    • Anticoagulation may be considered in patients with severe or chronic heart failure at risk for thromboembolic complications.[39]
    • Simultaneous initiation or early combination of all four GDMT pillars may be considered rather than strict sequential titration, based on individual clinical status.[39]
    • For more information on heart failure treatment, click here.

Treatment of Arrhythmia

Treatment of Advanced Myocarditis (Stage D)

Patients with Stage D myocarditis and cardiogenic shock require prompt consideration oftemporary circulatory support. The need for temporary circulatory support should be consideredif not previously implemented.

Restriction of Strenuous Physical Activity

  • Restriction of strenuous physical activity is a central component of myocarditis management. All patients with Stage C or Stage D myocarditis should be educated to refrain from strenuous physical activity and competitive sports until formally cleared to return to such activities.[6]
  • In patients with Stage C or Stage D myocarditis, strenuous physical activity and competitive sports should be avoided for 3–6 months following the initial diagnosis.[6]
  • A reassessment for return to strenuous physical activity, including competitive sports, is performed at 3–6 months after initial diagnosis. In some athletes, these assessments can be made as early as 3 months after the initial episode of myocarditis for consideration of return to competitive sports.[6]
  • Safety for return to strenuous physical activity is guided by the following assessments, typically at the 6-month follow-up visit:[43][44][45]
  1. Follow-up CMR with T1 and T2 parametric mapping, or echocardiography, to confirm resolution of myocardial edema and normalization of left ventricular ejection fraction.
  2. 24-hour ambulatory ECG monitoring (Holter) to exclude significant arrhythmia burden.
  3. Exercise stress testing to assess functional capacity and exclude exercise-induced arrhythmia.

Longitudinal Surveillance

  • Required care does not end even if symptoms resolve after 2–3 weeks. Patients with myocarditis require longitudinal follow-up with repeat assessment of circulating biomarker levels, echocardiography, and usually a follow-up CMR.[6]
  1. At 2–4 weeks: A repeat echocardiogram with an office visit is recommended for all Stage C and Stage D patients. This allows detection of new or progressive deterioration of left ventricular function suggestive of a diagnosis of giant cell myocarditis.[6]
  2. At 6 months: A second follow-up imaging study is recommended, stratified by risk:[6]
    1. For low-risk Stage C patients (normal LVEF, no electrical or hemodynamic instability): repeat echocardiogram.
    2. For higher-risk Stage C or Stage D patients: repeat CMR with T1 and T2 parametric mapping.
  3. Serial biomarker monitoring: Serial measurement of high-sensitivity cardiac troponin and natriuretic peptides may be used to assess for evidence of subclinical deterioration between scheduled imaging studies.[46]
  4. ICD implantation in patients with severe heart failure should continue to be deferred for several months to allow sufficient time for recovery of ventricular function, consistent with existing recommendations.

Surveillance and Treatment by Stage of Myocarditis[6]

Stage A: At-Risk for Myocarditis

  • Monitor for progression to higher stages of myocarditis
  • Remove offending agent and avoid reexposure when feasible
  • Counsel patient of risk

Stage B Myocarditis

  • Hospitalization depending upon clinical context and severity of myocardial involvement
  • Reassess for presence of symptoms
  • Obtain ECG if not done before
  • Remove offending agent and avoid reexposure when feasible
  • Treat by etiology
  • Repeat imaging (echocardiogram and/or CMR)
  • Outpatient genetic counseling and testing

Stage C Myocarditis

Stage D Myocarditis

2006 ACC/AHA/ESC Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Myocarditis, Rheumatic Disease, and Endocarditis[47]

Class I
1. Temporary pacemaker insertion is indicated in patients with symptomatic bradycardia and/or heart block during the acute phase of myocarditis. (Level of Evidence: C)
2. Acute aortic regurgitation associated with VT should be treated surgically unless otherwise contraindicated.(Level of Evidence: C)
3. Acute endocarditis complicated by aortic or annular abscess and AV block should be treated surgically unless otherwise contraindicated. (Level of Evidence: C)
Class III
1.ICD implantation is not indicated during the acute phase of myocarditis. (Level of Evidence: C)
Class IIa
1. ICD implantation can be beneficial in patients with life-threatening ventricular arrhythmias who are not in the acute phase of myocarditis, as indicated in the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmic devices who are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: C)[48]
2. Antiarrhythmic therapy can be useful in patients with symptomatic NSVT or sustained VT during the acute phase of myocarditis. (Level of Evidence: C)

