Heart Muscle Inflammation (Myocarditis): Drug Therapy

Therapeutic Targets

• Improvement of the symptomatology
• Avoidance of complications
• Healing of the disease

Therapy recommendations

• The most important measure is physical rest!
• Viral myocarditis (about 50% of cases): virostatic therapy with gan-/valaciclovir; so far only performed in controlled studies in human herpesvirus type 6A/B, cytomegalovirus (CMV), Epstein-Barr virus, EBV) in progressive courses.
  • Interferon-α/β achieves good effects in viral persistence (in: enterovirus, adenovirus).
  • Immunosuppressants in combination with extracorporeal immunoadsorption in case of autoantibody detection and highly acute course.
  • Ribavirin in respiratory syncytial virus.
  • Pegylated interferon-α and ribavarin in hepatitis C virus.
  • Antiretroviral drugs in HIV; interferon in viral genome detection.
• Bacterial myocarditis: antibiotic therapy (i. v.) as first-line therapy according to pathogen spectrum.
  • Initially calculated until blood culture results, then therapy correction if necessary.
• In sarcoidosis, eosinophilic myocarditis and giant cell myocarditis; if necessary, also in chronic, virus-negative myocarditis: immunosuppressive therapy.
• Depending on the complications:
  • Impaired left ventricular pump function (heart failure): heart failure therapy with an ACE inhibitor or angiotensin receptor antagonist, beta-blocker, aldosterone receptor antagonist, and loop diuretic (see heart failure below)), and/or
  • Cardiac arrhythmias, if necessary ICD pacemaker/assid device (restrained indication, since about 60% of cases spontaneous improvement).
• Intensive care therapy in hemodynamically unstable patients.
• Note: Acute myocarditis usually responds poorly to symptomatic medical therapy for heart failure!
• See also under “Further therapy”.