Myocarditis: Symptoms, Causes and Treatment

Overview

What is Myocarditis?

Myocarditis is a condition characterized by inflammation of the heart muscle known as myocardium, which affects its ability to pump blood effectively. It can range from mild to severe and may cause long-term complications if left untreated. This article will go through the signs, causes, risk variables, diagnosis, prevention, management, consequences, and prognosis of myocarditis.

Symptoms

Symptoms of Myocarditis

The symptoms of myocarditis can vary widely and some common symptoms may include:

• Chest pain
• Fever
• Shortness of breath
• Body aches
• Abdominal pain
• Sore throat
• Headache
• Fatigue
• Palpitations
• Irregular heartbeat
• Lightheadedness
• Swelling of legs, ankles, and feet ¹Symptoms| Researched based study from Bhf.org

Chest pain from myocarditis might feel like a heart attack, ranging from mild pain to severe crushing. Anyone suffering from shortness of breath and inexplicable chest pain should consult with a doctor right away.

Types

Types of Myocarditis

There are many types of myocarditis and may include:

• Acute
• Subacute
• Chronic

Acute myocarditis

• Symptoms may appear suddenly and last for a maximum of two weeks.
• Most myocarditis cases are acute and are caused by a viral infection.²Types| Researched based study from Nlm.nih.gov

Subacute myocarditis

• Ongoing myocardial injury by persistent or recurring cardiac inflammatory stimuli.
• If there is evidence of previous active myocarditis, it can instead be described as healing myocarditis.³Types| Researched based study from Nlm.nih.gov

Chronic myocarditis

• It occurs when the disease lasts longer than two weeks and takes more time to treat than usual.⁴Types| Researched based study from Nlm.nih.gov
• It happens due to inflammatory problems, including autoimmune disorders, in which the body’s immune system destroys healthy cells and tissue.

Causes

Causes of Myocarditis

The exact cause of myocarditis is unknown, however, when the cause is identified, it is usually linked to infections. Any of the following can cause myocarditis:

• Viral infections
• Bacterial infections
• Fungal infections
• Parasites
• Protozoans
• Autoimmune disorders
• Medicines
• Toxins
• Other diseases

Viral infections

• Various viruses, including the common cold adenovirus, HIV, herpes simplex virus, COVID-19, Coxsackievirus, Epstein-Barr virus, and hepatitis B and C virus, can cause myocarditis.
• Symptoms of viral myocarditis include fever, headache, joint pain, muscle aches, vomiting, sore throat, and diarrhea.⁵Causes| Researched based study from Pennmedicine.org

Bacterial infections

• Myocarditis can be caused by bacteria such as Legionella, salmonella, staphylococci, clostridium, TB, shigella, and streptococci, among others²Causes| Researched based study from Nlm.nih.gov

Fungal infections

• Myocarditis can be caused by a fungal infection, especially in people with weaker immune systems.
• Yeast infections such as candida, Aspergillus and Histoplasma, have all been related to myocarditis.

Parasites

• Myocarditis can be caused by trichinosis, schistosomiasis, Taenia solium, and Echinococcus granulosus.

Protozoans

• Trypanosoma cruzi causing Chagas disease; Toxoplasmosis gondii and Entamoeba histolytica, frequently causing acute pericarditis; and Leishmania can all cause myocarditis.⁶Causes| Researched based study from Nlm.nih.gov

Autoimmune disorders

• Causing myocarditis may include infection-negative lymphocytic myocarditis and giant cell myocarditis.
• Other autoimmune syndromes associated with myocarditis may include Rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, celiac disease, type I diabetes, and myasthenia gravis.⁶Causes| Researched based study from Nlm.nih.gov

Medicines

• Like sulfonamides, cephalosporins, penicillin, isoniazid, digoxin, tricyclic antidepressants, methyl dopa, phenylbutazone, thiazide, phenytoin, etc., may cause hypersensitivity reactions in some individuals, causing myocarditis.

Vaccinations

• Toxoids or vaccinations cause a serum sickness-like reaction.
• For example – Myocarditis was found in male adolescents and young adults within seven days of receiving mRNA COVID-19 vaccination.⁷Causes| Researched based study from Cdc.gov

Toxins, radiations, pollutants

• Toxicity from heavy metals such as copper, iron, and lead can cause myocarditis.
• Carbon monoxide with radiation exposure.

