Viral Myocarditis-Incidence, Diagnosis and Management

J Cardiothorac Vasc Anesth. 2020 Jun;34(6):1591-1601. doi: 10.1053/j.jvca.2019.12.052. Epub 2020 Jan 7.


Viral myocarditis has an incidence rate of 10 to 22 per 100,000 individuals. The presentation pattern of viral myocarditis can range from nonspecific symptoms of fatigue and shortness of breath to more aggressive symptoms that mimic acute coronary syndrome. After the initial acute phase presentation of viral myocarditis, the virus may be cleared, resulting in full clinical recovery; the viral infection may persist; or the viral infection may lead to a persistent autoimmune-mediated inflammatory process with continuing symptoms of heart failure. As a result of these 3 possibilities, the diagnosis, prognosis, and treatment of viral myocarditis can be extremely unpredictable and challenging for the clinician. Herein, the incidence, etiology, definition and classification, clinical manifestation, diagnosis, pathogenesis, prognosis, and treatment of viral myocarditis are reviewed, and how acute clinical care teams might differentiate between viral myocarditis and other acute cardiac conditions is discussed.

Keywords: fulminant viral myocarditis; mechanical circulatory support; parvovirus B19; viral myocarditis.

Publication types

  • Review

MeSH terms

  • Heart
  • Humans
  • Incidence
  • Myocarditis* / diagnosis
  • Myocarditis* / epidemiology
  • Myocarditis* / therapy
  • Parvovirus B19, Human*
  • Virus Diseases* / diagnosis
  • Virus Diseases* / epidemiology
  • Virus Diseases* / therapy