Viral infection occasionally triggers myocarditis (inflammation and necrosis of the heart muscle) which can result in severe, acute heart failure. The first signs of this condition may be flu-like symptoms which evolve into non-specific chest discomfort, shortness of breath or palpitations. The majority of patients recover spontaneously but others have continuing heart problems which require medication and can be severe enough to cause death.
Corticosteroids may suppress the inflammatory immune response to viral infection and improve outcomes but their use remains controversial. The review authors made a thorough search of the medical literature. No randomised trials which met the inclusion criteria compared corticosteroids with placebo, supportive therapy, antiviral therapy or conventional therapy, including trials of corticosteroids plus other treatment versus other treatment alone, for viral myocarditis.
Trials identified failed to use appropriate diagnostic criteria, were of poor methodological quality or used corticosteroids with additional Chinese traditional medicines in addition, which the control group did not receive. The reviewers concluded that further RCTs comparing corticosteroids in patients suffering viral myocarditis with placebo are warranted.