Myocarditis: The Role of Viral and Autoimmune Inflammation in Cardiovascular Pathology

Abstract

Myocarditis, an inflammatory disease of the myocardium, is a significant contributor to acute and chronic cardiac dysfunction, manifesting as heart failure, arrhythmias, and sudden cardiac death, particularly in younger individuals. Its pathogenesis involves a complex interplay between direct viral injury and immune-mediated mechanisms. Viral myocarditis, commonly caused by coxsackievirus, parvovirus B19, and SARS-CoV-2, results from viral invasion of cardiomyocytes, leading to cell lysis, cytokine release, and activation of innate immunity. Autoimmune myocarditis arises when molecular mimicry or systemic autoimmune disorders, such as systemic lupus erythematosus, trigger sustained immune attacks on myocardial tissue. Clinical presentation is heterogeneous, ranging from mild chest pain to fulminant heart failure, complicating diagnosis. Contemporary approaches emphasize multimodal strategies, integrating cardiac magnetic resonance imaging, biomarker profiling, and selective endomyocardial biopsy to improve diagnostic accuracy. Management combines supportive care—addressing heart failure and arrhythmias—with targeted therapies, including immunosuppressants for autoimmune cases and investigational antivirals for viral etiologies. Emerging technologies, notably artificial intelligence, enhance imaging interpretation and prognostic assessment, while novel therapies aim to prevent progression to dilated cardiomyopathy. Public health challenges include underdiagnosis, disparities in access to advanced diagnostics, and the growing burden associated with post-viral pandemics such as COVID-19. Addressing these requires targeted screening of high-risk populations, equitable access to care, and international collaboration to standardize guidelines. This review synthesizes current knowledge on the viral and autoimmune mechanisms of myocarditis, diagnostic advances, therapeutic strategies, and public health implications, highlighting opportunities for innovation to improve patient outcomes and reduce the global burden of this complex cardiovascular disease.