What are the current guidelines for the management of myocarditis, including pharmacological and non-pharmacological interventions?

Current UK guidelines do not provide specific detailed recommendations for the management of myocarditis. However, myocarditis management generally involves supportive care and treatment of heart failure symptoms if present, following heart failure guidelines.

Pharmacological interventions for myocarditis-related heart failure should align with standard heart failure treatment protocols, including the use of diuretics for fluid overload, ACE inhibitors or angiotensin II receptor blockers (AIIRAs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) as indicated by symptoms and ejection fraction status. Specialist advice should be sought for initiation and titration of these medications, especially in cases of reduced ejection fraction or complex presentations ¹,³.

In cases of severe or worsening heart failure, digoxin may be considered under specialist guidance ¹. For patients with persistent symptoms despite optimized standard care, options such as sacubitril valsartan, ivabradine, or hydralazine with nitrates may be considered, particularly in specific populations or ejection fraction criteria ¹,³.

Non-pharmacological interventions include supportive care such as monitoring and managing fluid status, oxygen therapy if needed, and consideration of advanced therapies in specialist settings. Exercise-based rehabilitation programs may be offered to suitable patients with heart failure to improve quality of life and reduce hospital admissions ³.

Because myocarditis can lead to acute or chronic heart failure, management principles from acute and chronic heart failure guidelines apply, including close monitoring, specialist referral, and addressing precipitating factors and comorbidities ¹,²,³.

In summary, myocarditis management in the UK is primarily supportive and guided by heart failure management protocols, with specialist involvement recommended for complex cases or when advanced therapies are considered.