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Myocarditis is a rare but serious condition characterized by inflammation in the middle muscular layer of the heart wall, known as the myocardium. When the heart muscle becomes inflamed, it can disrupt the heart’s electrical system, resulting in abnormal or rapid heartbeats called arrhythmias. Myocarditis can also lead to the weakening of the heart muscle and the development of cardiomyopathy.
There are several causes of myocarditis, including viral infections, drug reactions, and general inflammatory conditions. In cases of severe myocarditis, the weakened heart muscle fails to pump sufficient blood to the rest of the body. This can lead to the formation of blood clots in the heart, which can result in stroke or heart attack.
The treatment for myocarditis typically involves a combination of medications, procedures, or surgeries aimed at reducing inflammation, managing symptoms, and supporting heart function.
Symptoms
Myocarditis can manifest with a range of symptoms, which can vary in severity from person to person. The common symptoms of myocarditis include:
- Chest pain
- Fatigue
- Swelling in the legs, ankles, and feet
- Rapid or irregular heartbeat (arrhythmias)
- Shortness of breath, both at rest and during physical activity
- Light-headedness or a feeling of faintness
- Flu-like symptoms, such as headache, body aches, joint pain, fever, or sore throat
When myocarditis occurs in children, the symptoms may include:
- Difficulty breathing
- Chest pain
- Fainting
- Fever
- Rapid breathing
- Rapid or irregular heart rhythms (arrhythmias)
If you experience symptoms of myocarditis that resemble a heart attack, such as unexplained chest pain, rapid heartbeats, or shortness of breath, it is crucial to contact your healthcare provider immediately. Seek emergency medical assistance or call for help if your symptoms are severe.
Causes
Potential causes of myocarditis include:
- Viruses: Several viruses have been associated with myocarditis, including those responsible for the common cold (adenovirus), COVID-19, hepatitis B and C, parvovirus (which causes fifth disease, a mild rash in children), and herpes simplex virus. Gastrointestinal infections (echoviruses), mononucleosis (Epstein-Barr virus), and German measles (rubella) can also lead to myocarditis. Additionally, HIV, the virus that causes AIDS, can cause myocarditis.
- Bacteria: Certain bacteria can cause myocarditis, such as staphylococcus, streptococcus, and bacteria that cause diphtheria and Lyme disease.
- Parasites: Parasites like Trypanosoma cruzi and toxoplasma can cause myocarditis. Some parasites are transmitted by insects and can lead to Chagas disease, which is more prevalent in Central and South America than in the United States.
- Fungi: Myocarditis can be caused by fungal infections, especially in individuals with weakened immune systems. Yeast infections like candida, molds such as aspergillus, and histoplasma commonly found in bird droppings are among the fungi associated with myocarditis.
- Certain medications or illegal drugs: Myocarditis can be induced by certain medications, including those used for cancer treatment, antibiotics like penicillin and sulfonamides, some anti-seizure medications, and cocaine.
- Chemicals or radiation: Exposure to substances like carbon monoxide and radiation can occasionally lead to inflammation of the heart muscle.
- Other inflammatory diseases: Inflammatory conditions such as lupus, Wegener’s granulomatosis, giant cell arteritis, and Takayasu’s arteritis may cause myocarditis.
- COVID-19 vaccine: Rare cases of myocarditis have occurred in young individuals after receiving the Pfizer-BioNTech® or Moderna® COVID-19 vaccines. Most recover quickly with treatment and can resume regular activities but should consult a cardiologist before exercising. CDC recommends vaccination for young people, considering COVID-19 a greater risk than vaccine side effects.
Diagnosis
Early detection of myocarditis is crucial for preventing lasting cardiac harm, and its diagnosis commonly involves a thorough physical examination and listening to the heart using a stethoscope. Additionally, healthcare providers may employ blood tests and imaging techniques to assess the overall condition of the heart, aiding in the confirmation of myocarditis and the evaluation of its extent and severity.
