[ESC guidelines on myocarditis and pericarditis : First combined European guidelines for myocarditis and...

The new guidelines for myocarditis and pericarditis from the European Society of Cardiology (ESC) are the first guidelines for myocarditis and for the first time they also combine the two entities. A key aspect is the introduction of the term inflammatory myopericardial syndrome (IMPS), an umbrella term that covers the spectrum of both diseases and enables uniform diagnostics and treatment but in particular draws attention to the fact that there are overlapping causes, diagnostic approaches and treatment options. Other major aspects relate to noninvasive diagnostics using multimodal imaging. There is a paradigm shift that enables the definitive diagnosis of myocarditis also using cardiovascular magnetic resonance imaging. An etiologically oriented treatment mostly requires an endomyocardial biopsy in pericardial effusion cytological work-up is instrumental. Furthermore, an intuitive risk stratification is introduced, which influences both the treatment and follow-up examinations and involves abandoning fixed waiting periods with respect to resuming sports and work. Diagnostic algorithms are based on the initial symptoms, such as chest pain, heart failure and arrhythmia and integrate the risk stratification into the treatment process. For pericarditis, innovative treatment approaches using interleukin‑1 antagonists are coming to the fore. Another focus is the consideration of genetic factors, which are particularly relevant in recurrent forms.