What is myocarditis?

Myocarditis is a condition where the heart muscle becomes inflamed. The inflammation can reduce the heart's ability to pump and cause rapid or irregular heart rhythms (arrhythmias). The degree of inflammation can vary based on patient factors and the cause of myocarditis.

Often, the cause of myocarditis isn't identified. Potential causes include:

  • Infections: Many infections and viruses are commonly associated with myocarditis, including the viruses that cause the common cold (adenovirus), COVID-19, Epstein-Barr virus (EBV), parvovirus, and gastrointestinal viruses. In addition, bacterial infections have been known to cause myocarditis, including Lyme disease and fungal infections like histoplasmosis
  • Drugs: Myocarditis can occur due to an allergic reaction to some medications such as sulfa antibiotics, anti-seizure medications, or recreational drugs
  • Autoimmune disorders: Certain autoimmune disorders such as lupus, Wegener's granulomatosis, giant cell arteritis, and Takayasu's arteritis are associated with myocarditis

The condition is not affected by lifestyle and it cannot be prevented. While many people recover from the condition, it can lead to heart failure in rare cases.

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Symptoms of Myocarditis

Myocarditis can be brought on by a viral or bacterial infection, an auto immune disease or unknown causes. People usually develop symptoms around two weeks after the initial illness. Symptoms may include:

  • Chest pain and tightness, which may spread across the body
  • Shortness of breath
  • Finding it hard to breathe
  • Feelings of exhaustion
  • Flu-like symptoms
  • Palpitations

Diagnosis

Your consultant will discuss your symptoms with you and help to make a diagnosis. If you've had persistent symptoms for some time, they may order the following tests:

  • Electrocardiogram (ECG) to show abnormal heart rhythm
  • Blood tests, which might confirm the infection
  • An echocardiogram to show up muscle damage
  • CT scan
  • Cardiac MRI
  • PET scan
  • Placing an ambulatory heart monitor to capture arrhythmic episodes
  • Implantable heart monitors to detect rare and infrequent arrhythmias

Treatment Options

Your physician will discuss treatment options with you and help to determine the best approach.

Treatment for myocarditis is multifaceted. It is generally directed at controlling the abnormal heart rhythm, and specific treatment may be needed to reduce inflammation in the heart muscle.

Depending on the kind of arrhythmia, there are two ways to achieve rhythm control. These include medications called anti-arrhythmic medications and a procedure called catheter ablation.

In addition to treatment of the specific arrhythmias with either medications or catheter ablation, additional treatment focused on suppressing inflammation in the heart may also be needed. This involves administration of anti-inflammatory medications such as methotrexate and corticosteroids which can help reduce overall inflammation. In some cases, patients are co-managed with rheumatologists who have more experience with treating inflammatory disorders.