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.



he favorable effect of IVIG on the heart function and prognosis was proved in patients with chronic heart failure, DCMP with the high viral load of PVB19 and in children with the fulminant course of myocarditis and ICMP.

IVIG has no major side-effects, and may be used in myocarditis refractory to conventional heart failure therapy, both viral and autoimmune forms, particularly if autoantibody-mediated. However, therapy with IVIG still remains not quite clearly and convincingly proved by evidence in the literature in the case of adults.

However, in children and teenagers, in contrast to adults, the situation is the opposite. A positive influence on the heart function and 1-year-survival rate was proved in children receiving high doses of IVIG and in indicated cases they are administered even in routine practice because they are connected with better course and prognosis of the disease and there is described even the effect that they could prevent the progress of myocarditis into chronic phase.



This therapeutic option is indicated in cases of GCM, eosinophilic myocarditis, cardiac sarcoidosis and in myocarditis connected with autoimmune diseases. It consists mostly of a combination of prednisone, cyclosporine and/or azathioprine.

It has been proved by several studies that immunosuppressive therapy is beneficial in patients with the absence of a viral agent in the myocardium and in those with the production of autoantibodies.

The role of immunosupppressive therapy is research intensively in patients with ICMP. The biggest performed studies had a conclusion that there was observed the improvement of heart function and NYHA class in the group treated with immunosuppressants. However, it is necessary to exclude with EMB the presence of the agent of the disease in the myocardium.



The use of this therapy is considered in ICMP with induced autoimmune reaction and with the production of anti-myocardial autoantibodies. The principle of the therapy lies in the removal of circulating autoantibodies of IgG class circulating in peripheral blood. Its efficiency has been already confirmed, however, just in small groups of patients.

Antiviral therapy with interferon beta proved in several studies a favorable effect on cardiac function and symptomatology of patients, however just in myocarditis cases caused by enteroviruses and adenoviruses.