Myocarditis

Symptoms Of Myocarditis

People with myocarditis may not show any noticeable symptoms initially. Some of the common myocarditis symptoms include:

Symptoms in adults

1. Pain or discomfort in the chest

Chest pain in people with myocarditis may resemble the chest pain that occurs during a heart attack. It may last for a couple of minutes and make you experience an uncomfortable fullness and pressure in your chest.

2. Difficulty breathing or shortness of breath

A healthy adult, weighing around 70 kgs breathes at a rate of 14 breaths/minute when at rest. If this breathing pattern increases and hyperventilation (rapid breathing) occurs, one may experience shortness of breath or dyspnea. It may make one gasp for air.

3. Edema or swelling

Noticeable swelling in various parts of the body, including ankles, legs, and feet may be seen. It is due to fluid buildup and is often followed by fatigue.

4. Palpitations or abnormal heartbeat

An irregularity in the heartbeat might feel as if the heart is racing or has skipped a beat. Palpitations can also feel as if the chest is fluttering. In many cases, the abnormal heartbeat may also lead to fullness in the chest and shortness of breath.

5. Infection-related fever

If the myocardium has inflamed due to an infection, one may feel feverish and experience chills.

6. Other flu-like symptoms

Flu-like symptoms such as sore throat, headache, body aches, and joint pain can also be experienced in myocarditis.

Symptoms in children or infants

The symptoms of myocarditis are more nonspecific in infants and children. These include:

• Poor appetite

• Abdominal pain

• Malaise

• Chronic cough

• Rashes

• Fever

• Diarrhea

• Sore throat

• Difficulty breathing

• Pain in the joint

Causes Of Myocarditis

Myocarditis is a rare health condition. However, in most cases, an infection (bacterial, viral, fungal, parasitic) in the body can cause myocardial infarction. The causes are discussed below:

1. Viruses

Viral infections are among the most prevalent causes of myocarditis (viral myocarditis). These include influenza virus, adenovirus, COVID 19 and Coxsackie B virus, to name a few. Viruses are likely to infect the tissue of the heart muscle. It may lead to immune response (acute to chronic) from the body.

2. Bacterias

The bacteria that may cause inflammation of the myocardium include corynebacterium, meningococci, Streptococci, clostridia, etc. 

3. Fungi

Although rare, fungal myocarditis can occur due to infections caused by various fungi including candida, aspergillus, and histoplasma.

4. Parasites

Some parasites may directly or indirectly affect various structures of the heart, with infections manifested as myocarditis. Some of these parasites include Trypanosoma cruzi, Toxoplasma, and Trichinella. Chagas' disease is by far the most important parasitic infection of the heart.

5. Hypersensitivity or toxic reaction

Toxic myocarditis may be triggered by medications such as 

• Dobutamine

• Phenytoin

• Antibiotics like:

  • Ampicillin

  • Azithromycin

  • Cephalosporins

  • Tetracyclines

• Psychiatric medications like:

  • Tricyclic antidepressants

  • Benzodiazepines

  • Clozapine

• Recreational/illicit drugs like

  • Methamphetamine

  • Cocaine

Other agents include:

• Heavy metals (copper, lead and arsenicals)

• Antineoplastic agents (e.g., anthracyclines, cyclophosphamide, 5-fluorouracil and tyrosine kinase inhibitors).

6. Autoimmunity

When the immune system makes a mistake and attacks the body's own tissues or organs it is known as autoimmunity. Autoimmunity can be the main factor sustaining inflammation and disease progression in myocarditis. Pathogens, such as viruses, can initiate autoimmune mechanisms that lead to myocarditis.

Autoimmune disorders like lupus and rheumatoid arthritis can also lead to myocarditis.

7. Idiopathic myocarditis

When inflammation of the heart muscle develops without any identified cause, it is called an idiopathic condition.

Risk Factors for Myocarditis

The risk factors for myocarditis include the following:

1. Age 

Although myocarditis can affect all ages, it mostly occurs in young adults.

2. Gender

Men are often more prone to developing myocarditis than women. This is true except when the inflammation is caused by autoimmune diseases, such as lupus and rheumatoid arthritis, which are more common in women.

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3. Family history and genetics

Genetics may be partly responsible for developing myocarditis and how the body responds to infection and inflammation.

