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Subsections
Myocarditis: Treatment

Cardiovascular

Myocarditis: Treatment

Initial/Prep/Goals

  1. Supportive care, monitoring, and management of heart failure
    • Treatment depends on disease severity
    • ABCs
    • PALS
    • Manage:
      • Heart failure
      • Arrhythmias
      • Pulmonary edema (positive pressure ventilation may be required)
  2. Cardiogenic shock
    • Decrease metabolic demand by:
      • Sedation
      • Intubation and
      • Mechanical ventilation
  3. Severe and unresponsive cases
    • Extracorporeal membrane oxygenation (ECMO) or
    • Ventricular assist device
  4. Goals
    • Relieve symptoms
    • Prevent complications

Medical/Pharmaceutical

  1. Congestive heart failure
  2. Chronic heart failure
    • Diuretics
    • ACE inhibitors
      • Combination ACE-I and B-Blockers has shown survival (78%) for heart failure hospitalization
      • Beta blockers have shown mixed studies (i.e., poor outcomes)
    • Digoxin (not recommended for acute myocarditis)
    • Spironolactone
  3. Symptomatic heart failure
  4. Cardiogenic shock/Refractory to medical treatment
  5. Immunosuppressive
    • Benefit not established
  6. IVIG
    • Not shown to affect survival
  7. Antiarrhythmics should be given accordingly in consultation with a pediatric cardiologist

Surgical/Procedural

  1. Heart transplantation
    • Final therapeutic option for children with myocarditis and intractable severe heart failure
  2. ECMO
  3. Pacing
  4. Ventricular assist devices

Complications

  1. Heart failure
  2. Dilated cardiomyopathy
  3. Arrhythmia
  4. Need for cardiac transplantation
  5. Death

Prevention

  1. Prevention of etiological agents

Disposition

  1. Admit all
  2. Consult
    • Pediatric cardiology
  3. Discharge/Follow-up instructions
    • Long-term follow up should be guided by a pediatric cardiologist
    • Adequate rest
    • Avoid strenuous exercise
    • Clinical remission takes at least 1 month

Related Topics

References

  1. Schultz JC, Hilliard AA, Cooper LT Jr, Rihal CS. Diagnosis and treatment of viral myocarditis. Mayo Clin Proc. 2009; 84(11):1001–1009.
  3. Fong IW. New Perspectives of infections in cardiovascular disease. Curr Cardiol Rev. 2009;5(2):87-104.
  4. Kliegman RM, Stanton BF, et al. Myocarditis. In: Nelson's Textbook of Pediatrics 19th ed. Philadelphia, PA: Elsevier-Saunders; 2011;433
  5. Ghelani SJ, Spaeder MC, et al. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes. 2012;5(5):622-627.
  6. Cooper LT, Baughman KL, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J. 2007;28(24):3076-3093.
  7. Freedman SB, Haladyn JK, et al. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics. 2007;120(6):1278-1285.
  8. Durani Y, Egan M, et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009;27:942–947.
  9. Vashist S, Singh GK. Acute myocarditis in children: current concepts and management. Curr Treat Options Cardiovasc Med. 2009;11(5):383-391.
  10. Klugman D, Berger JT, et al. Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol. 2010;31(2):222-228.
  11. Mavrogeni S, Bratis K, et al. Evaluation of myocarditis in a pediatric population using cardiovascular magnetic resonance and endomyocardial biopsy. Int J Cardiol. 2012;18;160(3):192-5.
  12. Heinz-Peter Schultheiss,Uwe Kühl et al. The management of myocarditis. Eur Heart J. 2011;32(21):2616-2625.
  13. Shu-Ling C, Bautista D, et al. Diagnostic evaluation of pediatric myocarditis in the emergency department: a 10-year case series in the asian population. Pediatr Emerg Care. 2013;29(3):346-351.
  14. Teele SA, Allan CK, et al. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr. 2011;158(4):638-643.
  15. Canter CE, Simpson KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation. Jan 7, 2014 Jan 7;129(1):115-128
  16. Frobel AK, Hulpke-Wette M, Schmidt KG, Läer S. Beta-blockers for congestive heart failure in children. Cochrane Database Syst Rev. 2009; (1):CD007037
  17. Alabed S, Sabouni A, Al Dakhoul S, Bdaiwi Y, Frobel-Mercier AK. Beta-blockers for congestive heart failure in children. Cochrane Database Syst Rev. 2016 Jan 28;(1):CD007037.
  18. Grube PM, Beckett RD. Clinical studies of dapagliflozin in pediatric patients: a rapid review. Ann Pediatr Endocrinol Metab. 2022 Dec;27(4):265-272.
  19. Schulz-Menger J, Collini V, Gröschel J, et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. Eur Heart J. 2025 Aug 29:ehaf192.

Contributor(s)

  1. Ballarin, Daniel, MD
  2. Sindhwani, Maughan K., MD

Updated/Reviewed: October 2025