The Gold Standard Test

The gold standard test for diagnosis of myocarditis is an endomyocardial biopsy, although considerable debate remains on the exact histological diagnostic criteria. This will be combined with immunohistochemistry and viral polymerase chain reaction (PCR).

Infiltration of the myocardium by inflammatory cells and myocyte necrosis is pathognomonic of active myocarditis, but multiple samples may be required and biopsy has considerable limitations [6].

The decision when to perform an endomyocardial biopsy and the interpretation of the results clearly extends beyond the practise of the emergency physician.