Myocarditis

Everything You Need To Know About Myocarditis

Overview

What is Myocarditis?

Myocarditis is a condition characterized by inflammation of the myocardium (heart muscle), resulting in hampering the ability of the heart to pump blood. The condition is known to cause symptoms such as shortness of breath, chest pain, and rapid/irregular heart rhythms (known as arrhythmias).

Myocarditis is primarily caused by a viral infection. In some cases, it may be a reaction to a drug or a general inflammatory condition. A severe type of myocarditis tends to weaken the heart making it incapable of transporting blood to the rest of the body. Sometimes the condition may cause clots in the heart, resulting in a stroke or heart attack.

Treatment options for myocarditis may include surgeries or medications.

Stages and Types of Myocarditis

Types of Myocarditis

The condition can be categorized into several types. These include:

  1. Possible Subclinical Acute Myocarditis: The condition occurs without specific symptoms. It is characterized by a temporary increase in troponin or ECG after an acute viral illness, vaccination (rare), or adverse drug reaction.
  2. Probable Acute Myocarditis: The condition is diagnosed by one of four clinical syndromes consistent with myocarditis, such as chest pain, acute heart failure, Myopericarditis, and Presyncope or syncope.
  3. Definite Myocarditis: It is diagnosed with long-established histological analysis of the heart tissue by investigating a heart specimen under a microscope for the presence of specific inflammatory cells in the heart.
  4. Myocarditis Resembling a Heart Attack: The condition is characterized by chest pain due to inflammation of the blood vessels supplying the heart. The pain gets worse with leaning backward and better with leaning forward.
  5. Myocarditis Resembling Acute or Chronic Heart Failure: Some patients with myocarditis may cause symptoms such as fatigue, shortness of breath, and inability to endure exercise. Usually, these patients have enlarged hearts and show symptoms that occur for about two weeks to a few months due to infections of the gastro intestine or upper respiratory portion. Patients may suffer from a chronic form of the condition, which leads to an attack on the heart by the body's immune system.

Symptoms of Myocarditis

Some individuals with early myocarditis may not show any symptoms, while others may show mild symptoms depending on the severity of the condition. The most common symptoms of myocarditis include:

  • Fatigue
  • Chest pain
  • Shortness of breath (while at rest or during activity)
  • Swelling of the legs, ankles, and feet
  • Light-headedness
  • Dizziness
  • Flu-like symptoms such as fever, headache, joint pain, body aches, or sore throat
  • Rapid or irregular heartbeat (arrhythmias)
  • A feeling like you might faint

Occasionally, symptoms of myocarditis may feel like a heart attack. Hence, if you experience unexplained chest pain and shortness of breath, do not delay seeking emergency medical help.

Causes of Myocarditis

Certain drugs, inflammatory conditions, infections, and chemicals may cause the condition. Sometimes, it is difficult to determine the cause of myocarditis. Some of the potential causes of myocarditis include:

Viruses: Many viruses are linked to myocarditis. These include those causing the common cold (adenovirus), hepatitis B, COVID-19, parvovirus, and herpes simplex virus.

Infections: Myocarditis may be caused by gastrointestinal infections, German measles, and mononucleosis. Myocarditis can also be caused by HIV, the virus that causes AIDS.

Bacteria: Bacteria such as streptococcus and staphylococcus can cause myocarditis. Bacteria causing diphtheria and Lyme disease may also cause the condition.

Parasites: Trypanosoma cruzi, Toxoplasma, and parasites transmitted by insects may cause myocarditis.

Fungi: Sometimes, a fungal infection may cause myocarditis. It is more common among people with weak immune systems. Yeast infections (candida), molds (aspergillus), and bird droppings may cause this condition.

Drugs: Certain medications and illegal drugs may cause myocarditis. Medicines that treat cancer, anti-seizure medications, and antibiotics are also responsible for causing myocarditis.

Chemicals and Radiation: Inflammation of heart muscle may be caused due to exposure to carbon monoxide and radiation.

Inflammatory Conditions: Some conditions, such as Takayasu's arteritis, lupus, giant cell arteritis, and Wegener's granulomatosis, may cause myocarditis.

Prevention of Myocarditis

Myocarditis cannot be prevented. However, following the steps listed below can help prevent infections:

  • Keep a distance from individuals with symptoms of the flu or other respiratory illness until they fully recover.
  • Wash your hands frequently to avoid getting sick and spreading illness.
  • Avoid risky behaviors such as unsafe sex and using illegal drugs to minimize chances of getting an HIV-related myocardial infection.
  • Get recommended vaccines.

Frequently Asked Questions

Myocarditis is a rare condition. However, the most common cause of this condition is an infection in the body. Myocardial inflammation results from infections from viruses (common cold, COVID-19, influenza), parasites, bacteria, or fungi.

Myocarditis is known to be the primary cause of about 5-10% of sudden cardiac deaths in athletes. It is also a common cause of up to 20% of deaths in military recruits. These cases suggest that exercise may be a significant trigger for sudden death with myocarditis. Several clinical observations suggest a strong link between high-intensity physical exercise and myocarditis.

Complete recovery depends on the severity of the disease and other factors, such as fluid retention around the heart, electrical abnormalities, and heart function. It usually takes around 4-6 weeks.

If left untreated, myocarditis can severely damage the heart muscle, causing difficulty pumping blood. Severe myocarditis-related heart failure is treated with a ventricular assist device or, sometimes, a heart transplant.

The most common and serious complications caused by myocarditis include CHF, ventricular dysrhythmias, dilated cardiomyopathy and left ventricular aneurysm. Studies have revealed that the mortality rate is 20 percent in 1 year. In 5 years, it will be 50%.

Most cases of myocarditis can be resolved on their own. Other cases take several months after the patient receives treatment. The condition may even recur, causing symptoms of inflammation, including shortness of breath, chest pain, etc.

Some medical recommendations for treating myocarditis include rest from exercise (3-4 months) and frequent testing to determine normal cardiac function.

Yes. After treatment, many patients live happy, healthy life. Some patients may need regular cardiovascular medication under the guidance of a specialist or even a heart transplant depending on the severity of the condition.

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