Updates in the 2025 ESC guidelines for myocarditis and pericarditis: An integrative approach to inflammatory myopericardial syndromes and implications for clinical practice

Introduction: Myocarditis is an inflammatory disease of the myocardium that can present with highly heterogeneous clinical manifestations, ranging from asymptomatic forms to fulminant heart failure and sudden cardiac death. The aim of this review paper is to present contemporary diagnostic and therapeutic approaches according to the latest ESC recommendations, integrating clinical experience and emphasizing the need for further research.Literature review: In 2025, the European Society of Cardiology (ESC) published the first integrated guidelines addressing the diagnosis and treatment of myocarditis and pericarditis, introducing the new concept of inflammatory myopericardial syndrome (IMPS). This umbrella term recognizes the frequent clinical overlap between these two entities and their shared pathophysiological mechanisms. The paper analyzes key updates in classification, diagnostics, genetic evaluation, and therapeutic approaches, with particular emphasis on revised cardiac magnetic resonance (CMR) criteria (Lake Louise criteria), expanded indications for endomyocardial biopsy (EMB), and innovations in the treatment of pericarditis, including interleukin-1 inhibitors. The diagnostic paradigm for myocarditis has been changed. The discussion includes a comparison of ESC recommendations with American ACC/AHA guidelines, as well as contributions from domestic literature, particularly studies in the field of diastolic stress testing and inflammatory cardiomyopathies. The COVID-19 pandemic has further highlighted myocarditis as a potential complication of viral infections. Conclusion: The contemporary approach to myocarditis is shifting the paradigm by introducing the concept of inflammatory myopericardial syndrome and involves integrated diagnostics and therapy in accordance with the latest ESC guidelines, recognizing this syndrome as a clinically significant entity. Advances in the use of cardiac magnetic resonance imaging, broader indications for endomyocardial biopsy, and the introduction of targeted therapies, including interleukin-1 inhibitors, enable more precise diagnosis and individualized treatment strategies. Despite these advances, the heterogeneity of clinical presentation remains a challenge in everyday practice. Further research is necessary to improve understanding of the pathophysiology and to optimize the treatment of these patients.