Diagnosis and Management of Myocarditis: An Evidence-Based Review for the Emergency Medicine Clinician

J Emerg Med. 2021 Sep;61(3):222-233. doi: 10.1016/j.jemermed.2021.03.029. Epub 2021 Jun 7.


Background: Myocarditis is a potentially fatal condition that can be misdiagnosed in the emergency department (ED) setting.

Objective: The purpose of this narrative review article is to provide a summary of the background, pathophysiology, diagnosis, and management of myocarditis, with a focus on emergency clinicians.

Discussion: Myocarditis occurs when inflammation of the heart musculature causes cardiac dysfunction. Symptoms may range from mild to severe and are often preceded by a viral prodrome. Laboratory assessment and an electrocardiogram can be helpful for the diagnosis, but echocardiography is the ideal test in the ED setting. Some patients may also require advanced imaging, though this will often occur during hospitalization or follow-up. Treatment is primarily focused on respiratory and hemodynamic support. Initial hemodynamic management includes vasopressors and inotropes, whereas more severe cases may require an intra-aortic balloon pump, extracorporeal membrane oxygenation, or a ventricular assist device. Nonsteroidal anti-inflammatory drugs should be avoided while intravenous immunoglobulin is controversial.

Conclusion: Myocarditis is a serious condition with the potential for significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.

Keywords: cardiac; cardiomyopathy; emergency medicine; myocarditis.

Publication types

  • Review

MeSH terms

  • Emergency Medicine*
  • Extracorporeal Membrane Oxygenation*
  • Heart-Assist Devices*
  • Humans
  • Intra-Aortic Balloon Pumping
  • Myocarditis* / diagnosis
  • Myocarditis* / therapy