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Review
. 2025 Mar 3;17(3):e79949.
doi: 10.7759/cureus.79949. eCollection 2025 Mar.

Myocarditis: Diagnostic Modalities and Treatment Options

Dihan Thilakaratne  1 , Roshan Bista  2 , Mark Zenker  2 , Rohan Kaza  3 , Sasan Raissi  2 , Timir Paul  2
Affiliations
Review

Myocarditis: Diagnostic Modalities and Treatment Options

Dihan Thilakaratne et al. Cureus. .

Abstract

Myocarditis is an underdiagnosed condition that affects people of all ages. It can be asymptomatic or present with a variety of symptoms. The etiology of myocarditis is broad and can be infectious, autoimmune, or toxin-induced. The diagnosis of myocarditis can be challenging at times due to varied clinical features that sometimes overlap with other cardiac conditions. It is essential to have a high index of suspicion and use appropriate diagnostic methods for timely detection. In this review, we discuss establishing the diagnosis of acute myocarditis with initial workup to gold standard noninvasive cardiac magnetic resonance imaging methods and the use of invasive techniques such as endomyocardial biopsy. Furthermore, we discuss the treatment options, including novel approaches based on the severity of the symptoms and the specific etiologies of myocarditis.

Keywords: cmri cardiac magnetic resonance imaging; diagnostic testing; echocardiogram (echo); endomyocardial biopsy; myocarditis; etiology.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Diagnostic flowchart of myocarditis
PCR: polymerase chain reaction; HPI: history of present illness; CBC: complete blood count; CMP: comprehensive metabolic panel; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; EMB: endomyocardial biopsy; CMR: cardiovascular magnetic resonance; ICU: intensive care unit
Figure 2
Figure 2. Cardiac MRI reveals both pericarditis and myocarditis. Both arrows point to heterogeneous mild myocardial delayed enhancement along with circumferential pericardial enhancement. Parametric mapping showed elevated myocardial native T1 time of 1154 ms and myocardial T2 time of 66 ms, consistent with acute perimyocarditis.
(A) Horizontal long axis four-chamber anterolateral wall view; (B) Short axis view Image credit: Mark Zenker
Figure 3
Figure 3. Cardiac MRI confirms acute myocarditis. Both arrows show acute myocarditis involving the left ventricle. According to the parametric mapping, myocardial native T1 time was 1022 ms and myocardial T2 time was 55 ms.
(A) Horizontal long axis four chamber anterolateral wall view; (B) Short axis antero-apical wall view Image Credit: Mark Zenker
Figure 4
Figure 4. Cardiac MRI reveals acute peri-myocarditis. Arrows designate acute myocarditis involving the left ventricle. There is a diffuse mid myocardial delayed enhancement in all basal to apical segments along with pericardial enhancement. Moderate concentric left ventricular hypertrophy is also noted. According to the parametric mapping, there were significantly prolonged T2 and T1 mapping values. Myocardial native T1 time was 1250 ms and myocardial T2 time was 79 ms.
(A) Horizontal long axis four chamber inferolateral wall view; (B) Short axis antero-apical and septal apical wall view Image Credit: Mark Zenker
See this image and copyright information in PMC

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