Myocarditis and pericarditis

Abstract

Abstract Myocarditis can cause atrial and ventricular arrhythmias, and transient or chronic and progressive heart failure. Viruses are the most frequent infectious triggers. Systemic diseases and toxic agents are important non-infectious causes of myocarditis. As viral triggers in peri- and myocarditis are common cough viruses, with only a minority of infected persons developing peri- or myocarditis, a certain immune–genetic susceptibility—including coding and non-coding genes—of the affected person is key. Endomyocardial biopsies are indicated in acute myocarditis if progressive or persistent severe cardiac dysfunction and/or life-threatening ventricular arrhythmias with a lack of short-term response to usual medical treatment are present. Cardiac magnetic resonance is essential in all patients with a high suspicion of myocarditis, after significant coronary artery disease has been excluded or considered to be unlikely. This chapter will discuss the pathophysiology of (peri-)myocarditis and its heterogeneous disease presentation, as well as its diagnosis and treatment in more detail.