2013 ESC Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Myocarditis, Rheumatic Disease, and Endocarditis[49]

Class I
1. It is recommended that patients with a life-threatening presentation of sustained ventricular tachyarrhythmias in the context of clinically suspected myocarditis are referred to specialized centers with the ability to perform hemodynamic monitoring, cardiac catheterization and endomyocardial biopsy and to use mechanical cardio-pulmonary assist devices and specialized arrhythmia therapies. (Level of Evidence: C)[50][51][52][53]
2. Temporary pacemaker insertion is recommended in patients with bradycardia and/or heart block triggering VA during the acute phase of myocarditis/pancarditis.(Level of Evidence: C)[50][54]
Class IIa
1.Anti-arrhythmic therapy should be considered in patients with symptomatic non-sustained or sustained VT during the acute phase of myocarditis.(Level of Evidence: C)[50]
2. The implant of an ICD or pacemaker in patients with inflammatory heart diseases should be considered after resolution of the acute episode. (Level of Evidence: C)[50][55]
3. In patients with hemodynamically compromising sustained VT occurring after the resolution of acute episodes, an ICD implantation should be considered if the patient is expected to survive >1 year with good functional status. (Level of Evidence: C)
4. A wearable defibrillator should be considered for bridging until full recovery or ICD implantation in patients after inflammatory heart diseases with residual severe LV dysfunction and/or ventricular electrical instability. (Level of Evidence: C)[56][57]
Class IIb
1. ICD implantation may be considered earlier in patients with giant cell myocarditis or sarcoidosis who had hemodynamically compromising sustained VA or aborted cardiac arrest, due to adverse prognosis of these conditions, if survival >1 year with good functional status can be expected. (Level of Evidence: C)[58]
2. Demonstration of persistent myocardial inflammatory infiltrates by immunohistological evidence and/or abnormal localized fibrosis by CMR after acute myocarditis may be considered as an additional indicator of increased risk of SCD in inflammatory heart disease. (Level of Evidence: C)[59]

2025 ESC Recommendations for medical therapy in Myocarditis

Management of Symptoms[60]

Class IIa
1. NSAIDs (together with proton pump inhibition) should be considered in patients with associated symptoms of pericarditis to reduce symptoms.(Level of Evidence: C)
2.Colchicine should be considered in patients with myopericarditis to reduce recurrences. (Level of Evidence: B)

Management of Heart Failure[60]

Class I
1.Adherence to the ESC Heart Failure guidelines is recommended in cases of myocarditis with LV systolic dysfunction and/or HF to reduce symptoms and to improve LV function. (Level of Evidence: C)
Class IIa
2.HF therapy should be considered in patients with myocarditis and LV systolic dysfunction for at least 6 months upon complete LV functional recovery to stabilize LV function.(Level of Evidence: C)

Management of Arrhythmias[60]

Class IIa
1.β-Blockers, with a continuation for at least 6 months, should be considered in patients with acute myocarditis, especially those with troponin elevation, to control symptoms and prevent arrhythmias.(Level of Evidence: C)
2.Anti-arrhythmic treatment should be considered in post-myocarditis patients with recurrent, symptomatic VT to reduce arrhythmic burden.(Level of Evidence: B)

Immunosuppressive Therapy in Myocarditis[60]

Class IIa
1.Corticosteroids should be considered in patients with fulminant, non-infectious forms of myocarditis to stabilize the patients. (Level of Evidence: C)

