Therapeutic Advances in Emergency Cardiology: A Focus on Acute Myocarditis

BACKGROUND: Myocarditis, defined as an inflammation of the myocardium, is an important cause of dilated cardiomyopathy and congestive heart failure. Unfortunately, its diagnosis and etiology is often challenging in clinical practice, and thus, improving diagnosis and therapeutic approach of this cardiac pathology is a matter of great interest. AREAS OF UNCERTAINTY: The etiology of the disease may be represented by not only infectious agents, usually with viral determination, but also autoimmune and systemic diseases or drugs. Regarding diagnostic techniques, endomyocardial biopsy remains the gold standard; but beyond histological findings, an important step in achieving an accurate diagnosis was represented by the use immunohistochemical criteria and noninvasive diagnostic tests such as cardiac magnetic resonance imaging. DATA SOURCES: We reviewed current data on the current diagnosis and therapeutic approach of acute myocarditis. THERAPEUTIC ADVANCES: In addition to the standard heart failure therapy, some specific therapeutic options are available in selected cases. Viral myocarditis with persistent inflammation and viral clearance may be responsive to immunosuppressive therapy with azathioprine and cortisone or to immunoadsorption technique. Also, some chronic viral myocardial infections may benefit from 6 months of interferon-β therapy. CONCLUSIONS: The diagnosis of acute myocarditis still remains a great challenge, despite advances related to new diagnostic procedures. Endomyocardial biopsy, an invasive diagnostic tool that is not always usually available in clinical practice, still remains the standard diagnostic technique. Due to the potential evolution of acute myocarditis, identifying new parameters that may allow an early selection of patients with great risk of evolution toward myocardial fibrosis and dilated cardiomyopathy may be a field of great interest for future studies.