Treatment of myocarditis: contemporary approaches and perspective trends

The choice of adequate tactics for the treatment of myocarditis is particularly relevant today, and the most controversial among modern scientists and practitioners is the question of prescribing etiology-based and pathogenetic treatment. One of the most pressing and complex issues at the present stage is the problem of developing adequate schemes for etiology-based and pathogenetic treatment of severe chronic myocarditis, as so far the only recommended strategy is the treatment of heart failure according to current recommendations. The appointment of etiotropic therapy in patients with myocarditis may be appropriate in the acute phase of the disease and must take into account the results of endomyocardial biopsy. Immunosuppressive therapy should be used only in patients with severe myocarditis in the presence of conclusive evidence of active inflammatory process in the myocardium with mandatory re-examination after completion of its course to monitor safety and efficacy. In the presence of dilatation of the left ventricle and a reduced left ventricle ejection fraction, the basis for the treatment of myocarditis is the patient’s compliance with dietary restrictions and the use of standard heart failure therapy according to current recommendations. However, a large number of issues related to the management of patients with myocarditis remain debatable, so leading world scientists recognize the need for further research to assess the effectiveness of etiology-based and pathogenetic therapy.