Diagnostik und Therapie der Myokarditis

Myocarditis is an inflammatory heart disease resulting from a plethora of causes which may lead to the development of dilated cardiomyopathy and heart failure. There are no pathognomonic symptoms. The broad clinical spectrum ranges from asymptomatic courses to acute coronary syndrome-like presentations and fulminant cardiogenic shock. Non-invasive diagnostic imaging methods, such as cardiac magnetic resonance imaging may contribute important indicative findings; however, for confirmation of the definitive diagnosis endomyocardial biopsy remains crucial as the gold standard. Endomyocardial biopsies should only be carried out if appropriate histological, immunohistological and molecular biological analyses of the biopsy material for detection of inflammatory processes and confirmation of viral genome can be guaranteed. Despite the remarkable advances in the diagnosis of myocarditis, there is no specific evidence-based therapy as there is a lack of sufficient data from clinical trials. Immunosuppressive therapy appears to be efficient in patients with chronic virus negative inflammatory cardiomyopathy; however, this treatment option as well as other immunomodulatory and antiviral therapeutic strategies have to be investigated in further randomized and placebo controlled trials.