To diagnose myocarditis, various tests are conducted, including:
- Blood tests: These assess for signs of heart attack, inflammation, and infection. Cardiac enzyme tests can detect proteins indicating heart muscle damage, while antibody blood tests can help identify any infection associated with myocarditis.
- Electrocardiogram (ECG or EKG): This non-invasive test records the heart’s electrical activity, revealing its rhythm. By analyzing the ECG signal patterns, healthcare providers can identify irregular heartbeats (arrhythmias). Some personal devices, like smartwatches, offer ECG monitoring as well.
- Chest X-ray: X-ray imaging of the chest provides information about the size and shape of the heart and lungs. It can indicate the presence of fluid around the heart, potentially linked to heart failure.
- Cardiac Magnetic Resonance Imaging (MRI): This imaging technique employs magnetic fields and radio waves to generate detailed images of the heart. A cardiac MRI allows visualization of the heart’s size, structure, and shape, enabling identification of signs of heart muscle inflammation.
- Echocardiogram: By using sound waves, an echocardiogram produces real-time images of the beating heart. It helps assess the heart’s size, blood flow through the heart and valves, and the presence of fluid around the heart.
- Cardiac catheterization and heart muscle biopsy: During this invasive procedure, a thin tube (catheter) is inserted through a blood vessel in the arm or groin and guided to an artery in the heart. Contrast dye is injected to enhance the visibility of the coronary arteries in X-rays. Additionally, a small sample of heart muscle tissue (biopsy) may be obtained and examined in a laboratory to detect signs of inflammation or infection.
Treatment
If a mild case of myocarditis occurs, it may resolve on its own. However, if the condition persists, healthcare providers can prescribe appropriate treatments.
Medications
Possible medications for the treatment of myocarditis can include:
- Corticosteroids. These drugs reduce immunological function. Some uncommon viral myocarditis kinds, like giant cell and eosinophilic myocarditis, may be treated with them.
- Heart medications. In cases where myocarditis leads to severe heart failure or irregular heartbeats, medications may be prescribed to minimize the risk of blood clots within the heart. These drugs aim to alleviate the strain on the heart and remove excess fluid from the body, particularly in individuals with a weakened heart. Treatment options may include diuretics, beta blockers, as well as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
- Medications to treat chronic conditions. Treating the root cause of myocarditis, such as an underlying health condition like lupus, can potentially alleviate inflammation of the heart muscle.
Myocarditis can affect people differently. Some may only need medication for a few months and fully recover, while others may have long-term damage to their heart and require lifelong medication. It’s important to have regular checkups after being diagnosed with myocarditis to look out for any possible complications.
Surgeries and procedures
You will require intensive therapy if you have severe myocarditis, which may involve:
- Intravenous medications. Medications administered through an IV are employed to rapidly enhance the heart’s pumping function.
- Ventricular Assist Device (VAD). A VAD aids in the movement of blood from the ventricles, the heart’s bottom chambers, to the rest of the body. It is used to treat heart failure or a weak heart. While the patient is awaiting other therapies, such as a heart transplant, a VAD may be utilized to keep the heart pumping.
- Intra-aortic balloon pump. This device aids in boosting blood flow and reducing heart stress. A thin tube (catheter) is inserted into a blood vessel in the leg by the heart specialist (cardiologist), who then directs it to the heart. The primary artery (aorta) leaving the heart and entering the body is where a balloon linked to the end of the catheter inflates and deflates.
- Extracorporeal Membrane Oxygenation (ECMO). An ECMO machine functions similarly to the lungs by eliminating carbon dioxide and introducing oxygen into the bloodstream. It can provide oxygen support to the body in cases of severe heart failure. The ECMO process involves extracting blood from the body, passing it through the machine for carbon dioxide removal and oxygenation, and subsequently returning it to the body. This technique can aid in heart recovery or serve as a temporary measure while awaiting alternative treatments like a heart transplant.
- Heart transplant. In cases of extremely severe myocarditis, an urgent heart transplant may be necessary. This procedure involves replacing the damaged heart with a healthy donor heart.
