Myocarditis

Myocarditis is an inflammation of the heart muscle, myocardium. Although, myocarditis is uncommon, it is estimated that five to 20 percent of sudden deaths in young adults are due to myocarditis. Your heart wall consists of three layers: epicardium (outer layer), myocardium (middle layer), and endocardium (inner layer).

Myocarditis is mostly due to an infection by the viruses, toxins, and physical agents. The disease can affect your heart’s ability to pump the blood and leads to irregular heart rhythm. It can affect anyone and may occur at any age.

The exact cause of myocarditis is unknown. However, many triggering factors lead to myocarditis which includes:

  • Viruses: The viruses, such as coxsackievirus B, adenovirus, parvovirus B19, and herpes simplex virus may cause inflammation to the heart muscle. The conditions caused by the viruses such as echoviruses (gastrointestinal infections), Epstein-Barr virus (mononucleosis) and rubella (German measles) also lead to myocarditis.
  • Bacteria: The bacteria such as staphylococcus, streptococcus, and the tick-borne bacterium can cause myocarditis.
  • Parasites: Trypanosoma cruzi and toxoplasma are the parasites that may cause myocarditis.
  • Fungi: The infections caused by candida, aspergillus, and histoplasma also lead to myocarditis.

Other causes of myocarditis include:

  • Toxic substances: Medications such as antibiotics (penicillin and sulfonamide drugs), antiepileptics, and some illegal substances (cocaine) might cause a toxic reaction and lead to myocarditis.
  • Physical agents: Exposure to chemicals such as carbon monoxide and radiation can cause myocarditis.
  • Immunologic conditions: The immune system disorders such as lupus, giant cell arteritis, Wegener's granulomatosis, and Takayasu's arteritis may also lead to myocarditis.

In the early stages, myocarditis may not cause any noticeable symptoms. The signs and symptoms may vary in severe cases and include the following:

  • Severe chest pain
  • Abnormal heart rhythms (arrhythmias)
  • Shortness of breath, both at rest and while performing physical activity
  • Fluid retention that causes your legs, ankles, and feet to swell
  • Fatigue

The signs and symptoms of viral infection include a headache, body aches, joint pain, high body temperature, a sore throat or diarrhea.

Complications

Myocarditis can be severe and leads to the complications such as heart failure, heart attack or stroke, abnormal heart rhythms, sudden death.

Your doctor starts the diagnosis by performing a thorough physical examination and checks your medical history. The doctor would order any of the following tests to confirm the diagnosis.

  • Electrocardiogram: The test is used to detect the abnormal rhythms of your heart and also identifies damaged heart muscle.
  • Imaging studies: A chest X-ray or magnetic resonance imaging is suggested by your doctor to obtain a detailed view of your heart size, shape, and structure.
  • Echocardiogram: The test creates the moving images of your beating heart and detects the abnormal rhythms.
  • Endomyocardial biopsy: A small piece of your heart muscle is removed and examined under the microscope.

The treatment of the myocarditis depends on the underlying cause and severity. Usually, in mild cases, your doctor might recommend taking rest and prescribes certain medications to heal your heart. Antibiotics are prescribed if the myocarditis is due to bacteria.. Corticosteroids and immunosuppressant drugs would be helpful if the cause of myocarditis is any immunologic condition.

To eliminate excess fluids and reduce the cardiac workload, your doctor would prescribe any of the following medications:

  • Angiotensin-converting enzyme inhibitors, such as enalapril and captopril
  • Angiotensin II receptor blockers (ARBs, such as losartan and valsartan
  • Beta blockers, such as metoprolol and bisoprolol
  • Diuretics, such as furosemide

In severe cases, your doctor would prefer aggressive treatment which includes:

  • Administration of intravenous medications
  • Use of ventricular assist devices
  • Performing intra-aortic balloon pump
  • Use of extracorporeal membrane oxygenation
  • It is helpful for you to follow the below simple tips to reduce your risk of developing myocarditis,Maintain good hygiene
  • Reduce exposure to ticks
  • Get vaccinated as recommended
  • Avoid contact with the infected individuals
  • Consume low-salt diet
  • Avoid alcohol intake and smoking
  • Perform regular physical activity