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What Is Myocarditis And Its Complications?
 

Also known as viral heart disease, myocarditis is the inflammation of the heart muscle (myocardium), usually caused by viral infections. The inflammation of the heart muscle causes degeneration or death of heart muscle reducing heart's ability to pump. Certain viruses are known to cause myocarditis but the exact mechanism leading to the weakening of the heart muscle is still unknown. Approximately 400,000 people died of heart muscle disease (cardiomyopathy that includes myocarditis) worldwide in 2010, including 160,000 women and 240,000 men.

Myocarditis can result, in addition to viral infections, from other factors that include bacterial infections, Lyme disease, fungal disease, parasites, and toxoplasmosis, allergic reactions to certain medications, and exposure to certain chemicals. Systemic immune or inflammatory diseases, including lupus, sarcoidosis, inflammatory bowel disease, postpartum cardiomyopathy (myocarditis after delivering a baby), and Graves disease can cause myocarditis, too.

Symptoms caused by myocarditis can vary from extremely mild to extremely severe. The symptoms tend to correlate with how severe the inflammation present in the heart muscle. For most people, myocarditis often has no noticeable symptoms. In fact, they recover and never even know they had it. For others, they may have signs and symptoms including chest pain; shortness of breath during exercise at first, then at night while lying down; fatigue; light-headedness; signs of infection like fever, headache, sore throat, diarrhea, muscle aches, painful joints, swollen joints, legs or neck veins, small amounts of urine.

During acute myocarditis, heart arrhythmias can sometimes occur. These arrhythmias can be of any type, including both the bradycardias (slow heart rhythms) and tachycardias (rapid heart rhythms), such as atrial fibrillation and ventricular tachycardia. These arrhythmias usually will go away once the acute myocarditis resolves.
 

Patients who had myocarditis can mostly recover without complications, though in rare cases when inflammation is severe, myocarditis can lead to permanent heart damage, possibly causing heart failure, heart attack or stroke, sudden cardiac death. Between 0.5 and 3.5 percent of heart failure hospitalizations are due to myocarditis. Cases of myocarditis are mostly identified in young adults aged between 20 and 40. Men are generally more frequently affected than women, possibly due to effects of testosterone on the immune reaction to infection. Children can develop myocarditis and they might have signs and symptoms including fever, fainting, breathing difficulties, rapid breathing and rapid or abnormal heart rhythms.

To diagnose myocarditis, doctors need to gather clues from several sources, including the patient's symptoms and physical examination, the electrocardiogram (ECG), and several blood tests that include elevated cardiac enzymes, abnormal blood counts, abnormal rheumatologic screening tests, or viral blood tests. If symptoms of heart failure are present, an echocardiogram can be helpful in assessing the extent of heart muscle damage. Occasionally, a heart muscle biopsy is required to document the extent and type of inflammation present in the heart muscle. Myocardial biopsy is the removal of a small piece of heart muscle for examination, and it is a high-risk test.

How doctors treat myocarditis depends on both the severity and the cause. For instance, it is critical to treat an underlying infection with the appropriate antibiotics, to treat an underlying autoimmune disorder, or to remove the source of toxin exposure such as cocaine or alcohol. Medications such as ACE inhibitors, beta blockers, and diuretics are often used to help the heart work better. A period of rest or reduced activity for at least a few months is usually recommended during recovery. If heart failure is present, aggressive treatment for heart failure should be carried out immediately. In severe cases, an implantable cardiac defibrillator or heart transplant may even be recommended, though it is fairly rare.

There is apparently no specific prevention for myocarditis. But taking some steps to prevent infections might help. For example, avoid people who have a viral or flu-like illness until they have recovered, follow good hygiene, avoid risky behaviors like using illegal drugs, minimize exposure to ticks and get vaccines that protect against diseases like rubella and influenza that can cause myocarditis.
 

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