Myocarditis

Myocarditis does not have a typical clinical presentation, ranging from pseudo-infarction with unobstructed coronary arteries to fulminant, acute, or chronic heart failure, arrhythmia leading to palpitation, syncope, or sudden death. It may resolve, relapse, or lead to dilated cardiomyopathy, death, or heart transplantation. It is a diagnosis of exclusion that, starting from a plausible clinical presentation and noninvasive imaging features, is confirmed by endomyocardial biopsy using histological, immunohistochemical, and molecular features (e.g., identification of infectious agents). Myocarditis may be infectious or noninfectious (toxic or immune-mediated). Besides standard cardiological treatment, etiology-directed therapy is available for selected infectious forms and immune-mediated diseases.