What is myocarditis (heart muscle inflammation)?

In simple terms, myocarditis is a disease that causes inflammation of the heart muscle. This inflammation enlarges and weakens the heart, creating scar tissue and forcing the heart to work harder to circulate blood and oxygen throughout the body. You can find more information below.

What is myocarditis?

Myocarditis is an inflammation of the heart muscle. Myocarditis can affect your heart muscle and your heart’s electrical system, reducing your heart’s ability to pump and causing fast or abnormal heart rhythms (arrhythmias).

A viral infection usually causes myocarditis, but it can also be caused by a reaction to a drug or be part of a more general inflammatory condition. Symptoms include chest pain, fatigue, shortness of breath, and arrhythmias.

Severe myocarditis weakens your heart so the rest of your body doesn’t get enough blood. Clots can form in your heart, leading to a stroke or heart attack.

Treatment of heart muscle inflammation depends on the cause.

What causes myocarditis?

Often the cause of myocarditis cannot be determined. Although the possible causes are many, it is rare that these causes always trigger myocarditis. Possible causes include:

  • Viruses: Many viruses are commonly associated with myocarditis, including the viruses that cause the common cold (adenovirus). These include COVID-19, hepatitis B and C, parvovirus, which usually causes a mild rash in children, and herpes simplex virus. Gastrointestinal infections, mononucleosis, and rubella can also cause myocarditis. It is also common in people with HIV , the virus that triggers AIDS .
  • Bacteria: Numerous bacteria can cause myocarditis, including staphylococcus, streptococcus, diphtheria-causing bacteria, and the tick-borne bacteria responsible for Lyme disease.
  • Parasites: These include parasites such as Trypanosoma cruzi and toxoplasma, which are transmitted by insects and can cause a condition called Chagas disease. This disease is much more common in Central and South America. But it can also occur in travelers and immigrants from this part of the world.
  • Fungi: Yeast infections such as candida and other fungi such as histoplasm often found in bird droppings can sometimes cause myocarditis, especially in people with weakened immune systems.
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Inflammation of the heart muscle sometimes also occurs if you are exposed to:

  • Drugs or illegal drugs that can cause an allergic or toxic reaction: These include drugs used to treat cancer, antibiotics such as penicillin and sulfonamide drugs, some anti-seizure drugs, and some illegal substances.
  • Chemicals or radiation: Exposure to certain chemicals, such as carbon monoxide and radiation, can sometimes cause myocarditis.
  • Other diseases: These include disorders such as lupus disease , Wegener’s granulomatosis, giant cell arteritis, and Takayasu’s arteritis.

What are the symptoms of myocarditis?

If you have a mild case of myocarditis or are in the early stages, you may have symptoms such as chest pain or shortness of breath.

In severe cases, the symptoms of heart muscle inflammation vary depending on the cause of the disease. Common symptoms of myocarditis include:

  • chest pain
  • Fast or abnormal heart rhythms (arrhythmias)
  • Shortness of breath at rest or during physical activity
  • Swelling and fluid retention in your legs, ankles, and feet
  • Tiredness
  • Other signs of viral infection such as headache , body aches, joint pain, fever, sore throat, or diarrhea

Symptoms in children

When children develop myocarditis, they may have symptoms that include:

  • Fire
  • Fainting
  • difficulty breathing
  • rapid breathing
  • Fast or abnormal heart rhythms (arrhythmias)

When should you see a doctor?

You should contact your doctor if you have symptoms of heart muscle inflammation, especially chest pain and shortness of breath. If you have had an infection, you should be alert to the symptoms of myocarditis and notify your doctor if symptoms occur. If you have severe symptoms, you should go to the emergency room or seek emergency medical care.

How is myocarditis diagnosed?

