Management von Myokarditis und Perikarditis - DGK-Kommentar zu den Leitlinien der ESC (2025): aus der Kommission für Klinische Kardiovaskuläre Medizin [Management of myocarditis and pericarditis - comments of the German Cardiac Society on the guidelin …

The first guidelines of the European Society of Cardiology (ESC) on the management of myocarditis and pericarditis introduce the inflammatory myopericardial syndrome (IMPS) as an overarching disease encompassing the full spectrum of inflammatory myocardial and pericardial diseases. It emphasizes shared etiologies, clinical overlaps and the need for heightened awareness of high-risk features (red flags). A key innovation is the symptom-based algorithm (chest pain, arrhythmia, heart failure) providing structured diagnostic and treatment pathways. Multimodal imaging, primarily noninvasive and particularly using cardiovascular magnetic resonance imaging, enables a definitive diagnosis of myocarditis. An endomyocardial biopsy should be included in high-risk constellations, such as hemodynamic instability or suspected specific myocardial diseases requiring rapid treatment, such as giant cell myocarditis. Greater emphasis is placed on genetic, autoimmune and autoinflammatory mechanisms, including selective genetic testing. Treatment management follows a risk-adapted, personalized strategy ranging from anti-inflammatory treatment to heart failure and device treatment as well as individualized abstention from sports and work. Anti–interleukin-1 therapy is incorporated for recurrent pericarditis. Multidisciplinary care is a central component of the management in complicated cases.