Myocarditis is a condition characterized by inflammation of the myocardium. Viral infection is the major causative factor.
Mild cases of myocarditis seldom produce any symptoms. In severe cases, the following symptoms are experienced:
- Pain in the chest
- Onset of arrhythmia
- Feeling of shortness of breath, during activity or even at rest
- Development of fatigue
- Swelling in the legs, arm or ankle due to fluid retention
- Common symptoms of viral infections such as headache, fever, body ache, pain in the joints, diarrhea and or soreness in throat
If children are affected by myocarditis, then the following signs and symptoms are evident:
- Onset of fever and rapid breathing
- Difficulty in breathing
- Development of bluish to grayish color of skin
Entire Body System
Spotted fever group of rickettsial infections are emerging in Sri Lanka. We describe a patient with rapidly progressing ARDS and myocarditis secondary to spotted fever caused by Rickettsia conorii. [ncbi.nlm.nih.gov]
Patients with myocarditis may present with the following signs and symptoms: Mild symptoms of chest pain (in concurrent pericarditis), fever, sweats, chills, dyspnea In viral myocarditis: Recent history ( 1-2 wk) of flulike symptoms of fevers, arthralgias [emedicine.medscape.com]
Of note, she had complained of fatigue, feeling constitutionally unwell and a generalised rash in the days prior to her presentation. Her echocardiogram showed normal wall motion and preserved ejection fraction. [ncbi.nlm.nih.gov]
A month or two later, the symptoms of flu (weakness and malaise) merge with symptoms of heart failure (fatigue during physical activity and shortness of breath). [healthcentral.com]
We describe a male patient who presents 2 years posttransplant with cough and dyspnea. A negative pulmonary workup led to an endomyocardial biopsy and the diagnosis of cytomegalovirus (CMV) myocarditis. [ncbi.nlm.nih.gov]
Often the person has no preceding symptoms of a cold, cough, nasal congestion or rash and only becomes aware of the infection when heart failure occurs. [health.harvard.edu]
[…] immune system Are exposed to agents known to cause myocarditis (such as cocaine) Have previously had myocarditis Myocarditis Symptoms Myocarditis symptoms include: Fever and chills Fatigue Headache Muscle aches Joint pain Sore throat Diarrhea Chest pain Cough [everydayhealth.com]
- Exertional Dyspnea
The clinical presentation can be highly variable as patients can present with chest pain, exertional dyspnea and fatigue, or overtly decompensated heart failure and/or cardiogenic shock. 3-5 The initial ECG can also show variable findings including ST [acc.org]
dyspnea, fatigue, weakness, and tachycardia. It may lead to heart failure. Anaemia is often a cause of dyspnea. [en.wikipedia.org]
Clinical presentations of the disease range from nonspecific systemic symptoms (fever, myalgias, palpitations, or exertional dyspnea) to fulminant hemodynamic collapse and sudden death. [web.archive.org]
- Heart Failure
KEYWORDS: Artificial organs; Cardiomyopathy; Circulatory support device; Heart failure [ncbi.nlm.nih.gov]
For an outline of appropriate supportive measures, see separate Heart Failure Management article. [patient.info]
Treatment of heart failure follows the same treatment regimen regardless of the underlying cause (ie, inhibitors, beta-adrenergic blockers). [emedicine.medscape.com]
collapse) Acute myocarditis presents over a longer time period with features of heart failure (can lead to cardiomyopathy) Chronic myocarditides (active and persistent) are rare but may cause chest pain/palpitations without LVD. [dundeemedstudentnotes.wordpress.com]
However, if symptoms don’t go away you may need tests such as: an electrocardiogram (ECG) to check for an abnormal heart rhythm, if you have experienced palpitations a chest X-ray, to check for fluid in or around the heart an echocardiogram (echo), if [bhf.org.uk]
If you experience chest pain or palpitations, seek emergency help immediately. An EKG, Chest x-ray, and echocardiogram (ECHO) will be preformed. [chemocare.com]
Because myocarditis presents with non-specific symptoms including chest pain, dyspnoea, and palpitations, it often mimics more common disorders such as coronary artery disease. [ncbi.nlm.nih.gov]