References

  1. ↑ Adler, Y., Charron, P., Imazio, M., Badano, L., Barón-Esquivias, G., Bogaert, J., Brucato, A., Gueret, P., Klingel, K., Lionis, C., Maisch, B., Mayosi, B., Pavie, A., Ristić, A. D., Tenas, M. S., Seferovic, P., Swedberg, K., Tomkowski, W., & ESC Scientific Document Group. (2015). 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC): Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 36(42), 2921. https://doi.org/10.1093/eurheartj/ehv318
  2. ↑ 2.0 2.1 Tschöpe, C., Ammirati, E., Bozkurt, B., Caforio, A. L. P., Cooper, L. T., Felix, S. B., Hare, J. M., Heidecker, B., Heymans, S., Hübner, N., Kelle, S., Klingel, K., Maatz, H., Parwani, A. S., Spillmann, F., Starling, R. C., Tsutsui, H., Seferovic, P., & Van Linthout, S. (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nature Reviews. Cardiology, 18(3), 169–193. https://doi.org/10.1038/s41569-020-00435-x
  3. ↑ 3.0 3.1 Caforio, A. L. P., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S. B., Fu, M., Heliö, T., Heymans, S., Jahns, R., Klingel, K., Linhart, A., Maisch, B., McKenna, W., Mogensen, J., Pinto, Y. M., Ristic, A., Schultheiss, H.-P., Seggewiss, H., … European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart Journal, 34(33), 2636–2648, 2648a–2648d. https://doi.org/10.1093/eurheartj/eht210
  4. ↑ 4.0 4.1 Zeppenfeld, K., Tfelt-Hansen, J., de Riva, M., Winkel, B. G., Behr, E. R., Blom, N. A., Charron, P., Corrado, D., Dagres, N., de Chillou, C., Eckardt, L., Friede, T., Haugaa, K. H., Hocini, M., Lambiase, P. D., Marijon, E., Merino, J. L., Peichl, P., Priori, S. G., … ESC Scientific Document Group. (2022). 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal, 43(40), 3997–4126. https://doi.org/10.1093/eurheartj/ehac262
  5. ↑ Caforio, A. L. P., Adler, Y., Agostini, C., Allanore, Y., Anastasakis, A., Arad, M., Böhm, M., Charron, P., Elliott, P. M., Eriksson, U., Felix, S. B., Garcia-Pavia, P., Hachulla, E., Heymans, S., Imazio, M., Klingel, K., Marcolongo, R., Matucci Cerinic, M., Pantazis, A., … Linhart, A. (2017). Diagnosis and management of myocardial involvement in systemic immune-mediated diseases: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease. European Heart Journal, 38(35), 2649–2662. https://doi.org/10.1093/eurheartj/ehx321
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 Writing Committee, Drazner MD MSc FACC, M., Facc, B. B. M., Cooper MD FACC, L., Aggarwal MD FACC, N., Basso, C., Bhave MD FACC, N., Caforio, A. L. P., Ferreira, V. M., Facc, B. H. M., Kontorovich MD PhD FACC, A., Ms, P. M. P., Roth MD MPH FACC, G., & Van Eyk, J. E. (2025). 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2024.10.080
  7. ↑ Kishimoto C, Crumpacker CS, Abelmann WH (1988). "Prevention of murine coxsackie B3 viral myocarditis and associated lymphoid organ atrophy with recombinant human leucocyte interferon alpha A/D". Cardiovasc Res. 22 (10): 732–8. PMID 2855719.
  8. ↑ Yamamoto N, Shibamori M, Ogura M, Seko Y, Kikuchi M (1998). "Effects of intranasal administration of recombinant murine interferon-gamma on murine acute myocarditis caused by encephalomyocarditis virus". Circulation. 97 (10): 1017–23. PMID 9529271.
  9. ↑ Ray CG, Icenogle TB, Minnich LL, Copeland JG, Grogan TM (1989). "The use of intravenous ribavirin to treat influenza virus-associated acute myocarditis". J Infect Dis. 159 (5): 829–36. PMID 2775346.
