Myocarditis

An inflammation of the myocardium, the middle layer of the heart wall is called myocarditis. It can both affect the heart’s electrical system and the heart’s muscle that will lead to irregular heart rhythms and to reduction in the heart’s pumping function. A viral infection is the cause of myocarditis.

Some of the signs and symptoms of myocarditis are:

• abnormal heart rhythms,
• fatigue,
• chest pain,
• heart failure.

Severe myocarditis weakens the pumping action of your heart so the heart will not be able to supply enough blood.

Heart attack and stroke might happen because of clots.

Myocarditis treatment depends upon the cause of your myocarditis.

There are no signs and symptoms if it is a mild myocarditis, however, in severe myocarditis the signs and symptoms vary depending on the cause. 

Symptoms of myocarditis include:

• rapid or abnormal heart rhythms or arrhythmias,
• fatigue; chest pain,
• fluid retention with swelling of your legs, ankles and feet’ shortness of breath,
• other symptoms with viral infection such as body aches, headache, fever, joint pain, diarrhea, sore throat. 

Symptoms of myocarditis in children include: 

• rapid or abnormal heart rhythms or arrhythmias,
• fever,
• breathing difficulties,
• fainting,
• rapid breathing.

If you have chest pain or shortness of breath, contact your doctor as soon as possible or if it is severe go to emergency room and seek medical attention.

The cause of myocarditis isn’t clearly identified but some possible causes include:

• viruses such asparvovirus B19 that causes a rash called fifth disease,
• viruses that cause the common cold or adenovirus,
• herpes simples virus,
• coxsackievirus B that has similar symptoms of mild case of flu,
• mononucleosis or Epstein-Barr virus,
• German measles or rubella,
• Gastrointestinal infections or echoviruses. 
• Also common with people who have HIV the virus that causes AIDS,
• bacteria such as streptococcus that causes the tick-borne bacterium responsible for Lyme disease and diphtheria, staphylococcus,
• parasites such as toxoplasma, trypanosome, and parasites that are transmitted by insects that causes Chagas disease which is can occur in travelers and immigrants from parts of the world but more prevalent in Central and South America than in the United States; 
• Fungi such as yeast infection or candida, molds or aspergillus and other fungi like histoplasma found in bird droppings,
• if you are exposed to medications that can cause allergic or toxic reaction such as penicillin, sulfonamide drugs, anti-seizure medications, cocaine,
• chemical like carbon monoxide,
• radiation,
• other diseases such as Takayasu’s arteritis, Wegener’s granulomatosis, giant cell arteritis and lupus.

To diagnose myocarditis, your doctor may conduct a physical examination, and discuss your medical history and any signs or symptoms you may have.

Contact your doctor as soon as possible if you are experiencing these symptoms. He may refer you to a cardiologist that specializes in heart conditions and a doctor who is trained for infectious diseases. 

Bring a family member or close friend. Bring a notebook. Write down the symptoms you are experiencing and how often do you experience them, all the medications, supplements and vitamins that you are taking. You can also list down the previous illness that you have. Write down your recent travel, where and when it is.

You can ask your doctor some of these basic questions regarding myocarditis:

• What is causing my symptoms? Are there other causes?
• What tests do I need?
• Does it need preparation?
• What are the possible treatments?
• Do they have side effects?
• What are the possible complications?
• What are the restrictions I need?

Your doctor will likely ask you some questions such as:

• When did you first experience the symptoms?
• Have you become ill recently?
• When was your last travel?
• What improves your symptoms?
• What worsens them? 

Your doctor might recommend some tests to confirm the diagnosis of myocarditis and how severe it id. 

Some of the tests include: 

• chest X-ray that allows to check the shape and size of your heart and to look for fluid around your heart that may indicate heart failure; 
• electrocardiogram or ECG that will show electrical patterns in your heart, can detect abnormal rhythms and damaged heart muscles; 
• echocardiogram to detect enlargement of the heart, valve problems, fluid in your heart and poor pumping function; 
• MRI to show your heart’s shape, size and structure, and can show signs of inflammation of the heart muscle; 
• blood test to measure the red and white blood cell counts and the level of certain enzymes as well as  to detect antibodies against viruses; 
• cardiac catheterization and endomyocardial biopsy to look for signs of inflammation and infection, this is done by inserting a catheter into the vein in your leg or neck and threaded into your heart.

