New ESC Guidelines Enhance Diagnosis and Management of Myocarditis and Pericarditis

The European Society of Cardiology (ESC) has introduced comprehensive new guidelines aimed at improving the diagnosis and treatment of myocarditis and pericarditis, two inflammatory conditions affecting the heart. Published during ESC Congress 2025 and featured in the European Heart Journal, these guidelines mark the first time that clinical directives cover both diseases simultaneously, emphasizing their overlapping features and the importance of a unified approach.

The guidelines provide clinicians with practical algorithms and flowcharts to facilitate early detection, accurate diagnosis, and effective management of myocarditis and pericarditis. A key feature is the introduction of the term "inflammatory myopericardial syndrome" (IMPS), functioning as an umbrella diagnosis until more specific identification is possible. This aims to raise awareness and support timely intervention, ultimately enhancing patient outcomes.

Myocarditis involves inflammation of the heart muscle and can lead to serious complications like sudden cardiac death in some cases. Pericarditis refers to inflammation of the pericardial sac surrounding the heart. Causes for both conditions vary and include genetic predispositions and infectious agents. Despite their potential severity, diagnosis often remains challenging due to varied clinical presentations.

The new guidelines highlight the critical role of multimodal imaging, especially advanced cardiac magnetic resonance imaging (MRI), and endomyocardial biopsy in diagnosis. Patients are often advised to limit physical activity during recovery, with additional testing like cardiac MRI helping determine safe return to exercise and work.

Furthermore, the guidelines underscore the importance of a multidisciplinary team approach, involving cardiologists, imaging specialists, infectious disease experts, surgeons, and geneticists, for complex cases. They also specify the need for heightened awareness of clinical signs and biomarkers that could serve as early warning indicators.

Despite increased knowledge, significant gaps remain, notably the scarcity of large-scale trials and studies targeting specific patient groups such as children, pregnant women, the elderly, and those with chronic conditions. The ESC encourages ongoing research to bridge these gaps and improve tailored treatment strategies.

Epidemiological data suggests that myocarditis predominantly affects young men, with reported incidences ranging from 6.3 to 8.6 per 100,000 population, while pericarditis occurs at a rate of 3 to 32 cases per 100,000 person-years. The guidelines endorse the importance of recognizing these patterns for timely diagnosis and intervention.

Overall, the new ESC guidelines aim to foster a comprehensive, multidisciplinary, and patient-centered approach to inflammatory heart diseases, fostering better outcomes and quality of life for affected individuals.