title: Viral myocarditis--diagnosis, treatment options, and current controversies.
abstract: Myocarditis--a frequent cause of dilated cardiomyopathy and sudden cardiac death--typically results from cardiotropic viral infection followed by active inflammatory destruction of the myocardium. Characterization of this disease has been hampered by its heterogeneous clinical presentations and diverse aetiologies. Advances in cardiac MRI and molecular detection of viruses by endomyocardial biopsy have improved our ability to diagnose and understand the pathophysiological mechanisms of this elusive disease. However, therapeutic options are currently limited for both the acute and chronic phases of myocarditis. Several randomized, controlled trials have demonstrated potential benefit with immunosuppressive and immunomodulatory therapies, but further investigations are warranted. In this Review, we explore the pathophysiology, natural history, and modes of diagnosis of myocarditis, as well as evidence-based treatment strategies. As novel imaging techniques and human in vitro models of the disease emerge, the landscape of therapies for myocarditis is poised to improve.
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Ari
authors.initials: A
authors.lastname: Pollack
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Kontorovich
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: G William
authors.initials: GW
authors.lastname: Dec
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D006801:Humans; D009205:Myocarditis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy* / Q000821:virology*; D014777:Virus Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000998:Antiviral Agents