Inflammation of the Heart Muscle (Myocarditis) • Symptoms & Treatment

An inflammation of the heart muscle can cause symptoms such as heart attack and shortness of breath, but it can also be asymptomatic and go unnoticed. The trigger is often a previous infection. What can be done preventively, what are the symptoms, diagnosis and treatment of myocarditis?

Inflammation of the heart muscle (myocarditis) is usually dangerous because it weakens the performance of the heart muscle and can thus impair the blood flow to the organ systems. Other possible consequences are cardiac arrhythmias and, in the worst case, sudden cardiac death. If the inflammation also spreads to the pericardium surrounding the heart, then pericarditis or, more precisely, perimyocarditis is present.

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Triggers and causes of myocarditis

A basic distinction is made between infectious and non-infectious myocarditis. The former is triggered by viruses, bacteria, fungi or parasites, the latter by autoimmune processes, radiation or toxins.

Infectious myocarditis

The heart muscle inflammation can be caused by a Infection with viruses are caused, with certain viruses apparently preferring to settle in the area of ​​the heart muscle. Examples of viruses that can cause myocarditis:

  • Coxsackie B viruses and other enteroviruses: These pathogens are responsible for around 50 percent of infectious myocarditis in Europe and the USA.
  • Influenza viruses: They are generally considered to be the causative agent of the flu and can cause myocarditis.
  • Epstein Barr Virus (EBV): People are infected with EBV at a young age and then mostly suffer from Pfeiffer’s glandular fever. In recent years, the pathogen has been diagnosed more frequently as the cause of myocarditis.
  • Parvovirus B19: The causative agent of ringlet rubella has been increasingly detected in recent years as an infectious agent in myocarditis.
  • Entero-, adeno- and cytomegaloviruses: In the past they were very often found to be the causative agent of myocardial inflammation, but are less common today.

Although the number of potentially possible bacteria is large, bacterial myocarditis is rather rare in our part of the world. It should be considered in this context that in rare cases tick-borne borreliosis can trigger myocarditis. The disease is caused by the Borrelia burgdorferi bacterium, which enters the bloodstream with a tick bite and can also affect the heart muscle. The myocarditis is then referred to as Lyme carditis.

Theoretically, parasites can also attack the heart muscle and cause myocarditis. This is the case, for example, with so-called Chagas disease, which occurs mainly in Central and South America. In our part of the world, myocarditis caused by parasites is very rare. Fungal myocarditis is also very rare and only affects people with severe immunodeficiency.

Non-infectious myocarditis

Diseases of the immune system, in which immune cells are directed against the body’s own structures (autoimmune diseases), are usually associated with inflammatory processes that may also affect the heart muscle. This is well documented for chronic inflammatory bowel diseases, i.e. for so-called ulcerative colitis and Crohn’s disease. In rheumatic diseases such as rheumatoid arthritis, in addition to inflammatory reactions in the joint, inflammation of the heart muscle can also occur. Other autoimmune diseases in which heart muscle involvement has been observed in individual cases are systemic sclerosis, a disease that is characterized by serious skin changes, and lupus erythematosus, a disorder with immune reactions against various components of the body’s own cells.

The toxic form of myocarditis is caused by toxins (toxins). These primarily include alcohol and heavy metals. Chemicals and drugs can also cause myocarditis in rare cases.

Radiotherapy as part of the treatment of cancer can also be the cause of myocarditis.

Symptoms of myocarditis

The signs that myocarditis manifests itself vary and depend on the course and severity of the disease. It can run completely without symptoms and thus remain completely unnoticed or – in the case of a chronic course – lead to cardiac insufficiency.

Symptoms of acute myocarditis:

  • acute chest pain, similar to angina pectoris (chest tightness) or a heart attack
  • irregular heartbeat (palpitations)
  • Difficulty breathing, especially when exercising
  • Racing heart (tachycardia)
  • general weakness that is often misinterpreted in the aftermath of a cold
  • fever
  • dizziness

The individual symptoms can occur in isolation or in different constellations combined with one another.

Signs of chronic myocarditis:

  • Feeling tired
  • Reduced performance
  • Loss of appetite
  • Weight loss

In addition, a slightly bluish discoloration of the skin and mucous membranes, especially the lips (cyanosis), is possible. It is a consequence of the decreasing strength of the heart: Due to the impaired pumping function, less oxygen-enriched, bright red blood flows through the blood vessels and instead more oxygen-poor, rather dark-colored blood.

