Severe myocarditis, also known as fulminant myocarditis, is a serious type of myocarditis with a mortality rate of 70%-80%. The most important cause of myocarditis is viral myocarditis, in which a large number of myocardial cells become degenerative and necrotic after being invaded by the virus, which can clinically manifest as severe arrhythmias, cardiac insufficiency, and even cardiogenic shock. Early recognition of severe myocarditis is crucial if treatment is administered at this time, emphasizing early use of glucocorticoids and early activation of life support systems such as IBP and ECOM. Severe myocarditis generally occurs in children and adolescents, and is considered when this population presents with myocarditis, but older patients are more common in clinical practice and have graphic changes in the electrocardiogram that resemble acute myocardial infarction during the development of myocarditis. It is important to understand at this point that the treatment of severe myocarditis is completely different from the treatment of acute myocardial infarction, so early recognition is critical. In the elderly, if acute myocardial infarction-like ECG changes are present, it is important to pursue a detailed history and improve ancillary investigations. If necessary, coronary angiography should be performed to clarify whether severe myocarditis is combined with myocarditis, and then timely resuscitation measures should be given in order to fundamentally reduce the mortality rate of myocarditis.