**8. Conclusion**

The clinical signs and symptoms of myocarditis are highly variable. A thorough medical history with emphasis on possible causes is essential. A scrupulous awareness to ample clinical scenarios is essential for clinicians, particularly when the cases are lacking apparent etiologies or the presentations being similar to acute myocardial infarction, asymptomatic left ventricular systolic dysfunction, unexplained ventricular tachyarrhythmias or cardiogenic shock. Clinician need to be attentive when evidence of myocardial damage not attributable to epicardial coronary artery disease, primary valvular disease or noninflammatory causes. Usually, most cases of myocarditis are self limited and a spontaneous improvement occurs in a substantial number of patients with lymphocytic disease but is rarely, if ever, observed with granulomatous myocarditis. While routine diagnostic endomyocardial biopsy is not required in most cases of suspected acute myocarditis, the need for biopsy will depend upon the time course and severity of the clinical presentation.

Better understanding of the clinicopathologic aberration that characterize the diverse clinical scenarios and more comprehensive understanding of the natural history of the various subtypes of myocarditis should assist clinicians for better approach and subsequently plan more effective therapy in the future.
