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Myocarditis

Definition


Disease: Myocarditis Myocarditis
Category: Cardiovascular diseases
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Disease Definition:

The inflammation of the myocardium, the middle layer of the heart wall, is called myocarditis. A variety of signs and symptoms that include chest pain and abnormal heart rhythms can be caused by this uncommon condition.

The pumping action of the heart will weaken, and the heart won't be able to supply the rest of the body with enough blood in case myocarditis becomes severe. Leading to a heart attack or stroke, clots could form in the heart.

A viral infection usually causes myocarditis. The underlying cause is the thing that treatment for myocarditis depends on.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Depending on the cause and the severity of the disease, the signs and symptoms of myocarditis vary. The following are included in the most common signs and symptoms:

 

  • Fluid retention with swelling of the feet, ankles and legs
  • Chest pain that may feel like a heart attack or angina
  • Shortness of breath at rest or during physical activity
  • Fatigue
  • A rapid or abnormal heartbeat (arrhythmia)


The following are less-common signs and symptoms:

 

  • Fainting or a sudden loss of consciousness
  • Other symptoms one would have with a viral infection such as fever, joint pain, diarrhea, headache, sore throat or body aches.  


Pericarditis, which is an inflammation of the membrane covering the heart (pericardium), may sometimes develop in people with myocarditis. Sharp pains over the center of the chest may be caused by pericarditis.

Myocarditis may have no noticeable symptoms in mild cases. A person may have general symptoms of a viral infection and feel ill and never realize his/her heart is affected. Some people may recover without ever knowing they had myocarditis, and they may never seek medical care.

MYOCARDITIS IN CHILDREN:
The following signs and symptoms may be experienced by children when they develop myocarditis:

 

  • Bluish or grayish discoloration of the skin
  • Breathing difficulties
  • Loss of appetite
  • Fever

Causes:

Rheumatic fever was a common cause of myocarditis years ago; however, there are usually other causes of myocarditis nowadays. It most often develops due to an infection caused by the following:

Parasites:
Toxoplasma and Trypanosoma cruzi, including some parasites that are transmitted by insects and can cause a condition called Chagas' disease, are among these. The most common global cause of congestive heart failure is Chagas' disease.

Bacteria:
They include a tick-borne bacterium that is responsible for Lyme disease and Staphylococcus aureus, which can also cause an infection of the heart valves called endocarditis. In more than one-fourth of all people with the bacterial infection diphtheria, myocarditis occurs as well.

Fungi and Mold:
Some rare causes of myocarditis are molds such as aspergillus; yeast infections such as candida; and other fungi such as histoplasma, often found in bird droppings.

Viruses:
Coxsackievirus B, which can cause symptoms similar to a mild case of flu, is the virus most often associated with myocarditis. However, other causes of myocarditis include a rash called "fifth disease" caused by the parvovirus B19, mononucleosis caused by the Epstein-Barr virus, measles caused by rubella, gastrointestinal infections caused by echovirus, and the viruses that cause common cold (adenovirus) and flu. The heart muscle can be directly infiltrated by HIV, the virus that causes AIDS.

If one is exposed to the following, he/she may develop myocarditis:

Medications that may cause an allergic or toxic reaction:
Antibiotics such as penicillin and sulfonamide drugs, as well as some illegal substances such as cocaine are included.

Certain chemicals:
Substances such as hydrocarbons and arsenic may be included in these.

Other diseases:
Inflammation of blood vessels (vasculitis), lupus, connective tissue disorder, and rare inflammatory conditions such as Wegener's granulomatosis are included.

Complications

Complications:

Myocarditis can permanently damage the heart muscle if it is severe. If strain is put on the heart when its pumping action weakens, heart failure may result. So the heart becomes unable to pump efficiently enough to supply the body with the oxygen-rich blood it needs. Leading to a stroke or heart attack, a failing heart can also cause blood clots to form.

Heart arrhythmias, which can cause sudden death in severe cases, may develop in people with myocarditis. A heart transplant may be required in very severe cases of myocarditis related heart failure.

Treatments:

Either on its own or with treatment, the swelling that causes myocarditis usually improves leading to a complete recovery. The underlying cause, such as the particular infection that may have caused the heart inflammation, is the thing that treatment of myocarditis focuses on.

Coxsackievirus B — the most common type of virus that causes myocarditis — has no specific treatment other than relieving pain and other symptoms.

TREATING MILD CASES:
To help the body of the patient fight off the infection that is causing myocarditis, the doctor may prescribe medications and tell the patient to rest while his/her heart is recovering.
Antibiotics will be prescribed if bacteria are causing the infection. To suppress the immune system, certain rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis, respond to corticosteroids or other medications. The treatment will be directed at the underlying disease if the condition is caused by a chronic illness such as lupus.

One can gradually resume a more active lifestyle once his/her heart inflammation has improved. Avoiding cigarettes, alcohol and vigorous exercise and limiting the amount of salt in the diet may be recommended meanwhile. The workload on the patient's heart can be reduced by taking these steps.

MEDICATIONS TO HELP THE HEART:
A person may be hospitalized if he/she has rapid or irregular heartbeats as a symptom. To regulate the heartbeats, he/she will receive drugs. Medications are prescribed to reduce the heart's workload, help the patient eliminates excess fluid, or strengthen its pumping ability in case the heart is weak. The following may be included in these medications:

Digoxin, which increases the strength of the heart muscle contractions and tends to slow the heartbeat
Beta blockers such as carvedilol and metoprolol, which work in multiple ways to treat heart failure and help control irregular or fast heart rhythms
Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, ramipril, enalapril and captopril, which relax the blood vessels in the heart and help blood flow more easily
Diuretics, such as furosemide, which relieve sodium and fluid retention

TREATING SEVERE CASES:
Aggressive treatment such as the following, may be necessary in some severe cases of myocarditis:

 

  • Use of a temporary artificial heart (assist device)
  • Intravenous (IV) medications to improve the heart-pumping function
  • Consideration of urgent heart transplantation
  • Placement of a pump in the aorta (intra-aortic balloon pump)


Some people need medications for just a few months and then recover completely, while others may have chronic and irreversible damage to the heart muscle requiring lifelong medications. It's difficult for the doctor to predict how the patient will do because of this variability in the disease.

Prognosis:

Not Available

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