Prognóstico e Intervenções na Miocardite Viral

Abstract

Myocarditis is an inflammatory myocardial disease that remains an important problem in clinical practice due to the diagnostic and therapeutic challenges. In most cases, it has a viral etiology with multiple possible agents and variable clinical presentations, going from acute myocarditis with insidious onset to fulminant. In addition, the persistence of viral or immune-mediated response is in the pathogenesis of "chronic" myocarditis that often progresses to dilated cardiomyopathies, one of the main indications for heart transplantation. The greatest challenges of this pathology are associated with the diagnostic difficulty and the complexity in the management, treatment, and prognosis of the critical or chronic patient. Recently, endomyocardial biopsy with genetic identification of viruses and cardiac magnetic resonance have contributed to a more accurate diagnosis and prognosis. In addition to supportive treatments for hemodynamic instability, several therapies based on antivirals, interferon, immunoglobulins, and immunosuppression have been proposed. The purpose of this scientific review is to summarize the main advances in the pathogenesis, diagnosis, and treatment of myocarditis of viral etiology with an emphasis on the immunomodulatory approach and its impact on prognosis.