Summary

• Myocarditis describes a heterogeneous group of disorders characterised by myocardial inflammation in the absence of predominant acute or chronic ischaemia.
• Can affect all age groups with an apparent slightly higher incidence in males than females and equal incidence in black people and white people.
• May present as fulminant, acute or chronic myocarditis.
• Treatment is usually supportive care and conventional heart failure therapy. More severe presentations may need aggressive vasopressor or inotropic pharmacological support or mechanical haemodynamic assist devices such as intra-aortic balloon pump or left ventricular assist device. Occasionally, some cases do not respond to conventional therapy and progress to heart transplantation or death.
• Prognosis is variable but is related to presentation and underlying aetiology. Most cases of viral myocarditis are asymptomatic and spontaneously resolve. Patients who present with mild to moderate heart failure tend to improve or recover but may progress to chronic severe heart failure. Surprisingly, patients who present with fulminant, acutely decompensated heart failure almost universally recover back to baseline function, if death is prevented through management in the acute phase.