ESC 2025 Guidelines — Myocarditis and Pericarditis

This is the first ESC guideline to cover myocarditis and pericarditis together, and the pairing is clinically honest — the overlap syndromes sit between the two and had no clear home before.

On the pericardial side the therapeutic hierarchy is firm and frequently tested: a non-steroidal anti-inflammatory drug with colchicine is first line, corticosteroids are not, absent a specific indication. Questions tend to construct a reason why the first-line drug looks difficult — renal impairment, a previous ulcer — and check whether you reach for steroids anyway or for the dose-adjusted alternative.

On the myocardial side: which patients need cardiac magnetic resonance and which need biopsy, what the imaging criteria actually require, and how aetiology is pursued. Routine viral serology is not recommended; the named exceptions are the point of the recommendation. Arrhythmic risk, exercise restriction during the active phase and the conditions for returning to sport complete the examinable ground.