Myocarditis

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.