Myocarditis Natural History — EECC MCQ
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Correct answer: E — The majority (~50-70%) of patients with acute lymphocytic myocarditis recover LVEF within 3-6 months with supportive care; however, ~20-30% develop chronic inflammatory cardiomyopathy with persistent dysfunction requiring long-term HF management
The natural history of acute myocarditis varies by presentation and histological subtype: (1) Lymphocytic myocarditis (most common): ~50-70% recover LVEF within weeks to months (complete resolution of inflammation); ~20-30% develop chronic inflammatory cardiomyopathy (persistent/recurrent inflammation causing progressive fibrosis and DCM); ~5-10% develop fulminant myocarditis requiring MCS; (2) Giant cell myocarditis: poor prognosis without immunosuppression (median transplant-free survival ~5 months); (3) Eosinophilic myocarditis: variable — responds to corticosteroids. Paradoxically, fulminant myocarditis (acute, severe, requiring MCS) may have better long-term outcomes than non-fulminant (more complete immune-mediated viral clearance). The ESC 2025 Myocarditis Guidelines recommend: serial CMR at 3-6 months, continuation of HF GDMT, and consideration of immunosuppression for virus-negative inflammatory cardiomyopathy if dysfunction persists despite GDMT (TIMIC trial evidence).
Reference: ESC (2025): Myocarditis/Pericarditis Guidelines