Cardiovascular Institute and Center for Cardiovascular Health

Myocarditis

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he myocardium is the heart muscle. When the myocardium contracts, blood is pumped out of the heart to the rest of the body.

Myocarditis is an inflammation of the myocardium that usually occurs as a result of an underlying illness, but can also be caused by radiation therapy, injury, and toxic reactions to drugs. The diseases associated with myocarditis include almost every bacterial, viral, parasitic or other infectious diseases. Myocarditis affects all people of all ages, but the source of the disease varies from country to country according to geography, degree of industrialization, sanitation conditions, and public health programs.

Myocarditis accounts for 17% to 25% of unexplained sudden death in otherwise active, healthy young people.

What are the symptoms of myocarditis?
Most people do not experiences any symptoms, are not aware that they have the disease, and do not seek medical attention. This group by and large recovers rapidly on its own.

The symptoms of myocarditis vary depending on the underlying cause. Some people experience fatigue, shortness of breath, and palpitations. Other symptoms include: headache, fever, irregular or rapid heart beats (arrhythmia), swelling (especially of the ankles and feet), difficulty in breathing, swollen neck veins, pain behind the breastbone, and pain spreading to the neck and shoulders.

Which diseases cause myocarditis?
Some of the diseases which cause myocarditis are: Coxsackie viruses, measles, parasitic infections, influenza, polio, tuberculosis, diphtheria, gonorrhea, typhoid fever, tetanus, rheumatic fever, mumps, Epstein-Barr virus, rickettsia, and Chagas' disease.

Chagas, a rare disease in the United States, is transmitted by the bite of the kissing bug or by breast feeding. Symptoms include headache, anorexia, and conjunctivitis.

How can myocarditis be prevented?
You can prevent myocarditis by preventing and/or treating the underlying causes. You should keep your immunizations current.

How is myocarditis diagnosed?
Your doctor will talk with you and perform a complete physical examination. In particular, he will listen to your chest with a stethoscope to detect unusual heart sounds. He will probably order chest x-rays, electrocardiographic (ECGs) and echocardiographic tests. He may order nuclear testing and imaging (computed Tomography or Magnetic Resonance) scans. Finally, he may order a biopsy of your heart muscle. The biopsy is a procedure during which a small tube (catheter) is inserted into a vein in your neck or leg and then threaded into your heart. A scissor-like instrument, which is inserted through the catheter, snips tiny pieces of the myocardium, which are then studied.

A positive biopsy is the only sure way to know if you have myocarditis, However, since the biopsy can only test a small area of the heart, you may still have myocarditis even if the biopsy is negative.

How is myocarditis treated?
Myocarditis is usually treated by a three-pronged approach. First, therapy will be given for the underlying illness. Second, measures will be taken to attempt to decrease the workload of the heart. Finally, your physicians will control the complications of the myocarditis

Your doctor may recommend modified bed or chair rest and sodium and exercise restriction. Reduction of physical activity and exercise reduces the work of the heart. It reduces residual damage and promotes healing.

You may be given medications. Depending on your condition, your doctor may prescribe one or more of the following: Digoxin, diuretics, ACE inhibitors, beta blockers and anticoagulants. If you have a severe case of myocarditis, you may receive steroids and immunosuppressants which suppress inflammation.

Your condition may require more extensive monitoring and treatment in the hospital, This treatment may include the insertion of a temporary assist device such as an intraaortic balloon pump. The balloon pump is inserted into your aorta above the heart. It takes over some of the heart's pumping function. In rare cases, a heart transplant is required.

If you have developed a dangerous arrhythmia due to the myocarditis, you may be hospitalized in order to receive frequent monitoring.

What are the consequences or complications of myocarditis?
Most cases of myocarditis clear up by themselves without complications. Some people develop chronic weakness of the heart and heart failure. The latter is a rare occurrence.

Myocarditis can cause acute pericarditis (inflammation of the sac surrounding the heart), permanent heart muscle and heart valve problems, blood clots, stroke, and arrhythmias. Some arrhythmias may be fatal if untreated.

On rare occasions, untreated myocarditis can lead to death. Again, this depends upon the underlying disease. Chagas and diphtheria are two examples of diseases which must be treated to avoid fatal consequences.

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