Certain rare inherited conditions can affect how the body controls inflammation. For example, familial Mediterranean fever or tumor necrosis factor receptor-associated periodic syndrome (TRAPS) can increase the risk of developing myocarditis.

4. Medical conditions

Certain medical conditions can increase the risk of developing myocarditis:

• Diabetes

• HIV/AIDS

• COVID 19 

• Eating disorders such as anorexia

• Skin injuries caused by burns or infections

5. Lifestyle choices

• Excessive consumption of alcohol

• Use cocaine, amphetamines, or intravenous recreational drugs

6. Environment

Chagas disease, common in Central and South America, can cause acute and chronic myocarditis. It is caused by a parasite that is spread by certain types of insects. 

7. Other causes

Some of these medical problems that can put you at a higher risk of getting myocarditis include:

• Poor dental health

• Chest injury

• End-stage kidney disease

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Diagnosis Of Myocarditis

After a physical checkup and evaluation of medical history, the doctor may recommend the following tests to confirm the diagnosis:

Blood tests

Creatine kinase (CK): It is a blood test that checks the level of CK in the blood. If it is more than the normal range, it might indicate an infection in the myocardium.

Total leukocyte count: Abnormal WBC (white blood cells) count can be helpful in diagnosing myocarditis due to infections.

CRP: Increased levels of CRP (C-reactive protein) act as an inflammatory marker.

ESR: Elevated ESR (Erythrocyte Sedimentation rate) is also another marker for inflammation in the body.

Troponin levels: Increased level of troponin (circulating) in the blood indicates damage to the heart muscle.

Imaging tests

Electrocardiography: Electrocardiogram is performed to detect the electrical activity of the heart. 

Chest X-ray: A chest X-ray may help to check for enlargement of the heart or accumulation of fluid in the heart's sac.

Echocardiography: It is a vital component in myocarditis diagnosis. It uses high-pitched sound waves to produce a picture of your heart. It also helps with blood flow analysis and analysis of any valve problems, heart enlargement, and the presence of a clot within or around the heart.

Cardiac magnetic resonance imaging (MRI): A cardiac MRI uses radio waves and a magnetic field to show the size, shape, as well as swelling, inflammation, or scarring of the heart.

Biopsy

Cardiac Catheterization is performed by threading a tiny tube through a vein, into the heart to take measurements or collect a biopsy sample to check for inflammation or infection. Biopsy is not routinely performed and is suggested in special cases of:

• Severe arrhythmia

• Conventional supportive therapy that did not work

• Suspected acute dilated cardiomyopathy (A heart condition that is caused due to blockage in the coronary arteries).

Micro-RNA profiling

This test is done to detect acute and chronic myocarditis. It also helps in identifying the severity of myocardial damage. 

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Prevention Of Myocarditis

Although there is no specific preventive measure to practice, one may follow the below tips to minimize the risks of getting infected:

1. Avoid exposure to germs

Make sure to avoid people with flu-like symptoms. Similarly, if you have a viral infection, try not to expose others.

2. Practice hand hygiene

Following hygienic practices, such as washing hands every time before and after eating, or using the toilet is always a good idea. Washing cuts or scrapes right away can also help to prevent any infection.

3. Dental care

Brush and floss your teeth every day. Visit the dentist regularly for timely diagnosis and treatment of any dental issues.

4. Practice safe sex

Safe sex practices can prevent an HIV infection. This condition weakens the immune system and  makes one more susceptible to develop myocarditis.

5. Avoid use of illegal drugs

As myocarditis is likely to affect people with a compromised immune system, it is advisable to avoid any illegal drugs.

6. Avoid exposure to ticks

Make sure to wear long pants and cover hands if you live in a tick-infested region. You may also use tick repellents containing DEET (N, N-Diethyl-meta-toluamide).

7. Get vaccinated

Make sure to get vaccinated to prevent COVID-19, influenza, rubella, measles, mumps, and poliomyelitis. 

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Specialist To Visit

Always remember, that the symptoms of myocarditis are familiar to that of a heart attack. Make sure to get in touch with your doctor if you experience any of the signs of myocarditis, especially shortness of breath and chest pain. Severe symptoms may require hospitalization.

