Treatments and drugs

By Mayo Clinic Staff

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 might tell you to rest and might prescribe medication 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 might hospitalize you. You might receive drugs or other treatments to regulate your heartbeat if you have an abnormal heart rhythm (arrhythmia). If you have certain abnormal heart rhythms or severe heart failure, you may be prescribed medications to reduce the risk of blood clots forming in your heart.

If your heart is weak, your doctor might prescribe medications to reduce your heart's workload or help you eliminate excess fluid. These medications might include:

  • Angiotensin-converting enzyme (ACE) inhibitors. These medications, such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil) and ramipril (Altace), relax the blood vessels in your heart and help blood flow more easily.
  • Angiotensin II receptor blockers (ARBs). These medications, such as losartan (Cozaar) and valsartan (Diovan), relax the blood vessels in your heart and help blood flow more easily.
  • Beta blockers. Beta blockers, such as metoprolol (Lopressor, Toprol-XL), bisoprolol (Zebeta) and carvedilol (Coreg), work in multiple ways to treat heart failure and help control irregular or fast heart rhythms.
  • Diuretics. These medications, such as furosemide (Lasix), relieve sodium and fluid retention.

Treating severe cases

In some severe cases of myocarditis, aggressive treatment might be necessary, such as:

  • Intravenous (IV) medications. IV delivery of medications might improve the heart-pumping function more quickly.
  • Ventricular assist devices. Ventricular assist devices (VADs) are mechanical pumps that help pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. VADs are used in people who have weakened hearts or heart failure. This treatment may be used to allow the heart to recover or while waiting for other treatments, such as heart transplant.
  • Intra-aortic balloon pump. In this procedure, doctors insert a thin tube (catheter) in a blood vessel in your leg and guide it to your heart using X-ray imaging. Doctors place a balloon attached to the end of the catheter in the main artery leading out to the body from the heart (aorta). As the balloon inflates and deflates, it helps to increase blood flow and decrease the workload on the heart.
  • Extracorporeal membrane oxygenation (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 may be used to allow the heart to recover or while waiting for other treatments, such as heart transplant.

In the most severe cases, doctors might consider urgent heart transplantation.

Some people might 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.

Oct. 24, 2015