Other diseases

• Certain illnesses, such as sarcoidosis or giant cell myocarditis, can also cause myocarditis.

Risk factors

Risk factors

While myocarditis affects anyone, a number of factors may enhance a person’s chances of having it:

• Family history – Individuals with myocarditis or other heart conditions running in their families may have an increased risk.
• Age – People of all ages can get myocarditis; however, young adults are more prone to it.
• Gender – males are at an increased chance of developing myocarditis.
• Viral infections – Recent viral illnesses, particularly respiratory or gastrointestinal infections, can increase the risk.
• Exposure to toxins – Regular exposure to toxins such as alcohol or illicit drugs can contribute to myocarditis.⁸Risk| Researched based study from Clevelandclinic.org
• Immune system disorders – People with weakened immune systems or autoimmune diseases are more susceptible to myocarditis.
• Health conditions – like eating disorders, Diabetes, HIV, etc.
• Medical treatments include Radiation therapy, dialysis, Intravenous (IV) line, and implanted heart devices.⁸Risk| Researched based study from Clevelandclinic.org

Diagnosis

Myocarditis Diagnosis

Myocarditis is normally diagnosed with the help of a medical history, physical examination, and few tests, including:

• Blood tests – to identify markers of inflammation and detect viral or bacterial infections.
• Chest X-ray – displays the size and form of the heart and lungs and whether there is fluid within or around the heart, which could indicate heart failure.⁹Diagnosis| Researched based study from Mayoclinic.org
• Electrocardiogram (ECG) – helps detect abnormal rhythms or changes in heart function.
• Echocardiogram provides detailed images of the heart, assessing its structure, function, and abnormalities.
• Cardiac MRI (Magnetic resonance imaging) – can reveal inflammation and abnormalities in the heart muscle.
• Endomyocardial biopsy – the doctor may take a small sample of the tissue from the heart for analysis in a laboratory.¹⁰Diagnosis| Researched based study from Nlm.nih.gov

Treatment

Myocarditis treatment may involve the following:

• Medications – like corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), and diuretics may be given to reduce inflammation, manage symptoms like pain, and reduce fluid accumulation in the feet or ankles.¹¹Treatment| Researched based study from Hopkinsmedicine.org
• Immune therapies – Immunosuppressive drugs or intravenous immunoglobulin (IVIG) may be given to some people to control the immune response and reduce inflammation.
• Supportive care – Rest, fluid management, and monitoring of heart function are essential components of supportive care for individuals with myocarditis.
• Treatment of complications – If problems such as heart failure or arrhythmias develop, additional therapies like drugs, implanted devices, or surgical interventions may be necessary.

Treatment may vary according to each person’s condition. For continuous maintenance and to evaluate the effectiveness of therapy, routine follow-up visits and tracking heart function are essential.

Prevention

Preventing Myocarditis

Myocarditis cannot be prevented as the exact cause is unknown. ¹²Prevention| Researched based study from Myocarditisfoundation.org However, specific prevention measures for myocarditis may decrease a person’s risk by removing the causative factors and may include:

• Vaccinations – Ensuring up-to-date vaccinations, particularly against viral infections such as diphtheria, influenza and hepatitis.¹³Prevention| Researched based study from Harvard.edu
• Hygiene practices – Regular handwashing and maintaining good personal hygiene can decrease the chance of getting viral infections.
• Avoiding exposure to toxins – Minimizing exposure to substances that can harm the heart, such as excessive alcohol or illicit drugs.
• Avoiding unprotected sex – can help reduce the risk of getting myocarditis associated with HIV or hepatitis.

Complications

Complications

Myocarditis may lead to the following complications:

• Cardiomyopathy
• Abnormal heart rhythm ¹⁴Complications| Researched based study from Medlineplus.gov
• Pericarditis
• Cardiogenic shock
• Lung problems
• Heart failure
• Sudden cardiac death ²Complications| Researched based study from Nlm.nih.gov

Prognosis

Prognosis of Myocarditis

Myocarditis’ prognosis is influenced by several variables, such as how severe the inflammation is, how quickly it is identified, and how well it is treated. In moderate cases, relaxation and supportive care may be sufficient to resolve the illness. However, in more severe situations, the prognosis can be altered by the development of comorbidities and the extent of cardiac damage. It may necessitate continued therapy or even a heart transplant.