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Myocarditis is a heart muscle inflammation (myocardium). Inflammation can impair the heart's ability to pump blood and create fast or irregular heartbeats (arrhythmias).
Myocarditis is mainly caused by a virus infection. Myocarditis can sometimes be caused by a medication reaction or be part of a larger inflammatory illness. Myocarditis symptoms include chest pain, exhaustion, shortness of breath, and rapid or irregular heartbeats.
Severe myocarditis weakens the heart, causing the rest of the body to get insufficient blood. Clots in the heart can cause a stroke or heart attack.
The treatment for myocarditis is determined by the cause.
WHAT ARE THE SIGNS AND SYMPTOMS OF MYOCARDITIS?
If you have myocarditis in its early stages, you may experience modest symptoms such as chest pain, fast or irregular heartbeats, or shortness of breath. Some persons with early-stage myocarditis have no symptoms at all.
Depending on the source of the disease, the signs and symptoms of myocarditis differ. The following are common myocarditis signs and symptoms:
- Chest pain
- A fast or irregular heartbeat (arrhythmias)
- Breathing difficulties, whether at rest or during activity
- Swelling of the legs, ankles, and feet due to fluid buildup
- Fatigue
- Other symptoms of a viral infection include a headache, muscle aches, joint pain, fever, a sore throat, and diarrhea.
Myocarditis symptoms can mimic those of a heart attack. Seek emergency medical attention if you are experiencing inexplicable chest discomfort and shortness of breath.
Myocarditis in children
When children acquire myocarditis, they may exhibit the following signs and symptoms:
- Fever
- Fainting
- Breathing problems
- Breathing quickly
- Chest pain
- Heartbeats that are fast or irregular (arrhythmias)
WHAT ARE THE CAUSES OF MYOCARDITIS?
The cause of myocarditis is frequently unknown. There are numerous probable causes, but the likelihood of getting myocarditis is extremely low.
Myocarditis can be caused by a variety of factors, including:
- Viruses: The viruses that cause the common cold (adenovirus); COVID-19; hepatitis B and C; parvovirus, which causes a slight rash, generally in children (fifth illness); and herpes simplex virus are all regularly associated with myocarditis.
Myocarditis can also be caused by gastrointestinal infections (echoviruses), mononucleosis (Epstein-Barr virus), and German measles (rubella). It is also prevalent in patients infected with HIV, the virus that causes AIDS.
- Bacteria: Staphylococcus aureus, streptococcus, the bacterium that causes diphtheria, and the tick-borne bacterium that causes Lyme disease are all bacteria that can cause myocarditis.
- Parasites: Among these are parasites like Trypanosoma cruzi and toxoplasma, as well as those that are spread by insects and can cause Chagas disease. Chagas disease is far more frequent in Central and South America than in the United States, but it can infect tourists and immigrants from that region.
- Fungi: Yeast infections, such as candida; molds, such as aspergillus; and other fungi, such as histoplasma, which are frequently found in bird droppings, can occasionally cause myocarditis, especially in patients with compromised immune systems.
- Myocarditis can also occur if you are exposed to: Medications or illegal medications that could result in an allergic or hazardous reaction:
These include cancer treatments, antibiotics such as penicillin and sulfonamide pharmaceuticals, anti-seizure medications, and illegal narcotics such as cocaine.
- Chemicals or radiation: Myocarditis can be caused by exposure to certain substances, such as carbon monoxide, and radiation.
- Other diseases: Lupus, Wegener's granulomatosis, giant cell arteritis, and Takayasu's arteritis are examples of these diseases.
HOW IS MYOCARDITIS DIAGNOSED?
Early detection of myocarditis is critical for preventing long-term heart damage. Following a physical examination, your doctor may prescribe one or more tests to confirm the presence of myocarditis and to establish the severity of the condition. The following tests may be used to diagnose myocarditis:
- Electrocardiogram (ECG or EKG): This rapid and painless examination shows the electrical patterns of your heart and can detect irregular heartbeats.
