ESC 2025 – Myocarditis & Myopericarditis Management
ESC 2025 – Myocarditis & Myopericarditis Management
Diagnosis
1. New Paradigm: Cases classified as:
• Definite → clear evidence (cardiac MRI showing typical inflammation/fibrosis or biopsy confirmation).
• Possible → clinical suspicion + some supportive findings (symptoms, labs, partial imaging).
• Unlikely/Rejected → no convincing evidence.
2. Role of Troponin
• Elevated troponin suggests myocardial injury.
• Often positive in acute myocarditis, but not always (normal troponin does not fully exclude myocarditis).
• Used for prognosis & monitoring, not as a sole diagnostic test.
Treatment Overview:
1. Pure Myocarditis (without pericardial involvement)
• No routine NSAIDs (they may worsen healing).
• Supportive care, treat underlying cause (viral, autoimmune, toxic, parasitic).
• Steroids (corticosteroids):
• Not for all patients.
• Reserved for immune-mediated, drug-induced, or severe/refractory myocarditis.
• Must be tapered carefully to avoid recurrence or chronic course.
2. Myopericarditis / IMPS (inflammatory myopericardial syndrome)
• NSAIDs + Colchicine from the beginning.
• Rationale: control pericardial inflammation, reduce recurrence.
• Need monitoring for myocardial complications (LV dysfunction, arrhythmias).
3. Pericarditis (isolated)
• NSAIDs + Colchicine are standard first-line therapy.
• Colchicine reduces recurrence risk.
Exercise & Prognosis
• Strict rest for minimum 4 weeks, then gradual return if low risk.
• Monitor with symptoms, troponin trends, biomarkers, imaging.
• Depression and psychological distress common (~44% patients) → psychosocial care is important.
Key Points to Remember
• NSAIDs + Colchicine: for pericarditis & myopericarditis (not for pure myocarditis).
• Steroids: only in selected immune/toxic or severe myocarditis; taper slowly.
• Troponin: often positive, but not always; useful for risk and follow-up.
• Diagnosis: MRI central (can confirm without biopsy); classification into definite/possible/unlikely helps early management.