  10. ↑ Kühl U, Pauschinger M, Schwimmbeck PL, Seeberg B, Lober C, Noutsias M; et al. (2003). "Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction". Circulation. 107 (22): 2793–8. doi:10.1161/01.CIR.0000072766.67150.51. PMID 12771005. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  11. ↑ 11.0 11.1 Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, Glanowska G, Wilczewski P, Niklewski T; et al. (2001). "Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results". Circulation. 104 (1): 39–45. PMID 11435335.
  12. ↑ Mason JW, O'Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME; et al. (1995). "A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators". N Engl J Med. 333 (5): 269–75. doi:10.1056/NEJM199508033330501. PMID 7596370.
  13. ↑ Frustaci A, Russo MA, Chimenti C (2009). "Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study". Eur Heart J. 30 (16): 1995–2002. doi:10.1093/eurheartj/ehp249. PMID 19556262. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  14. ↑ Invalid <ref> tag; no text was provided for refs named pmid20610207
  15. ↑ McNamara DM, Holubkov R, Starling RC, Dec GW, Loh E, Torre-Amione G; et al. (2001). "Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy". Circulation. 103 (18): 2254–9. PMID 11342473.
  16. ↑ Shioji K, Matsuura Y, Iwase T, Kitaguchi S, Nakamura H, Yodoi J; et al. (2002). "Successful immunoglobulin treatment for fulminant myocarditis and serial analysis of serum thioredoxin: a case report". Circ J. 66 (10): 977–80. PMID 12381097.
  17. ↑ Takeda Y, Yasuda S, Miyazaki S, Daikoku S, Nakatani S, Nonogi H (1998). "High-dose immunoglobulin G therapy for fulminant myocarditis". Jpn Circ J. 62 (11): 871–2. PMID 9856608.
  18. ↑ McNamara DM, Rosenblum WD, Janosko KM, Trost MK, Villaneuva FS, Demetris AJ; et al. (1997). "Intravenous immune globulin in the therapy of myocarditis and acute cardiomyopathy". Circulation. 95 (11): 2476–8. PMID 9184576.
  19. ↑ Kim HS, Sohn S, Park JY, Seo JW (2004). "Fulminant myocarditis successfully treated with high-dose immunoglobulin". Int J Cardiol. 96 (3): 485–6. doi:10.1016/j.ijcard.2003.05.037. PMID 15301907. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  20. ↑ Drucker NA, Colan SD, Lewis AB, Beiser AS, Wessel DL, Takahashi M; et al. (1994). "Gamma-globulin treatment of acute myocarditis in the pediatric population". Circulation. 89 (1): 252–7. PMID 8281654.
  21. ↑ Meune C, Spaulding C, Mahé I, Lebon P, Bergmann JF (2003). "Risks versus benefits of NSAIDs including aspirin in myocarditis: a review of the evidence from animal studies". Drug Saf. 26 (13): 975–81. PMID 14583071. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  22. ↑ Imazio M, Trinchero R (2008). "Myopericarditis: Etiology, management, and prognosis". Int J Cardiol. 127 (1): 17–26. doi:10.1016/j.ijcard.2007.10.053. PMID 18221804. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  23. ↑ Khatib R, Reyes MP, Smith F, Khatib G, Rezkalla S (1990). "Enhancement of coxsackievirus B4 virulence by indomethacin". J Lab Clin Med. 116 (1): 116–20. PMID 1695914.
  24. ↑ Rezkalla S, Khatib G, Khatib R (1986). "Coxsackievirus B3 murine myocarditis: deleterious effects of nonsteroidal anti-inflammatory agents". J Lab Clin Med. 107 (4): 393–5. PMID 2420912. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  25. ↑ Menghini VV, Savcenko V, Olson LJ, Tazelaar HD, Dec GW, Kao A; et al. (1999). "Combined immunosuppression for the treatment of idiopathic giant cell myocarditis". Mayo Clin Proc. 74 (12): 1221–6. PMID 10593350.
  26. ↑ Cooper LT, Berry GJ, Shabetai R (1997). "Idiopathic giant-cell myocarditis--natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators". N Engl J Med. 336 (26): 1860–6. doi:10.1056/NEJM199706263362603. PMID 9197214.
