Diagnosis and management of viral myocarditis.

Myocarditis has been shown to be a common cause of cardiomyopathy; it is believed to account for 25% of all cases of heart failure in humans. Unfortunately, the disease is difficult to detect clinically before a myopathic process ensues. Treatment of myocarditis-induced heart failure includes the standard regimen of diuretics, digoxin, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and beta-adrenergic blockers. Treatment of myocarditis itself is dependent on the etiology of the illness. Additional treatments under investigation for viral and autoimmune myocarditis include immunosuppressants, nonsteroidal anti-inflammatory agents, immunoglobulins, immunomodulators, and antivirals, with no specific therapy having a real advantage over standard treatment for heart failure. Despite advances in treatment, more work needs to be done in the early detection of myocarditis. In addition, better means need to be established for distinguishing between viral and noninfectious autoimmune forms of the disease so that appropriate treatment can be instituted.