New European Society of Cardiology guidelines covering the spectrum of myocarditis and pericardial disease

The long-awaited guidelines for the management of myocarditis and pericarditis were published by the European Society of Cardiology in 2025. The aim is to improve detection, management, and long-term outcomes in patients with inflammatory myocardial and pericardial disease. A central new umbrella term introduced in the document is Inflammatory Myopericardial syndrome (IMPS), a concept covering the entire spectrum, including the overlap of myocardial and pericardial inflammation. Advanced imaging with cardiac magnetic resonance (CMR) now allows for diagnosis, follow-up, and risk stratification of myocarditis. Because inflammatory heart disease can overlap with cardiomyopathies, the guidelines recommend obtaining a family history, and genetic testing should be considered in specific cases. Routine viral serology is no longer recommended except in selected situations, while invasive endomyocardial biopsy is reserved for advanced cases. Treatment management is individualized. A minimum of one month of physical activity restriction is recommended during the acute phase, with return to exercise and work guided by individual recovery and clinical/imaging remission rather than fixed timeframes. Long-term follow-up is advised, particularly for patients with complicated myocarditis.