  27. ↑ Cooper LT, Hare JM, Tazelaar HD, Edwards WD, Starling RC, Deng MC; et al. (2008). "Usefulness of immunosuppression for giant cell myocarditis". Am J Cardiol. 102 (11): 1535–9. doi:10.1016/j.amjcard.2008.07.041. PMC 2613862. PMID 19026310.
  28. ↑ Cooper LT, Zehr KJ (2005). "Biventricular assist device placement and immunosuppression as therapy for necrotizing eosinophilic myocarditis". Nat Clin Pract Cardiovasc Med. 2 (10): 544–8. doi:10.1038/ncpcardio0322. PMID 16186853. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  29. ↑ Corradi D, Vaglio A, Maestri R, Legname V, Leonardi G, Bartoloni G; et al. (2004). "Eosinophilic myocarditis in a patient with idiopathic hypereosinophilic syndrome: insights into mechanisms of myocardial cell death". Hum Pathol. 35 (9): 1160–3. PMID 15343520. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  30. ↑ Kim JS, Judson MA, Donnino R, Gold M, Cooper LT, Prystowsky EN; et al. (2009). "Cardiac sarcoidosis". Am Heart J. 157 (1): 9–21. doi:10.1016/j.ahj.2008.09.009. PMID 19081391. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  31. ↑ Frustaci A, Cuoco L, Chimenti C, Pieroni M, Fioravanti G, Gentiloni N; et al. (2002). "Celiac disease associated with autoimmune myocarditis". Circulation. 105 (22): 2611–8. PMID 12045166.
  32. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG; et al. (2009). "2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation". Circulation. 119 (14): e391–479. doi:10.1161/CIRCULATIONAHA.109.192065. PMID 19324966. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  33. ↑ Magnani JW, Danik HJ, Dec GW, DiSalvo TG (2006). "Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors". Am Heart J. 151 (2): 463–70. doi:10.1016/j.ahj.2005.03.037. PMID 16442915. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  34. ↑ Tominaga M, Matsumori A, Okada I, Yamada T, Kawai C (1991). "Beta-blocker treatment of dilated cardiomyopathy. Beneficial effect of carteolol in mice". Circulation. 83 (6): 2021–8. PMID 1674900.
  35. ↑ Matsumori A, Igata H, Ono K, Iwasaki A, Miyamoto T, Nishio R; et al. (1999). "High doses of digitalis increase the myocardial production of proinflammatory cytokines and worsen myocardial injury in viral myocarditis: a possible mechanism of digitalis toxicity". Jpn Circ J. 63 (12): 934–40. PMID 10614837.
  36. ↑ Wang JF, Meissner A, Malek S, Chen Y, Ke Q, Zhang J; et al. (2005). "Propranolol ameliorates and epinephrine exacerbates progression of acute and chronic viral myocarditis". Am J Physiol Heart Circ Physiol. 289 (4): H1577–83. doi:10.1152/ajpheart.00258.2005. PMID 15923319. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  37. ↑ Rockman HA, Adamson RM, Dembitsky WP, Bonar JW, Jaski BE (1991). "Acute fulminant myocarditis: long-term follow-up after circulatory support with left ventricular assist device". Am Heart J. 121 (3 Pt 1): 922–6. PMID 2000764.
  38. ↑ Chen JM, Spanier TB, Gonzalez JJ, Marelli D, Flannery MA, Tector KA; et al. (1999). "Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance". J Heart Lung Transplant. 18 (4): 351–7. PMID 10226900. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  39. ↑ 39.0 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the Management of Heart Failure: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Journal of the American College of Cardiology, 79(17), e263–e421. https://doi.org/10.1016/j.jacc.2021.12.012