Specialists that can help diagnose and treat myocarditis include:

• Cardiologists

• Cardiothoracic surgeons

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Treatment Of Myocarditis

Myocarditis treatment options differ from person to person, depending on the underlying causes and seriousness of the condition. The following treatment protocols are used for managing myocarditis:

1. Antibiotics

If myocarditis is due to an underlying cause, like a bacterial infection, the doctor may prescribe antibiotics. However, people with severe and prolonged illness due to myocarditis are likely to need specific medicines and sometimes hospitalization. 

2. Corticosteroids 

Sometimes autoimmune conditions like lupus may also cause myocarditis. In such cases, doctors may prescribe corticosteroids to minimize the immune response of your body. Some medications may include:

• Ciclosporin

• Prednisone

3. Medications for heart failure

The doctor is likely to prescribe diuretics, beta-blockers, and ACE (angiotensin-converting enzyme)-inhibitors to minimize edema and the workload on the heart. These may include the following:

• Enalapril (ACE inhibitor)

• Lisinopril (ACE inhibitor)

• Metoprolol (Beta-blocker)

• Furosemide (Diuretic)

• Captopril (ACE inhibitor)

• Ramipril (ACE inhibitor)

• Carvedilol (Beta-blocker)

4. Antiviral drugs

Antiviral therapy with ribavirin or interferons in viral myocarditis can help to prevent onset of cardiomyopathy, reduce the severity of the disease, and decrease mortality.

If the symptoms are severe and medications are not working the way they should, more proactive treatment options might be tried. These include the following:

1. IVIG (Intravenous immunoglobulin)

To make sure the body's inflammatory and immune responses are under check, the doctor may recommend intravenous immunoglobulin (IVIG). 

2. VAD (ventricular assist device)

It is a mechanical device that is used to pump an adequate amount of blood from the ventricles (lower chambers) of the heart to the other parts of the body. 

3. Intra-aortic balloon pump

Intra-aortic balloon pump, also known as IABP, is a therapeutic device. It allows the heart to pump more blood and reduce its load.

4. Extracorporeal membrane oxygenation (ECMO)

ECMO is a respiratory or cardiac support machine. It allows the lungs and heart to function normally. 

5. Heart transplant

In case of severe conditions and if the other myocarditis treatment did not work, the doctor is likely to suggest heart transplantation surgery.

Prevention of a disease  is always better than cure. There are certain habits that can cause harm to the heart. Understand what they are and to avoid them effectively. 
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Home-care For Myocarditis

Myocarditis is marked by inflammation of the heart. Here are some home care tips if one has been diagnosed with myocarditis:

1. Take adequate rest

Rest and reducing the strain on the heart is an important part of myocarditis recovery. If you have or had myocarditis, ask your health care provider which type and amount of physical activity are safe for you. If you have myocarditis, you should avoid competitive sports for at least 3 to 6 months.

2. Eat a heart-friendly diet

Foods that are good for your heart include green leafy vegetables, fruits, nuts, whole grains & low-fat dairy products. Try to limit the consumption of trans fat, salt, saturated fats, cholesterol, red meat, and sugary foods. Have an anti-inflammatory diet that focuses on fresh produce, including fruits, vegetables, and nuts. 

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3. Avoid stress

Stress can increase blood pressure, hence it is important to manage it effectively. Yoga, meditation and deep breathing exercises are effective in managing stress.

Find out how yoga can keep your heart healthy.
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4. Limit fluid intake

Do not drink more than 1.5 liters or 6 cups of fluid every day. Fluids include water, juice, soup, tea, coffee, and even some fruits like watermelons. Maintain a fluid balance chart to track the quantity of fluid consumption.

5. Maintain a healthy weight

Obesity directly increases the risk of complications due to myocarditis. A healthy weight can go a long way in keeping the heart healthy.

6. Reduce alcohol intake

Drinking excessive alcohol can increase the levels of certain fats known as triglycerides in the blood and might harm the immune system. Thus, it is important to keep alcohol intake to a minimum.

7. Quit smoking

Smoking is known to increase heart rate and blood pressure, so it is important to quit smoking in order to improve the symptoms of myocarditis. 

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8. Stay physically active

Supervised moderate exercise is an integral part of a healthy heart regimen. Consult your doctor to understand the range of physical activities you can do.

