What is myocarditis?
Myocarditis is inflammation of the heart muscle (myocardium). The inflammation of the heart muscle causes degeneration or death of heart muscle cells. Myocarditis has many different causes and can result in a range of outcomes from mild (presenting briefly and resolving) to rapidly progressing fatal diseases. Myocarditis is differentiated from pericarditis because pericarditis is inflammation of the sac that surrounds the heart and does not involve heart muscle as myocarditis does. However, it is not unusual to have a patient present with both pericarditis and myocarditis.
There are many different types of myocarditis and a wide range of possible agents that can trigger the disease. Examples include:
- Viral: Coxsackie B virus, enterovirus, adenovirus, influenza, and many others
- Bacterial: Streptococci, meningococci, clostridia, Corynebacterium, mycobacteria, and many others
- Fungal and parasites: Candida, aspergillosis, Cryptococcus, schistosomes, filaria, malaria, toxoplasma, and many others
- Lymphocytic: Heart muscle infiltrated with lymphocytes
- Eosinophilic: Heart muscle infiltrated with eosinophils
- Autoimmune: Caused by autoimmune diseases, such as lupus
- Fulminant: Inflammatory process in the heart muscle that leads to acute severe heart failure
- Idiopathic: Inflammatory process in the heart muscle with no known cause
- Acute: Symptoms appear rapidly and usually decrease after a week or two
- Chronic: Slow appearance of symptoms that last greater than two weeks
What causes myocarditis?
The causative agents that damage the myocardium includes the following:
- Cytotoxic effects of infecting agents like viruses, bacteria fungi, and/or parasites
- Immune response triggered by infecting agents and cytokines produced in the myocardium in response to infection or inflammation
- Chemicals released during myocardial cell death
- Autoimmune responses can also trigger myocardial inflammation
- Some medications and/or toxins such as clozapine, radiation therapy, arsenic, carbon monoxide, and many others
- Certain diseases like lupus, Wegener's granulomatosis, and others
About half of the time, the triggering agent for myocardial inflammation is not known (idiopathic). This is especially true in the pediatric population where the majority of patients are diagnosed with idiopathic myocarditis.
What are symptoms of myocarditis?
Myocarditis can be mild and cause virtually no noticeable symptoms. The most frequent symptom of myocarditis is pain in the chest. Other symptoms are related to the underlying triggering cause, like infection or an autoimmune disorder. The following is a list of symptoms and signs of myocarditis:
- Chest pain or chest discomfort
- Shortness of breath
- Swelling and/or edema
- Liver congestion
- Abnormal heartbeat (palpitations)
- Sudden death (in young adults)
- Fever (usually associated with an infectious process)
Myocarditis in children and infants has more nonspecific symptoms:
- Malaise
- Poor appetite
- Abdominal pain
- Chronic cough
- Increasing difficulty breathing
- Fever
- Rash
- Diarrhea
- Joint pains
SLIDESHOW
Muscle Cramps (Charley Horse) and Muscle Spasms See SlideshowHow is myocarditis diagnosed?
Myocarditis is preliminarily diagnosed by detecting signs of irritation of heart muscle during the patient's history and physical exam.
- Blood tests for heart muscle enzymes (CPK levels) can be elevated.
- Electrical testing (EKG) can suggest irritation of heart muscle and document irregular beating of the heart.
- Nuclear heart scan testing can show irregular areas of the heart muscle.
- Other tests to help definitively diagnose myocarditis include chest X-rays to determine the size and shape of the heart, MRI, and echocardiogram.
- Sometimes cardiac catheterization with heart muscle biopsy (endomyocardial biopsy) may be done to determine the likely underlying cause for the disease definitively.
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What is the treatment for myocarditis?
Often, myocarditis improves on its own without treatment with complete recovery. Sometimes, treatment of the underlying cause (such as bacterial infections) can lead to full recovery (for example, after antibiotics). Consequently, the diagnosis of the precise underlying cause of myocarditis can help optimal treatment.