  40. ↑ Cooper LT (2009). "Myocarditis". N Engl J Med. 360 (15): 1526–38. doi:10.1056/NEJMra0800028. PMID 19357408. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  41. ↑ Pahuja, M., Adegbala, O., Mishra, T., Akintoye, E., Chehab, O., Mony, S., Singh, M., Ando, T., Abubaker, H., Yassin, A., Subahi, A., Shokr, M., Ranka, S., Briasoulis, A., Kapur, N. K., Burkhoff, D., & Afonso, L. (2019). Trends in the incidence of in-hospital mortality, cardiogenic shock, and utilization of mechanical circulatory support devices in myocarditis (analysis of National Inpatient Sample data, 2005-2014). Journal of Cardiac Failure, 25(6), 457–467. https://doi.org/10.1016/j.cardfail.2019.04.012
  42. ↑ Ali, J. M., & Abu-Omar, Y. (2020). Complications associated with mechanical circulatory support. Annals of Translational Medicine, 8(13), 835. https://doi.org/10.21037/atm.2020.03.152
  43. ↑ Maron, B. J., Udelson, J. E., Bonow, R. O., Nishimura, R. A., Ackerman, M. J., Estes, N. A. M., 3rd, Cooper, L. T., Jr, Link, M. S., & Maron, M. S. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 3: Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: A scientific statement from the American heart association and American college of cardiology. Journal of the American College of Cardiology, 66(21), 2362–2371. https://doi.org/10.1016/j.jacc.2015.09.035
  44. ↑ Patriki, D., Baltensperger, N., Berg, J., Cooper, L. T., Kissel, C. K., Kottwitz, J., Lovrinovic, M., Manka, R., Scherff, F., Schmied, C., Tanner, F. C., Luescher, T. F., & Heidecker, B. (2021). A prospective pilot study to identify a myocarditis cohort who may safely resume sports activities 3 months after diagnosis. Journal of Cardiovascular Translational Research, 14(4), 670–673. https://doi.org/10.1007/s12265-020-09983-6
  45. ↑ Pelliccia, A., Solberg, E. E., Papadakis, M., Adami, P. E., Biffi, A., Caselli, S., La Gerche, A., Niebauer, J., Pressler, A., Schmied, C. M., Serratosa, L., Halle, M., Van Buuren, F., Borjesson, M., Carrè, F., Panhuyzen-Goedkoop, N. M., Heidbuchel, H., Olivotto, I., Corrado, D., … Sharma, S. (2019). Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal, 40(1), 19–33. https://doi.org/10.1093/eurheartj/ehy730
  46. ↑ Puzanov, I., Subramanian, P., Yatsynovich, Y. V., Jacobs, D. M., Chilbert, M. R., Sharma, U. C., Ito, F., Feuerstein, S. G., Stefanovic, F., Switzer, B., Hicar, M. D., Curtis, A. B., Spangenthal, E. J., Dy, G. K., Ernstoff, M. S., Vachhani, P., Page, B. J., Agrawal, N., Khunger, A., … Schentag, J. J. (2021). Clinical characteristics, time course, treatment and outcomes of patients with immune checkpoint inhibitor-associated myocarditis. Journal for Immunotherapy of Cancer, 9(6), e002553. https://doi.org/10.1136/jitc-2021-002553
  47. ↑ European Heart Rhythm Association. Heart Rhythm Society. Zipes DP, Camm AJ, Borggrefe M, Buxton AE; et al. (2006). "ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)". J Am Coll Cardiol. 48 (5): e247–346. doi:10.1016/j.jacc.2006.07.010. PMID 16949478. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  48. ↑ Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA; et al. (2002). "ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines)". Circulation. 106 (16): 2145–61. PMID 12379588.
  49. ↑ Priori, Silvia G.; Blomström-Lundqvist, Carina; Mazzanti, Andrea; Blom, Nico; Borggrefe, Martin; Camm, John; Elliott, Perry Mark; Fitzsimons, Donna; Hatala, Robert; Hindricks, Gerhard; Kirchhof, Paulus; Kjeldsen, Keld; Kuck, Karl-Heinz; Hernandez-Madrid, Antonio; Nikolaou, Nikolaos; Norekvål, Tone M.; Spaulding, Christian; Van Veldhuisen, Dirk J. (2015). "2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". European Heart Journal. 36 (41): 2793–2867. doi:10.1093/eurheartj/ehv316. ISSN 0195-668X.
