Treatment of myocarditis and ICMP is relatively complicated what is caused by a number of factors. Further, it is still a subject for research.
From the point of view of causal therapy, an important obstacle is a vast number of different agents of myocarditis and ICMP. Their spectrum includes viral, bacterial and protozoal agents, autoimmune disorders and hypersensitive reactions to different medications, whereas the activity of these agents is not still completely known in many of them. Patients differ even in the disease course when myocarditis may progress in some of the cases even in ICMP what is influenced by the persistence of the agent in the myocardium, by the development of autoimmune reaction against components of cardiomyocytes, chronic inflammatory reaction in the heart muscle or by the combination of both above-mentioned factors (chapter Pathogenesis).
The disease heterogeneity is thus a limiting factor – from the point of view of manifestation and the course of examination findings and so even from the point of view of when myocarditis/ICMP was diagnosed and when the specific therapy was instituted. It is because, in a part of patients, myocarditis with a mild course do not have to be diagnosed and thus may be detected until the stage of ICMP [26].
The effectivity of therapy is influenced even by the extent of changes in the myocardium as a result of myocarditis, thus what is the degree of damage (fibrosis, necrosis) and what are regeneration possibilities of the myocardium [23].
Currently, the treatment of myocarditis and ICMP thus consists primarily of symptomatic and support therapy and physical activity restriction [24, 26]. 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 [24, 98, 127]. 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. However, according to the references, in a large number of specific treatment procedures, other studies are necessary [24, 98].
Author of the opening picture: Madprime
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References:
23) SCHULTHEISS, Heinz-Peter, Uwe KÜHL a Leslie T. COOPER, JR. The management of myocarditis. European Heart Journal. 2011, 32(-), 2616–2625.
24) CAFORIO, A.L.P, PANKUWEIT S., ARBUSTINI E., et al. Current state knowledge on aetiology, diagnosis, management, and Therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease. European Heart Journal. 2013, 34(-), 2636–2648.
26) COOPER L. T., JR., KNOWLTON K. U. Chapter 67: Myocarditis. In.: D.P., ZIPES, MANN D.L., LIBBY P., BONOW R.O. a BRAUNWALD E. (eds.). Braunwald´s Heart Disease: A Textbook of Cardiovascular medic Tenth edition. Philadelphia: Elsevier Saunders, 2015. pp. 1589–1602. ISBN 978-1-4557-5133-4.
98) KINDERMANN, I. a et al. Update on Myocarditis. Journal of the American College of Cardiology. 2012, 59(9), 779-792.
127) JCS Joint Working Group. Guidelines for Diagnosis and Treatment of Myocarditis (JCS 2009). Circulation Journal. 2011, 75(-), 734-743.