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Complications Of Myocarditis

Timely treatment of myocarditis has a good prognosis without having any long-term complications. However, severe cases may have some permanent complications related to heart muscles. These include the following:

1. Heart failure

Myocarditis, if left untreated, is likely to damage the heart muscles, making it inefficient to work properly. It may also lead to heart failure.

2. Stroke or heart attack

If the heart is unable to pump an adequate amount of blood, there is a risk of blood clot formation in the heart. If a blood clot creates a blockage in an artery of the heart, one may suffer a heart attack. Also, if the clot travels to the brain it can cause a stroke.

3. Arrhythmia

When the heart muscles are injured or become weak, it may lead to arrhythmia or irregular heart rhythm.

4. Ventricular dysrhythmias

These are abnormal heart rhythms that make the lower chambers of the heart twitch instead
pump. This can limit or stop the heart from supplying blood to the body. 

5. Left ventricular aneurysm

It forms when a section of the heart muscle in the left ventricle (the chamber of the heart that pumps blood to the body) stretches and becomes very thin. 

6. Dilated cardiomyopathy

It is a type of heart muscle disease that causes the heart chambers (ventricles) to thin and stretch, growing larger.

7. Cardiogenic shock

This is a life-threatening condition in which your heart suddenly can't pump enough blood to meet the body's needs. 

8. Sudden cardiac death or SCD

It is a life-threatening complication in which the heart may stop beating due to severe arrhythmia.

Myocarditis is often related to an increased possibility of SCD (sudden cardiac death) in young people. Know why sudden cardiac arrests happen. 
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Alternative Treatment For Myocarditis

The following alternative treatment modalities can help in management of myocarditis or factors affecting it, like stress:

1. Yoga

There are plenty of benefits of yoga supported by scientific evidence. Some of the yogasanas you may perform for stress relief include Savasana, Balasana, Viparita Karani, and Marjaryasana to Bitilasana.

2. Meditation

It is indeed an effective tool for stress management. If you are trying it for the first time, you might find it hard to focus. In such a situation, guided meditation audio may help.

Meditation can do wonders for your body and soul.
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3. Breathing exercises

The next time you feel stressed out, try deep breathing exercises. These will help you calm down and relax your senses so that you may get relief from stress. Some deep breathing techniques you may try include belly breathing, box breathing, alternate-nostril breathing, lion breathing, and 4-7-8 breathing, to mention a few.

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Living With Myocarditis

In some people with myocarditis, no symptoms show up. Some do not even know if they have the condition. In most such cases, the symptoms resolve on their own. Many people who have had treatment for myocarditis live their usual life span like normal individuals sans any complications.

Some people may require treatment in the form of medications, while some might need heart surgery. Besides medications and alternative therapies, a healthy lifestyle may also help your heart work well. Here are some tips that can help you improve heart conditions like myocarditis more effectively:

• Reduce the amount of sodium in diet ( less than 1,500 milligrams a day)

• Keep a watch on daily fluid intake and weight

• Maintain a healthy weight

• Eat wholesome and well balanced diet

• Quit smoking

• Limit alcohol intake

• Avoid strenuous exercises and competitive sports

• Prefer light physical activity

• Avoid stress

• Track your symptoms

• Monitor blood pressure regularly

• Follow proper medication regimen

• Ensure regular follow-up with the cardiologist

• Get vaccinated as flu and pneumonia pose a greater danger to people with heart conditions.

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Endocarditis Vs. Myocarditis Vs. Pericarditis

Endocarditis

Endocarditis is a heart condition where inflammation develops in the endocardium of the heart. The endocardium is the inner lining of the valves and chambers of the heart. It is an uncommon health condition and can be fatal if left untreated. 

Myocarditis

Myocarditis is also a rare disease in which the myocardium (a heart muscle) swells. This condition is likely to affect a little or large portion of the myocardium. It makes your heart work harder to pump blood and carry it to the rest of the body. It may also lead to heart failure and stroke.

Pericarditis

It is another type of heart inflammation that affects the pericardium, the membrane that covers the heart. The pericardium ensures that your heart is in position in the thoracic girdle while protecting it from infections. The pericardium comprises two thin sheaths of tissue with a small amount of fluid in it. It reduces the friction between the layers when your heart pumps.