Myocarditis, which is caused by viral infection, can lead to heart failure, malignant arrhythmias, and
even sudden cardiac death in young patients. It is also one of the most important causes of dilated cardiomyopathy
worldwide. Although remarkable advances in diagnosis and understanding of pathophysiological mechanisms of
viral myocarditis have been gained during recent years, no standard treatment strategies have been defined as yet.
Fortunately, recent studies present some evidence that immunomodulating therapy is effective for myocarditis. The
immunomodulatory effect of the autonomic nervous system has raised considerable interest over recent decades.
Studying the influence on the inflammation and immune system of the sympathetic and parasympathetic nervous
systems will not only increase our understanding of the mechanism of disease but could also lead to the identification
of potential new therapies for viral myocarditis. Studies have shown that the immunomodulating effect of the
sympathetic and parasympathetic nervous system is realized by the release of neurotransmitters to their corresponding receptors (catecholamine
for α or β adrenergic receptor, acetylcholine for α7 nicotinic acetylcholinergic receptor). This review will discuss the current
knowledge of the roles of both the sympathetic and parasympathetic nervous system in inflammation, with a special focus on their roles
in viral myocarditis.
Keywords: Viral myocarditis, autonomic nervous system, sympathetic nerve, adrenergic receptor, vagus nerve, cholinergic
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