Overview of myocarditis
Myocarditis is a disease marked by the inflammation of the heart muscle known as the myocardium the muscular layer of the heart wall. This muscle is responsible for contracting and relaxing to pump blood in and out of the heart and to the rest of the body.
When this muscle becomes inflamed, its ability to pump blood becomes less effective. This causes problems like an abnormal heartbeat, chest pain, or trouble breathing. In extreme cases, it can cause blood clots leading to a heart attack or stroke, damage to the heart with heart failure, or death.
Normally, inflammation is a bodily response to any sort of wound or infection. Imagine when you cut your finger within a short time, the tissue around the cut swells up and turns red, which are classic signs of inflammation. The immune system in your body is producing special cells to rush to the site of the wound and implement repairs.
But sometimes another cause of inflammation or inflammation of the immune system can lead to myocarditis.
What are the symptoms of myocarditis?
The danger of myocarditis is that it can affect anyone, it can occur at any age, and it can continue without having any symptoms. If symptoms do develop, they are similar to symptoms experienced with the flu, namely:
- Shortness of breath
- Joint pain
- Lower extremity swelling
- Achy feeling in the chest
Most of the time, myocarditis goes away on its own without treatment, and the incision in your finger will eventually heal. Even in some cases that last a long time do not cause symptoms of sudden cardiac arrest.
But secretly, they can damage the heart muscle, where heart failure symptoms appear slowly over time. In other cases, the heart reveals its problems faster with symptoms such as chest pain, shortness of breath, palpitations and cardiac arrest.
What are the causes of myocarditis?
In most cases, the exact cause of myocarditis has not been found. When the cause of myocarditis is found, it is usually a viral infection (common) or an infection of the heart muscle that leads to a bacterial, parasitic, or fungal infection.
As the infection tries to take hold, the immune system fights back, trying to get rid of the disease. This results in an inflammatory response that may weaken heart muscle tissue. Some autoimmune diseases, like lupus (SLE), can cause the immune system to turn against the heart, resulting in inflammation and myocardial damage.
It’s often difficult to determine exactly what’s causing the myocarditis, but potential culprits include the following causes.
According to the Myocarditis Foundation, viruses are one of the most common causes of infective myocarditis. The most common viruses that cause myocarditis are group B coxsackievirus (an enterovirus), human herpesvirus 6, and parvovirus B19 (which causes the fifth disease).
Other possibilities include echovirus (which causes gastrointestinal infections), Epstein-Barr virus (which causes infectious mononucleosis), and rubella virus (which causes German measles).
Myocarditis can also be caused by infection with Staphylococcus aureus or Corynebacterium diphtheriae. Staphylococcus aureus is a bacterium that causes inflammation and is a strain resistant to methicillin (MRSA). Corynebacterium diphtheriae is a bacterium that causes diphtheria, destroying the tonsils and cells in the throat.
Yeast infections, moulds, and other fungi can sometimes cause myocarditis.
Parasites are microorganisms that are shed from organisms. They can also cause myocarditis. It is very rare in the United States, but more common in Central and South America (where the parasitic trypanosome causes a condition called Cruzi Chagas disease).
Myocarditis can sometimes be caused by autoimmune diseases that cause inflammation in other parts of the body, such as rheumatoid arthritis or SLE.
How is myocarditis diagnosed?
Though myocarditis can be difficult to diagnose, your doctor can use several tests to narrow down the source of your symptoms. These tests include:
- Blood test: to check for signs of infection or inflammation sources.
- Chest X-ray: to show chest anatomy and potential signs of heart failure.
- Electrocardiogram (ECG): to detect abnormal heart rates and rhythms that may indicate a damaged heart muscle.
- Echocardiogram (ultrasound imaging of the heart): to help detect structural or functional issues in the heart and adjacent vessels.
- Myocardial biopsy (sampling of heart muscle tissue): in some cases, may be performed during heart catheterization to allow the doctor to examine a small piece of muscular tissue from the heart.
In many cases, myocarditis improves on its own or with treatment, leading to a full recovery. Treatment for myocarditis focuses on the causes and symptoms of heart failure.
In mild cases, people should stay away from competitive sports for at least three to six months. You will need rest and medicine to help your body fight the infection that causes myocarditis. Although antiviral drugs are available, they are not effective in treating most cases of myocarditis.
Medicines that help your heart
If myocarditis causes heart failure or arrhythmia, your doctor may hospitalize you and prescribe medications or other treatments. For some abnormal heart rhythms or severe heart failure, you may be given medicine to reduce the risk of blood clots in the heart.
If your heart is weak, your doctor might prescribe medications to reduce your heart’s workload or help you eliminate excess fluid, including:
- Angiotensin-converting enzyme (ACE) inhibitors. These medications, such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil) and ramipril (Altace), relax the blood vessels in your heart and help blood flow more easily.
- Angiotensin II receptor blockers (ARBs). These medications, such as losartan (Cozaar) and valsartan (Diovan), relax the blood vessels in your heart and help blood flow more easily.
- Beta-blockers. Beta-blockers, such as metoprolol (Lopressor, Toprol-XL), bisoprolol and carvedilol (Coreg), work in multiple ways to treat heart failure and help control arrhythmias.
- These medications, such as furosemide (Lasix), relieve sodium and fluid retention.
Treatment for severe cases
In some severe cases of myocarditis, aggressive treatment may include:
- Intravenous (IV) medications. These might improve the heart-pumping function more quickly.
- Ventricular assist devices. Ventricular assist devices (VADs) are mechanical pumps that help pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. VADs are used in people who have weakened hearts or heart failure. This treatment may be used to allow the heart to recover 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 the leg and guide it to the heart using X-ray images. Doctors place the balloon attached to the end of the catheter into the body from the heart (aorta) into the main artery. When the balloon inflates and blooms, it helps increase blood flow and reduces the workload on the heart.
Lifestyle and home remedies
Relaxing and reducing the workload on your heart is an important part of recovery. Your doctor will tell you what kind of physical activity you can do during the months when your heart recovers and when you can resume your normal activities.
If you have a heart attack, it’s important to keep salt to a minimum, limit the number of fluids you drink, at least drink alcohol, and if anything, smoke. Your doctor will tell you how to take your fluid intake, as well as how much salt to include in your diet.
Acute myocarditis can permanently damage the heart muscle, which can be caused by:
- Heart failure. If left untreated, myocarditis can damage the heart muscle and prevent it from pumping blood effectively. In severe cases, heart failure related to myocarditis may require a ventricular assist device or a heart transplant.
- Heart attack or stroke. If your heart muscle is injured and cannot pump blood, the blood that has collected in your heart can clot. If a clot clogs one of your arteries, you have a heart attack. If the blood from your heart goes to the artery to the brain before it clots, you have a stroke.
- Fast or abnormal heart rhythms (arrhythmia). Damage to the heart muscle can lead to arrhythmia.
- Sudden cardiac death. Some serious arrhythmias can cause your heart to stop beating (sudden cardiac arrest). It can be fatal if not treated right away.
There’s no specific prevention for myocarditis. However, taking these steps to prevent infections might help:
- Avoid people who have a viral or flu-like illness until they’ve recovered. If you’re sick with viral symptoms, try to avoid exposing others.
- Follow good hygiene. Regular hand-washing can help prevent spreading illness.
- Minimize exposure to ticks. If you spend time in tick-infested areas, wear long-sleeved shirts and long pants to cover as much of your skin as possible.