- Chest X-ray: An X-ray scan indicates the size and form of your heart, as well as whether you have fluid in or around your heart, which could indicate heart failure.
- Heart MRI (Cardiac MRI): A cardiac MRI depicts the size, shape, and structure of your heart. This test can detect evidence of cardiac muscle inflammation.
- Echocardiogram: A moving image of the beating heart created by sound waves. An echocardiography can reveal the size of your heart as well as how well it pumps. The test may also indicate valve issues, a blood clot within the heart, or fluid around your heart.
- Blood tests: A total blood count and a test to examine the levels of particular proteins (enzymes) that signify heart muscle injury are two blood tests used to diagnose or confirm myocarditis. Other blood tests can be performed to see if you have antibodies to viruses and other organisms that could cause a myocarditis-related infection.
- Cardiac catheterization and biopsy of heart muscle: A tiny tube (catheter) is threaded into your heart through a vein in your leg or neck. In rare situations, doctors will use a special equipment to extract a little sample of heart muscle tissue (biopsy) for testing for inflammation or infection in the lab.
WHAT ARE THE TREATMENTS FOR MYOCARDITIS?
Many patients recover completely from myocarditis on their own or with treatment. The treatment of myocarditis focuses on the etiology as well as the symptoms, such as heart failure.
Medications
Mild myocarditis may merely require rest and medicines.
- Corticosteroids: Certain rare kinds of viral myocarditis, such as giant cell and eosinophilic myocarditis, may respond to corticosteroids or other immune-suppressing drugs.
- Heart medications: If your myocarditis is causing heart failure or arrhythmias, you may need to be hospitalized. Depending on your indications and symptoms, your doctor will prescribe medicines or other therapies. If you have certain abnormal heart rhythms or severe heart failure, for example, you may be given drugs to minimize the chance of blood clots forming in your heart.
If your heart is weak, your doctor may prescribe blood pressure drugs to reduce the strain on your heart or to assist your body in eliminating extra fluid. Diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers are examples of these drugs (ARBs).
- Medications used to treat chronic illnesses: If myocarditis is caused by a persistent illness, such as lupus, treatment focuses on the underlying condition.
Surgeries and procedures
If you have severe myocarditis, you may require vigorous therapy, which may involve the following:
- IV medications: Medications administered through a vein are used to strengthen your heart's ability to pump fast.
- Ventricular assist devices (VAD): A VAD is a device that aids in the circulation of blood from your heart's bottom chambers (the ventricles) to the rest of your body. VADs are utilized in patients with weaker hearts or heart failure. This treatment may be used to allow your heart to heal or while you await other therapies, such as a heart transplant.
- Heart transplant: If you have severe myocarditis, your doctor may advise you to have a heart transplant as soon as possible.
- Intra-aortic balloon pump: Using X-ray imaging, the doctor inserts a small tube (catheter) into a blood vessel in your leg and directs it to your heart. A balloon linked to the catheter's tip inflates and deflates in the major artery traveling from the heart to the body (aorta). An intra-aortic pump improves blood flow while reducing the strain on your heart.
- Extracorporeal membrane oxygenation (ECMO): The function of an ECHO machine is similar to that of the lungs. It eliminates carbon dioxide from the blood and replaces it with oxygen. This gadget can give oxygen to your body if you have serious heart failure. ECMO involves the removal of blood from the body, its passage through the ECMO equipment, and its return to the body.
The ECMO machine performs the functions of your heart. This treatment may be used to allow the heart to heal or while awaiting other treatments such as a heart transplant.
Some persons with myocarditis may have persistent and irreparable heart muscle damage that necessitates lifelong medication, whereas others may only require drugs for a few months and then recover entirely. In either case, your doctor will most likely advise you to schedule regular follow-up sessions, which may include tests to assess your condition.