Treatment of myocarditis and ICMP is relatively complicated what is caused by a number of factors. Further, it is still a subject for research.

Currently, the treatment of myocarditis and ICMP thus consists primarily of symptomatic and support therapy and physical activity restriction. In the therapy of heart failure and arrhythmias, there are used the procedures suggested by the European and American Society of Cardiology. The parts of the therapy are both pharmacological therapy and the use of ICD and mechanical organ support in the fulminant course of myocarditis. Despite these facts, the treatment of heart failure in myocarditis and ICMP has some specifics. It is, for example, proved protective effect of some medicaments or their unfavorable impact on the prognosis.

Specific therapy, primarily immunosuppressive therapy, depends on the results of EMB.  Other researched procedures are immunoglobulines, immunoadsorption and interferons.



Strict physical and sports activity restriction is always indicated in patients with myocarditis. In both sportsmen and non-professional sportsmen, the minimal time of this restriction is six months provided that the heart function normalized, there are observed no clinically relevant arrhythmias and the patients is asymptomatic. The physical activity should be increased gradually. In experiment with mice models, the mortality rate of mice was higher in groups with an increased physical activity during the acute phase of myocarditis (67-72 % in “exercising” and 4-40 % in “non-exercising”).



Heart failure therapy in myocarditis and ICMP should, according to references, follow the recommendations of cardiological societies. However, some studies proved the positive or negative impact of some medicaments on prognosis and inflammatory changes and the myocardial remodelation.

The basis of the therapy is ACE-inhibitors, eventually sartans, beta-blockers (in acute phase administered after the stabilization of a patient´s state of health), diuretics and antagonist of mineralocorticoid receptors.

To sustain the adequate cardiac output, dopamine or dobutamine is indicated in some cases.

The indication of digoxin is full of contradiction in the case of acute heart failure in myocarditis.



In the treatment of arrhythmias, there are not recommended any specific procedures yet. Their treatment with instrument techniques is problematic because arrhythmias may disappear themselves after the acute disease phase and thus in references, rather a little bit reserved posture is recommended in the question of indication of instrument correction of arrhythmias during the acute phase of the disease.

There are no specific recommendations even for treatment of thromboembolism in myocarditis and thus it follows recommendations of cardiological societies.



In the Czech Republic, Borrelia burgdorferi dominates over other bacterial agents of myocarditis. It is treated with 3-weeks´ therapy with cephalosporines of the 3rd generation administering intravenously. Even in ICMP, this treatment led to the heart function improvement.

Treatment with antivirotics has according to the references in the majority of patients very limited importance. Their positive effect was documented primarily in patients treated with antivirotics in the initial phase of a viral infection.

According to the references, antivirotics may be considered as a therapeutic option in patients in which the heart failure therapy did not lead to the left ventricular function improvement or as a medication to the reduction of heart failure symptomatology.



This part of therapy is currently still a subject of researches which are aimed at both acute and chronic myocarditis treatment. Their conclusions are however often different or the specific kinds of therapy are suitable just for specific groups of patients like for example immunosuppressive therapy.

The following chapters contain the description of four types of immunological therapy which are investigated in myocarditis and ICMP – treatment with immunoglobulins, immunosuppressive therapy, immunoadsorption and treatment with interferons. All chapters include the results of up to now the largest performed studies.



This kind of therapy is indicated in the fulminant course of myocarditis and patients with cardiogenic shock with haemodynamic instability despite the optimal therapy. It serves as “bridge to recovery or bridge to transplant”.

From mechanical supports, there are used left or both-sided cardiac supports and extracorporeal membrane oxygenation (ECMO).

The heart transplant is indicated just in cases of advanced heart disease accompanied by considerable symptomatology of a patient when there are exhausted all possibilities of pharmacological and non-pharmacological therapy.

Worldwide, approximately 45 % of the heart transplants are performed because of idiopathic DCMP and 8 % because of myocarditis [162]. In the Czech Republic, DCMP is the most frequent cause of heart transplant, specifically in 49,2 %.



It is difficult to determine the prognosis of myocarditis and ICMP because it depends on a number of different factors including age and disease type. The highest mortality and heart transplant necessity are in GCM with 48 to 89 %. In HIV/AIDS patients with myocarditis, it is 15 to 55 % and it is similar in cardiac sarcoidosis with 17 to 48 % 10-year survival rate. In cardiac sarcoidosis and GCM, the prognosis is influenced even by early initiation of immunosuppressive therapy.

The prognosis of patients depends of course on clinical presentation, NYHA class, the severity of systolic dysfunction of left or right ventricle, ECG finding in which prolongation of QRS complex was put in association with higher risk of mortality or heart transplant, and it depends also on the levels of laboratory parameters – troponin, BNP etc. Prognosis is usually good in patients with the mild course of the disease and with preserved LV EF.

There were described as prognostically significant also cardiac MRI findings (specifically LGE), and EMB results.