  50. ↑ 50.0 50.1 50.2 50.3 Caforio, A. L. P.; Pankuweit, S.; Arbustini, E.; Basso, C.; Gimeno-Blanes, J.; Felix, S. B.; Fu, M.; Helio, T.; Heymans, S.; Jahns, R.; Klingel, K.; Linhart, A.; Maisch, B.; McKenna, W.; Mogensen, J.; Pinto, Y. M.; Ristic, A.; Schultheiss, H.-P.; Seggewiss, H.; Tavazzi, L.; Thiene, G.; Yilmaz, A.; Charron, P.; Elliott, P. M. (2013). "Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases". European Heart Journal. 34 (33): 2636–2648. doi:10.1093/eurheartj/eht210. ISSN 0195-668X.
  51. ↑ "Guidelines for diagnosis and treatment of myocarditis (JCS 2009): digest version". Circulation journal : official journal of the Japanese Circulation Society. 75 (3): 734–743. 2011. doi:10.1253/circj.cj-88-0008. PMID 21304213.
  52. ↑ Naoyoshi Aoyama, Tohru Izumi, Katsuhiko Hiramori, Mitsuaki Isobe, Masatoshi Kawana, Michiaki Hiroe, Hitoshi Hishida, Yasushi Kitaura & Tsutomu Imaizumi (2002). "National survey of fulminant myocarditis in Japan: therapeutic guidelines and long-term prognosis of using percutaneous cardiopulmonary support for fulminant myocarditis (special report from a scientific committee)". Circulation journal : official journal of the Japanese Circulation Society. 66 (2): 133–144. doi:10.1253/circj.66.133. PMID 11999637. Unknown parameter |month= ignored (help)
  53. ↑ Liberman, Leonardo; Anderson, Brett; Silver, Eric S.; Singh, Rakesh; Richmond, Marc E. (2014). "INCIDENCE AND CHARACTERISTICS OF ARRHYTHMIAS IN PEDIATRIC PATIENTS WITH MYOCARDITIS: A MULTICENTER STUDY". Journal of the American College of Cardiology. 63 (12): A483. doi:10.1016/S0735-1097(14)60483-6. ISSN 0735-1097.
  54. ↑ "Guidelines for diagnosis and treatment of myocarditis (JCS 2009): digest version". Circulation journal : official journal of the Japanese Circulation Society. 75 (3): 734–743. 2011. doi:10.1253/circj.cj-88-0008. PMID 21304213.
  55. ↑ Kindermann, Ingrid; Kindermann, Michael; Kandolf, Reinhard; Klingel, Karin; Bültmann, Burkhard; Müller, Thomas; Lindinger, Angelika; Böhm, Michael (2008). "Predictors of Outcome in Patients With Suspected Myocarditis". Circulation. 118 (6): 639–648. doi:10.1161/CIRCULATIONAHA.108.769489. ISSN 0009-7322.
  56. ↑ Prochnau, Dirk; Surber, Ralf; Kuehnert, Helmut; Heinke, Matthias; Klein, Helmut U.; Figulla, Hans R. (2009). "Successful use of a wearable cardioverter-defibrillator in myocarditis with normal ejection fraction". Clinical Research in Cardiology. 99 (2): 129–131. doi:10.1007/s00392-009-0093-2. ISSN 1861-0684.
  57. ↑ Chung, Mina K. (2014). "The Role of the Wearable Cardioverter Defibrillator in Clinical Practice". Cardiology Clinics. 32 (2): 253–270. doi:10.1016/j.ccl.2013.11.002. ISSN 0733-8651.
  58. ↑ Kandolin, Riina; Lehtonen, Jukka; Salmenkivi, Kaisa; Räisänen-Sokolowski, Anne; Lommi, Jyri; Kupari, Markku (2013). "Diagnosis, Treatment, and Outcome of Giant-Cell Myocarditis in the Era of Combined Immunosuppression". Circulation: Heart Failure. 6 (1): 15–22. doi:10.1161/CIRCHEARTFAILURE.112.969261. ISSN 1941-3289.
  59. ↑ Schumm, Julia; Greulich, Simon; Wagner, Anja; Grün, Stefan; Ong, Peter; Bentz, Kerstin; Klingel, Karin; Kandolf, Reinhard; Bruder, Oliver; Schneider, Steffen; Sechtem, Udo; Mahrholdt, Heiko (2014). "Cardiovascular magnetic resonance risk stratification in patients with clinically suspected myocarditis". Journal of Cardiovascular Magnetic Resonance. 16 (1): 14. doi:10.1186/1532-429X-16-14. ISSN 1532-429X.
  60. ↑ 60.0 60.1 60.2 60.3 Imazio M, Collini V, Groeschel J, Schulz-Menger J (September 2025). "The 2025 ESC myocarditis and pericarditis guidelines - what clinicians needs to know". J Cardiovasc Med (Hagerstown). 26 (9): 469–472. doi:10.2459/JCM.0000000000001776. PMID 40977465 Check |pmid= value (help).

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