In many cases myocarditis improves, either on its own or with treatment, leading to a complete recovery. Myocarditis treatment focuses on treating the underlying cause.
In mild cases, your doctor may tell you to rest and may prescribe medications to help your body fight off the infection causing myocarditis while your heart recovers. If bacteria are causing the infection, your doctor will prescribe antibiotics. Although antiviral medications are available, they haven't proven effective in the treatment of most cases of myocarditis.
Certain rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis, respond to corticosteroids or other medications to suppress the immune system response. In some cases caused by chronic illnesses, such as lupus, the treatment is directed at the underlying disease.
Drugs to help your heart
If myocarditis is causing heart failure or rapid or irregular heartbeats as a symptom, your doctor may hospitalize you. You may receive drugs to regulate your heartbeat. If your heart is weak, your doctor may prescribe medications to reduce your heart's workload or help you eliminate excess fluid. These medications may include:
- Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil) and ramipril (Altace), which relax the blood vessels in your heart and help blood flow more easily
- Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar) and valsartan (Diovan), which relax the blood vessels in your heart and help blood flow more easily
- Beta blockers, such as metoprolol (Toprol-XL) and carvedilol (Coreg), which work in multiple ways to treat heart failure and help control irregular or fast heart rhythms
- Diuretics, such as furosemide (Lasix), which relieve sodium and fluid retention
Treating severe cases
In some severe cases of myocarditis, aggressive treatment may be necessary, such as:
- Intravenous (IV) medications. IV delivery of medications may improve the heart-pumping function more quickly.
- A temporary artificial heart (ventricular assist device). These devices, which can be implanted or worn outside the body, take over part of the heart's job of moving blood in and out.
- A pump in the aorta (intra-aortic balloon pump). In this procedure, a balloon is surgically inserted into the aorta. As the balloon inflates and deflates, it helps to increase blood flow and decrease the workload on the heart.
- Increasing the oxygen content of the blood (extracorporeal membrane oxygenation, or ECMO). With severe heart failure, doctors sometimes recommend the use of this device to provide oxygen to the body. When blood is removed from the body, it passes through a special membrane in the ECMO machine that removes carbon dioxide and adds oxygen to the blood. The newly oxygenated blood is then returned to the body. The ECMO machine takes over the work of the heart. This treatment is used to allow the heart to recover or while waiting for other treatments, such as heart transplant.
In the most severe cases, doctors may consider urgent heart transplantation.
Some people may have chronic and irreversible damage to the heart muscle requiring lifelong medications, while other people need medications for just a few months and then recover completely.
May 02, 2012
- Kindermann I, et al. Update on myocarditis. Journal of the American College of Cardiology. 2012;59:779.
- Cooper LT. Clinical manifestations and diagnosis of myocarditis in adults. http://www.uptodate.com/index. Accessed March 14, 2012.
- Schultz JC, et al. Diagnosis and treatment of viral myocarditis. Mayo Clinic Proceedings. 2009;84:1001.
- Schultheiss HP, et al. The management of myocarditis. European Heart Journal. 2011;32:2616.
- Allan CK, et al. Clinical manifestations and diagnosis of myocarditis in children. http://www.uptodate.com/index. Accessed March 14, 2012.
- Cooper LT. Etiology and pathogenesis of myocarditis. http://www.uptodate.com/index. Accessed March 14, 2012.
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