Some cases of myocarditis improve with or without treatment and leads to full recovery.

The treatment of myocarditis include:

• total rest and medications to fight body infections,
• antibiotics if you have bacteria.

Giant cell and eosinophilic myocarditis respond well to corticosteroid or other medication to suppress the immune system response. In lupus, the treatment is directed at the underlying disease.

If you have a heart failure or irregular heartbeats, you might be hospitalized. If you have arrhythmia, drugs will be recommended to regulate heartbeat and to reduce the risk of blood clots that can form in your heart. 

Your doctor might prescribe medication to reduce the workload of your heart or eliminate excess of fluid such as: 

• Angiotensin II receptor blockers or ARBs such as losartan (Cozaar) and valsartan (Diovan) to relax the blood vessels in your heart and help blood flow more easily; 
• Angiotensin-converting enzyme or ACE inhibitors such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil) and ramipril (Altace) to help blood flow more easily and relax the blood vessels in your heart; 
• Diuretics such as furosemide (Lasix) to relieve fluid retention and sodium; Beta blockers such as metoprolol (Lopressor, Toprol-XL), bisoprolol (Zebeta) and carvedilol (Coreg) to help control irregular or fast heart rhythms and to treat heart failure. 

If your myocarditis is severe, aggressive treatment might be needed such as:

• Ventricular assist devices or VADs that helps pump blood from the ventricles to the rest of your body, this is used for people who have heart failure or can be used while waiting for a heart transplant; 
• Intravenous or IV to improve the heart pumping function; extracorporeal membrane oxygenation or EMO to provide oxygen in the body, when blood is removed from the body it passes through a membrane in the ECMO machine to remove carbon dioxide and adds oxygen to the blood then the newly oxygenated blood is returned to the body, this treatment may also be use while waiting for heart transplant; 
• Intra-aortic balloon pump that will insert a catheter in a blood vessel from your leg an d guide it to your heart using X-ray, the balloon will be place at the end of the catheter in the main artery leading out of the body from the aorta, it helps tom increase blood flow and decrease workload of the heart as the balloon inflates and deflates,
• Heart transplant for severe cases. Some people may have lifelong medications while some may recover within just a few months.

Myocarditis has no specific prevention but following some of these tips might be helpful to prevent the disease:

• follow good hygiene such as regular hand washing to prevent the spread of the illness; 
• avoid people who have viral or flu-like illness; minimize exposure to ticks by using insect repellants that has DEET and wear long pants and sleeved shirts to cover as much skin as possible; 
• do not use illegal drugs and practice safe sex;
• stay up to date with your vaccines especially those that protects you from influenza and rubella.

Some homeopathic remedies for myocarditis might be helpful such as:

• Spigelia,
• Aconite,
• Arsenic Iod,
• Bryonia,
• Cactus G,
• Carbo Veg,
• Crataegus,
• Digitalis,
• Lachesis,
• Naja,
• Veratrum V,
• Vipera,
• Adonis Vernalis,
• Aesculus,
• Apis Mel,
• Apocynum,
• Aurum Mur,
• Cannabis Sativa,
• Causticum.

If you are going to use homeopathic remedy, consult your doctor first.

Lifestyle modifications are necessary in order to cope with myocarditis.

Rest a lot and reduce the workload while recovering.

Your doctor will limit your physical activities for several months while your heart heals. He will tell you when you can do your normal activities. 

You might need regular follow-up appointments. He might do some tests such as echocardiograms to evaluate your heart.

Have a low-salt diet and restrict the amount of fluid intake. Avoid smoking and alcohol.

Myocarditis can lead to some complications such as:

• heart attack, because your heart muscle cannot pump blood and can create clots that can block on of your heart’s arteries,
• heart failure, if your heart can no longer pump blood and this may require ventricular assist device or heart transplant,
• stroke, if a blood clot in your heart travels to an artery that leads to your brain,
• arrhythmias,
• sudden death or cardiac arrest when your heart suddenly stops beating due to serious arrhythmias.