What is myocarditis?
Cardiac muscle inflammation is known as myocarditis. The myocardium is the muscle layer within the heart wall. It is responsible for the contraction and relaxation of the heart to pump blood inside and outside the heart and the rest of the body.(1)
Once the inflammation occurs in that muscle, his capacity to pump blood becomes less efficient. This results in various problems such as abnormal heartbeat, chest pain, or difficulty breathing. In extreme cases, it may result in blood clots leading to a heart attack or stroke, cardiac injury with heart failure or death.
Generally, inflammation is a reaction of your body to any type of injury or infection. Imagine when you cut your finger in a little while, the fabric around the cut inflates and looks red, These are cardinal indications of inflammation. Your body’s immune system generates special cells to move around the wound site and begin repair.(2)
However, sometimes the immune system or other reason for inflammation causes myocarditis.
What causes myocarditis?
In many cases, the exact reason for myocarditis is uncertain. When the cause of myocarditis is found, it’s usually an infection that goes to the cardiac muscle, for example, viral infection (most commonly) or bacterial, parasitic or fungal infection.
As the infection attempts to trigger an effect, the immune system retaliates in an attempt to get rid of the disease. It leads to an inflammatory reaction that can weaken the heart muscle tissue. Certain autoimmune diseases, such as lupus (SLE), can cause the immune system to roll back against the heart, causing inflammation and injury to the myocardium.
Determining the exact cause of myocarditis is generally challenging, but some possible causes are:
As per the Myocarditis Foundation, viruses are among the most frequent causes of infectious myocarditis. The most commonly occurring viruses that may lead to myocarditis include Coxsackievirus group B (an enterovirus), Human Herpes Virus 6, and Parvovirus B19.
Other possible causes are echoviruses (known to cause infection of the digestive system), Epstein-Barr virus (leads to infectious mononucleosis) and Rubella virus (leads to German measles).
Myocarditis may also develop as a result of infection with Staphylococcus aureus or Corynebacterium diptheriae. Staphylococcus aureus is the bacterium which may lead to impetigo and be a methicillin-resistant strain (MRSA). Corynebacterium diptheriae is the bacterium responsible for diphtheria, an acute infection that infects tonsils and throat cells.
Yeast infections, moulds and other fungi may also result in myocarditis.
Parasites are micro-organisms, the survival of which depends on other organisms. They may cause myocarditis, too. It is uncommon in the US but more common in Central and South America (where the parasite Trypanosoma cruzi causes a disease known as Chagas disease).
Auto-immune diseases that induce inflammation in other parts of the body, like rheumatoid arthritis or SLE, may also occasionally lead to myocarditis.
What are the symptoms?
The threatening thing about myocarditis is that it can hurt everyone, happen at any age, and can grow without showing any symptoms. If symptoms appear, they are usually similar to what you may experience with influenza, such as:
- joint pain
- breathlessness or dyspnea
- swelling in lower extremities
- feeling of pain in the chest
Several times, myocarditis can resolve itself without any therapy, just as a cut on the finger gradually recovers. Even long-lasting cases can never result in sudden symptoms of heart failure.
But, in private, they can cause damage to the heart muscle where symptoms of heart failure appear progressively over time. In other cases, the heart can show his fights earlier, with symptoms such as chest pain, breathlessness, heart palpitations and heart failure.
How is it diagnosed?
Although myocarditis may not be easily diagnosed, Your physician may use a variety of tests to reduce the source of your symptoms. Such tests include:
- blood testing: check if there are any signs of infection or sources of inflammation.
- chest X-ray: to show chest anatomy and potential signs of cardiac insufficiency.
- electrocardiogram (ECG): Identify abnormal heart rates and rhythms that may be indicative of damage to the heart muscle.
- echocardiogram (ultrasound imaging of the heart): assist in identifying structural or functional issues in the core and adjacent vessels.
- myocardial biopsy (sampling of heart muscle tissue): in some cases, may be done during a cardiac catheterization to allow the doctor to inspect a small piece of heart muscle tissue.
Complications related to myocarditis.
Myocarditis may cause serious cardiac damage. The body’s immune response, because of a virus or another infection leading to myocarditis, may cause significant damage such as some chemicals or autoimmune diseases which may cause myocarditis. It may result in heart failure and ultimately death. These cases are rare, as most patients with myocarditis recover and re-enter healthy cardiac activity.
Other complications are heart rate or rhythm issues, a heart attack and a stroke. In a very small number of cases, immediate cardiac transplantation may be required.
Myocarditis also occurs with sudden death, with up to 9 per cent of adult revealing cardiac muscle inflammation. This figure rises to 12% for autopsies of young adults showing inflammation of the heart muscle.
What is the treatment for myocarditis?
Myocarditis can be treated by:
- corticosteroids treatment (to help reduce inflammation)
- cardiac medicines, such as beta blockers, ACE inhibitors, or ARB.
- behavioural changes, such as resting, fluid restriction and a salt-poor diet.
- diuretic treatment to deal with fluid overload.
- antibiotic therapy
Treatment is determined by the source and severity of myocardial inflammation. In many cases, this gets better with the appropriate steps, and you will completely recover.
Nearly all these treatments work to relieve the workload on the heart so that it can heal itself.
If your myocarditis continues, your physician may recommend corticosteroid medication to help reduce inflammation. They are also likely to recommend rest, fluid restriction and a salt-poor diet. Antibiotherapy can help treat the infection if you suffer from bacterial myocarditis. Diuretic treatment may be recommended for the removal of excess fluid from the body. Your physician may also prescribe medicines that help the heart function normally.
If the heart fails, other more invasive procedures can be carried out in the hospital. The implementation of pacemakers and/or defibrillators may be essential. If the heart is severely damaged, doctors may recommend a heart transplant.
Can it be prevented?
There are no measures for definitely preventing myocarditis, but avoiding serious infections can help. Some of the recommended ways in which this can be achieved are:
- having sex safely.
- Monitor the date of immunizations correctly.
- proper hygiene
- avoiding ticks
The outlook for myocarditis is mostly positive. The probability of recurrence is estimated at approximately 10 to 15 per cent, according to the Myocarditis Foundation. Most myocarditis sufferers heal and have no long-term negative effects on their heart.
We still have a lot to study on myocarditis. The doctors believe that myocarditis is not hereditary and found no specific gene for it.