In case of suspected myocarditis in an adolescent with acute cardiac decompensation requiring mechanical circulatory support (MCS), how long is ideal to wait on MCS before considering a heart transplant? Should endomyocardial biopsy be a part of the clinical algorithm before even considering heart transplant (since transplant outcome due to myocarditis is not as good as those with dilated cardiomyopathy without evidence of myocarditis)? If endomyocaridial biopsy is done and is positive for one of the cardiotropic viruses, how should anti-viral or interferon therapy be started? In case of virus negative myocarditis (so called auto-immune myocarditis), what anti-inflammatory strategy is used? The early trials of immunosuppression and anti-inflammatory therapy are limited.