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Acute Myocarditis: From Pathophysiology to Risk-Stratified Management-A Clinical Review
Michele Golino1,2,3, Marco Giuseppe Del Buono4, Michele Marchetta1,5
1Robert M. Berne Cardiovascular Research Center, and Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA.
European Journal of Clinical Investigation
|August 10, 2026
Summary
Acute myocarditis, affecting young adults, presents nonspecific symptoms. Management involves guideline-directed therapy, with immunosuppression for severe cases, guided by cardiac MRI and biopsy.
Area of Science:
- Cardiology
- Immunology
- Pathophysiology
Background:
- Acute myocarditis is an inflammatory heart condition with 4-14/100,000 incidence, primarily impacting young adults.
- Triggers include viral infections, autoimmune disorders, and mRNA vaccines, involving complex immune system dysregulation.
- Clinical presentation is often nonspecific, mimicking acute coronary syndrome, complicating early diagnosis.
Purpose of the Study:
- To review updated guidelines and emerging data on acute myocarditis.
- To support a phenotype-driven approach for managing acute myocarditis.
- To highlight the role of advanced diagnostics and targeted therapies.
Main Methods:
- Synthesis of recent guideline updates and clinical trial data (last 10 years).
- Emphasis on phenotype-driven management strategies.
- Selective utilization of Cardiac Magnetic Resonance (CMR) and endomyocardial biopsy (EMB).
Main Results:
- Cardiac Magnetic Resonance (CMR) with updated Lake Louise criteria is key for diagnosis.
- Endomyocardial biopsy (EMB) remains the gold standard for histological characterization.
- Approximately 25% of patients experience complications like heart failure or arrhythmias.
Conclusions:
- A phenotype-driven approach, guided by clinical severity and etiology, is recommended.
- Management includes guideline-directed heart failure therapy, with immunosuppression for specific cases.
- Ongoing research into novel immunomodulatory strategies promises refined personalized treatments.
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