Acute Myocarditis with LV Systolic Dysfunction: Management After Initial Symptom-Control Has Failed
Clinical scenario
Patients with acute myocarditis in whom initial empirical therapy did not achieve resolution of chest pain and adequate symptom control, and who present with left ventricular systolic dysfunction and/or heart failure.
Prior treatment & failure condition
Initial management included aspirin or NSAIDs with proton pump inhibition, colchicine where indicated for myopericarditis, and beta-blockers. When this line does not achieve resolution of chest pain and control of symptoms, a further structured approach is required — particularly in the presence of LV dysfunction or heart failure.
Next-line approach (overview only)
This protocol applies guideline-directed heart failure therapy in line with established ESC HF guidance, tailored to myocarditis with reduced LV function. The full protocol specifies the criteria for initiation, continuation thresholds, and individualised management — details available in the complete regimen.
Treatment goals
Improvement in left ventricular function and reduction of heart failure symptoms.
References
DOI: 10.1093/eurheartj/ehaf192
- Adherence to the ESC HF guidelines is recommended in cases of myocarditis with LV systolic dysfunction and/or HF to reduce symptoms and to improve LV function.
- HF therapy should be considered in patients with myocarditis and LV systolic dysfunction for at least 6 months upon complete LV functional recovery to stabilize LV function.
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