How is myocarditis diagnosed?

Myocarditis is not always easy to spot because it is often accompanied by symptoms of other heart and lung diseases or a simple cold. If myocarditis is suspected, the following examinations are available to the doctor:

  • in the electrocardiogram (EKG), changes in the heart rhythm typical for myocardial inflammation can be detected.

  • With a Ultrasound examination of the heart (echocardiography), pumping weaknesses or enlarged heart chambers can be detected. A so-called pericardial effusion (fluid accumulation in the pericardium) can also be detected in the ultrasound.

  • A Chest x-ray (heart x-ray) often shows an enlarged heart.

  • Blood tests and especially an investigation of the inflammatory factors in the blood can corroborate the suspicion of an inflammation of the myocardium. An example here is the creatine kinase value (CK value). Antibodies against viruses, bacteria or the body’s own structures can also be detected in this way.

  • Over a Magnetic resonance imaging (MRI) can be used to detect the individual foci of inflammation in the heart.

  • When in doubt, a biopsy, i.e. a tissue removal from the heart muscle. The samples obtained using a catheter are examined for inflammatory cells and pathogens.

Treatment of inflammation of the heart muscle

The therapy for myocarditis depends on the individual situation and, above all, on the severity. If the disease is extremely acute, everything revolves around saving the person’s life. It must be treated and monitored in the intensive care unit so that the heart’s pumping function is ensured.

If the situation is not life-threatening, strict physical rest with absolute bed rest is important so that the heart is not stressed too much. After three to six months at the earliest, physical exertion should be started again – and only under medical supervision. To relieve the heart, medication is also used to flush fluids out of the body (diuretics).

Other possible therapy methods for heart muscle inflammation are:

  • Antiviral treatment: If the virus infection persists As the cause of myocarditis, attempts can be made to get the viruses under control through targeted antiviral treatment. Treatment is then for example with immunoglobulins or with interferon.

  • Immunosuppressants: If, on the other hand, there are signs of an immunological process triggering the inflammation, then drugs that dampen the excessive activity of the immune system are helpful. Heart muscle inflammation is only treated in this way if the underlying infection no longer persists.

  • Antibiotics: In the rare cases in which the disease is caused by bacteria and these are still detectable, a specific treatment is usually used to try to eliminate the respective pathogen in order to cure the disease.

In the further course of the heart muscle inflammation, its consequences are practically treated, such as the developing heart failure (heart failure). For this purpose, drugs are prescribed that are usually to be taken when the heart is weak and that relieve the heart – such as active ingredients from the group of diuretics, ACE inhibitors, angiotensin antagonists or beta blockers.

If the heart failure as a result of the inflammation of the heart muscle cannot be brought under control through the usual treatment options, a heart transplant should be considered as the last possible treatment option.

Course and complications of myocarditis

Myocarditis can take very different courses. It can remain with a rather mild disease that hardly causes symptoms and completely heals after a short time. However, myocarditis can also develop acutely, deteriorate rapidly and endanger the life of the sick person. This is the case with around five to ten percent of those affected. Without rapid treatment, massive disturbances of the heart function up to so-called cardiogenic shock with impending heart failure can occur.

Possible consequences of myocarditis are:

  • enlarged heart muscle (dilated cardiomyopathy)
  • chronic heart failure (heart failure)
  • severe arrhythmia
  • sudden cardiac death

Unexpected deaths are not uncommon: It is assumed that up to 20 percent of sudden deaths in athletes are caused by myocarditis.

The transitions between the different forms of the disease are fluid. The inflammation of the myocardium, initially caused by an infection, can turn into a chronic form of disease in which the inflammation is sustained by immunological factors. Therefore, those affected must be carefully monitored – even if the acute myocardial inflammation has already subsided.

Prevent heart muscle inflammation

Myocarditis can be prevented by practically all measures that serve to prevent infections – from hygienic measures to vaccinations such as the flu shot.

If there is an infectious disease, it should definitely be cured so that the viruses or bacteria do not spread to the heart muscle. This also includes giving the body rest and time to recover before putting too much physical strain on yourself and doing sports. Above all, athletes should take this to heart, especially in competitive sports. After a serious infectious disease, it is advisable to refrain from physical activity for at least four weeks.

22 tips for a healthy heart


22 tips for a healthy heart




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