Diagnosis and treatment of myocarditis

Abstract

The recommendations are dedicated to contemporary aspects of epidemiology, etiology, pathogenesis, diagnosis, etiology-based, pathogenetic and symptomatic treatment of myocarditis. Various pathogenetic mechanisms that cause the development and progression of inflammatory heart disease and cause dilatation and systolic dysfunction, lead to heart failure and the development of other complications of myocarditis are described in detail. These recommendations present the modern classification of myocarditis, approved in Ukraine, and modern algorithms for diagnosis and clinical management of patients, in particular the algorithm that justifies the appointment of glucocorticoids for patients with myocarditis. The characteristics of different variants of myocarditis are also presented with clarifications concerning diagnosis and treatment. Much attention is paid to various approaches to the etiotropic and pathogenetic treatment of myocarditis and their possible prospects. It is obvious that in order to standardize approaches to the diagnosis and management of acute and chronic myocarditis, it is necessary to conduct large-scale multicenter studies and create special registries. In addition, in the current context of the COVID-19 pandemic, the pathological effects of SARS-Cov-2 as a trigger of myocarditis need further study, in particular in terms of impact on the prognosis and approaches to pathogenetic therapy in such patients. Unification of terminology and approaches to diagnosis and clinical monitoring of patients with myocarditis can improve management tactics and increase the survival rate of such patients. To identify high-risk patients (with arrhythmias, high probability of recurrence or transformation of myocarditis into dilated cardiomyopathy) and candidates for heart transplantation, the most promising is the creation of special databases of such patients