**Abstract**

Myocarditis is an inflammatory disease of the myocardium diagnosed through a combination of histological, immunological and immunohistochemical criteria. Its clinical presentation varies from an acute coronary-like symptoms to heart failure. Diagnostic workup includes elevated biomarkers, ECG and echocardiographic findings. Cardiac magnetic resonance is the most important examination providing information on both ventricular function and tissue characterization. However, in the case of critically ill patients, CMR should be replaced with endomyocardial biopsy (EMB) which remains the gold standard in myocarditis diagnosis. EMB provides information on both the etiology and prognosis thus affecting the therapeutic approach to the patient. For example, virus positive myocarditis benefits from antiviral treatment while in virus negative ones, immunosuppression is more appropriate. Mechanical circulatory support (MCS) is often necessary in patients presenting with cardiogenic shock. MCS includes intra-aortic balloon pump, temporary percutaneous or even surgically implanted ventricular assist devices and extracorporeal membrane oxygenation (ECMO). ECMO essentially bypasses the heart and provides adequate oxygenation to peripheral organs. Due to the increased afterload under ECMO support, it seems reasonable to be combined with intra-aortic balloon pump or percutaneous VAD implantation to promote left ventricular unloading and potential recovery.

**Keywords:** myocarditis, cardiogenic shock, ecmosupport, extracorporeal membrane oxygenation, acute myocarditis
