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Myocarditis and pericardial syndromes

Myocarditis is defined as inflammatory disease of the myocardium, diagnosed by established histological, immunological, and immunohistochemical criteria. Aetiology-targeted therapy is indicated when supported by evidence. However, in the vast majority of patients with myocarditis, the most important targets of treatment are heart failure and arrhythmias. Management of systolic left ventricular (LV) dysfunction should follow the recommendations of current European Society of Cardiology guidelines on heart failure. Immunosuppression is indicated only in giant cell myocarditis. In patients with severe LV dysfunction, inotropic support may be necessary and ventricular assist devices may represent a bridge to recovery or to heart transplantation There are no specific treatments of arrhythmias in myocarditis. Implantation of cardioverter–defibrillators must be deferred in the acute phase. In patients with severe ventricular arrhythmia, a wearable cardioverter–defibrillator can represent a bridge to recovery, implantation of cardioverter–defibrillators, or heart transplantation. Pericardial diseases may be either an isolated disease or part of a systemic disease. The main pericardial syndromes that are encountered in clinical practice include pericarditis (acute, subacute, chronic, and recurrent), pericardial effusion, cardiac tamponade, and constrictive pericarditis, and pericardial masses. Major advances have occurred in therapy with the first multicentre randomized clinical trials. Colchicine has been demonstrated as a first-line drug to be added to conventional anti-inflammatory therapies in patients with a first episode of pericarditis or recurrences, in order to improve response to therapy, increase remission rates, and reduce recurrences.