Myocarditis

Myocarditis is usually caused by infection, autoimmune disease, or exposure to toxic substances. The grounding also supports drug-related and immune-mediated causes, including myocarditis associated with immune checkpoint inhibitors. Viral causes are specifically discussed, including SARS-CoV-2 as a suspected trigger of myocardial inflammation.

The core process is inflammation within the myocardium leading to injury of cardiac myocytes. The literature also describes a transition from an initial trigger to myocardial inflammation and then to chronic ventricular dysfunction, although the mechanisms are not fully defined. Immune activation, including T-cell-mediated injury and cytokine-mediated damage, is implicated in some forms, and viral direct injury is also discussed.

Supported risk factors include infection, autoimmune disease, exposure to toxic substances, and treatment with immune checkpoint inhibitors. The COVID-19 review also notes that severe infection and mortality increase with advancing age and male sex, and that cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer increase mortality risk in COVID-19. These factors are relevant to cardiovascular complications in the supplied grounding, including myocardial inflammation.

Management is described at the level of diagnostic and therapeutic modalities rather than specific regimens. Cardiac magnetic resonance imaging is highlighted as an important diagnostic tool, and treatment discussions include general drug therapy and management of inflammatory cardiomyopathy. For immune checkpoint inhibitor-associated myocarditis, the literature frames it as an immune-mediated toxicity requiring recognition and treatment within cardio-oncology care, but the supplied grounding does not support a more specific standard-of-care summary.