However, in patients with more prolonged or more severe cases of myocarditis, individuals may need more specific medications or even hospitalization. Medications to reduce the heart's workload and/or reduce edema are commonly used to treat symptoms of myocarditis. They may include the following:
- Enalapril(Vasotec)
- Captopril (Capoten)
- Lisinopril (Zestril, Prinivil)
- Ramipril (Altace)
- Metoprolol (Lopressor)
- Carvedilol (Coreg)
- Furosemide (Lasix)
Individuals with severe symptoms of myocarditis (heart failure, acute shortness of breath) may require other treatments such as IV medications and/or vascular assist devices (pumps that help a weak heart pump) or extracorporeal membrane oxygenation (ECMO) to help provide oxygen to the blood. Occasionally, patients may require a heart transplant. Individuals who develop very irregular heartbeats (arrhythmias) may need an implanted pacemaker.
What is the prognosis (outlook) for patients with myocarditis?
The prognosis for patients with acute myocarditis who rapidly recover is very good. Even patients that develop severe myocarditis can completely recover with mild or no complications. However, if damage to the heart muscle becomes chronic and/or progressive, the prognosis for the patient declines. Those who develop severely weakened heart muscle cardiomyopathy have a poorer prognosis.
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Tang, W. H. W., et al. "Myocarditis." Medscape. 5 Sept. 2014.
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Chest X-Ray
Chest X-Ray is a type of X-Ray commonly used to detect abnormalities in the lungs. A chest X-ray can also detect some abnormalities in the heart, aorta, and the bones of the thoracic area. A chest X-ray can be used to define abnormalities of the lungs such as excessive fluid (fluid overload or pulmonary edema), fluid around the lung (pleural effusion), pneumonia, bronchitis, asthma, cysts, and cancers.
Congestive Heart Failure (CHF): Symptoms, Causes, Stages, Treatment
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
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Coronary heart disease or coronary artery disease (CAD) screening tests can be used to potentially prevent a heart attack or cardiac event in a person without heart disease symptoms, and can assist in diagnosing heart disease in individuals with heart disease symptoms. Coronary heart disease tests can include electrocardiogram (ECC, EKG), exercise stress test, radionuclide stress test, stress echocardiography, pharmacologic stress test, CT coronary angiogram, and coronary angiogram.
Diarrhea
Diarrhea is a change in the frequency and looseness of bowel movements. Symptoms associated with diarrhea are cramping, abdominal pain, and the sensation of rectal urgency. Causes of diarrhea include viral, bacterial, or parasite infection, gastroenteritis, food poisoning, and drugs. Absorbents and anti-motility medications are used to treat diarrhea.
Echocardiogram (Echocardiography, Diagnostic Cardiac Ultrasound)
Echocardiogram is a test using ultrasound to provide pictures of the heart's valves and chambers. There are several types of echocardiograms, for example, transthoracic echocardiogram, transesophageal echocardiogram (TEE), stress echocardiogram, dobutamine or adenosine/sestamibi stress echocardiogram, and and intravascular ultrasound.
Electrocardiogram (ECG or EKG)
An electrocardiogram is known by the acronyms "ECG" or "EKG" more commonly used for this noninvasive procedure to record the electrical activity of the heart. An EKG generally is performed as part of a routine physical exam, part of a cardiac exercise stress test, or part of the evaluation of symptoms. Symptoms evaluated include palpitations, fainting, shortness of breath, dizziness, fainting, or chest pain.
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Low Blood Pressure (Hypotension)
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, and fainting if not enough blood is getting to the brain. Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
MRI (Magnetic Resonance Imaging Scan)
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Skin Rash
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Upper Respiratory Infection (URI)
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barr. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infections are based upon the cause. Generally, viral infections are treated symptomatically with over-the-counter (OTC) medication and home remedies.