Early detection is key to preventing long-term heart damage. After the physical exam, your doctor may order one or more tests to confirm that you have myocarditis and determine its severity. Tests may include:

  • Electrocardiogram (ECG): This noninvasive test shows the electrical patterns of your heart and can detect abnormal rhythms.
  • Chest X-ray: An X-ray image shows the size and shape of your heart, as well as whether there is fluid in or around the heart, which can indicate heart failure .
  • Magnetic resonance imaging (mammary): A cardiac MRI shows the size, shape, and structure of your heart. This test can show signs of heart muscle inflammation.
  • Echocardiogram: Sound waves create moving images of the beating heart. An echocardiogram can detect an enlarged heart, poor pumping function, valve problems, a clot in the heart, or fluid around your heart.
  • Blood tests: These measure the levels of certain enzymes in your heart muscle that indicate damage, as well as white and red blood cell counts. Blood tests can also detect antibodies to viruses and other organisms that may indicate an infection associated with heart muscle inflammation.
  • Cardiac catheterization and endomyocardial biopsy: A small tube (catheter) is inserted into a vein in your leg or neck and threaded into your heart. In some cases, doctors use a special instrument to remove a small sample of heart muscle tissue (biopsy) for analysis in the laboratory to check for inflammation or infection.
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How is myocarditis treated?

In most cases, myocarditis resolves on its own or with treatment and a full recovery is achieved. Myocarditis treatment focuses on the cause and symptoms, such as heart failure.

In mild cases, individuals should avoid competitive sports for at least three to six months. Rest and medication may be all you need to help your body fight the infection causing heart muscle inflammation. Although antiviral drugs are available, they have not proven effective in treating most cases of myocarditis.

Some rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis, respond to corticosteroids or other medications to suppress your immune system. In some cases caused by chronic diseases such as lupus, treatment is directed at the underlying disease.

Medicines to help your heart

If myocarditis is causing heart failure or arrhythmias, your doctor may put you in the hospital and order medications or other treatments. For certain abnormal heart rhythms or severe heart failure, you may be given medicines to reduce the risk of blood clots forming in your heart.

If your heart is weak, your doctor may prescribe medications to reduce your heart’s workload or help you eliminate excess fluid.

  • Angiotensin-converting enzyme inhibitors: These medications, such as enalapril, captopril, lisinopril, and ramipril, relax the blood vessels in your heart and help blood flow more easily.
  • Angiotensin 2 receptor blockers: These medications, such as losartan and valsartan, relax the blood vessels in your heart and help blood flow more easily.
  • Beta blockers: Beta blockers such as metoprolol, bisoprolol, and carvedilol work in several ways to treat heart failure and help control arrhythmias.
  • Diuretics: These drugs, such as furosemide, relieve sodium and fluid retention.

Remember, your doctor will decide which medicine to take and how.

treating severe cases

In some severe cases of myocarditis, aggressive treatment may include:

  • Intravenous medications: These can improve heart pumping function more quickly.
  • Ventricular assist devices: Ventricular assist devices (VADs) are mechanical pumps that help pump blood from your heart’s lower chambers (ventricles) to the rest of your body. VADs are used in people whose hearts are weakened or who have heart failure. This treatment can be used to allow the heart to heal or while waiting for other treatments, such as a heart transplant.
  • Intra-aortic balloon pump: Doctors insert a thin tube (catheter) into a blood vessel in your leg and guide it to your heart using X-ray imaging. Doctors place a balloon attached to the end of the catheter in the main artery leading from the heart to the body. As the balloon inflates and deflates, it helps increase blood flow and reduce the workload on the heart.
  • Extracorporeal membrane oxygenation (ECMO): In severe heart failure, this device can supply oxygen to the body. When blood is removed from the body, it passes through a special membrane in the ECMO machine that removes carbon dioxide and adds oxygen to the blood. The newly oxygenated blood is then returned to the body. The ECMO machine takes over the work of the heart. This treatment can be used to allow the heart to heal or while waiting for other treatments, such as a heart transplant.
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In the most severe cases of heart muscle inflammation, doctors may consider emergency heart transplant.

Some people may have chronic and irreversible damage to the heart muscle that requires lifelong medication, while others only need medication for a few months and then recover completely. In either case, your doctor will recommend regular follow-up appointments, including tests, to assess your condition.

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