Some children may have very few, difficult to detect symptoms, however as myocarditis affects the heart’s ability to pump blood normally, symptoms can include trouble breathing, heart palpitations, chest pain, fatigue and fainting. [nicklauschildrens.org]
The most common abnormality seen in myocarditis is sinus tachycardia with non-specific ST segment and T wave changes. [litfl.com]
Myocarditis should be suspected in patients with a history of flulike symptoms and new evidence of ECG abnormalities, such as sinus tachycardia or concave ST-segment elevations. [amboss.com]
Clinical presentation included: shortness of breath (67%), fever (67%) and tachycardia (58%). Cardiac markers were elevated in 87% of the 54 cases that reported these markers. [ncbi.nlm.nih.gov]
- Jugular Venous Distention
Physical exam will look like congestive heart failure, with jugular venous distention, pulmonary rales, peripheral edema, pulsatile liver, and perhaps a laterally displaced point of maximal impulse (PMI). E. [cancertherapyadvisor.com]
This stage may be very subtle histopathologically and mimic other dermatoses such as eczema or lichenoid dermatoses, as the atypia may be difficult to appreciate. [dermnetnz.org]
Often, it is misdiagnosed as psoriasis or eczema at first and only recognized after several biopsies. Cancers of the lymphatic system are called "lymphomas". The most well known lymphoma is Hodgkin's disease. [aocd.org]
These lesions may resemble other skin disorders such as psoriasis, parapsoriasis, lichen planus, or eczema. STAGE II: The second stage is called the plaque or “infiltrating stage.” Bluish red circular or oval plaques develop on affected areas. [rarediseases.org]
The following tests are employed for diagnosing the condition of myocarditis:
- Electrocardiogram: This is a non-invasive test, which measures the electrical activity of the heart. It also helps in detecting abnormal heart rhythms.
- Holter monitor: Some abnormalities noticed in the electrocardiogram, would call for further investigation. A holter monitor is a device that records the heart rhythm round the clock and helps in arriving at appropriate diagnosis.
- Imaging studies such as X-ray of the chest and MRI of the heart are carried out. Such tests would reveal inflammation of the muscles of the heart and help in appropriate diagnosis .
- Echocardiogram is indicated which would help reveal heart enlargement, poor pumping of the heart and valve problems if any.
- Blood tests: Blood tests to measure the levels of white and red blood cells would be done. An elevated level would suggest infection as the causative factor.
- Biopsy and cardiac catheterization: These are done to check for presence of inflammation of the myocardium .
In several cases, myocarditis can resolve without treatment promoting complete recovery. However, many cases may demand an appropriate treatment plan which would primarily focus on correcting the underlying condition. The various treatment methods that are employed include :
- Medications such as antibiotics to treat bacterial infections and anti-inflammatory agents to lessen the swelling in the legs and ankles are prescribed. In addition, digoxin and diuretics to remove excess water from the body in order to reduce the swelling caused due to fluid retention are also administered .
- Ventricular assist device or intra-aortic ballon pump is indicated in severe cases.
- Heart transplantation is usually the last resort and employed when there is severe damage to the heart.
Individuals who can successfully survive fulminant myocarditis usually have a favorable prognosis. It was observed that majority of the patients do well even without a transplant. The onset of left ventricular dysfunction is less severe in individuals with fulminant myocarditis. Individuals with mild symptoms, completely recover with no cardiac dysfunction . However, in patients suffering from giant cell myocarditis, 89% of them did not survive or had to undergo transplantation with median survival period of just 5.5 months after transplant .
Viral infections are the most common cause of myocarditis. The various pathogens that are known include parvovirus B19, coxsackievirus B, Epstein-Barr virus, adenovirus and echoviruses. Individuals with HIV/AIDS are also susceptible to develop the condition. In certain cases, bacterial and fungal agents can also cause myocarditis .
Underlying disease conditions such as inflammatory conditions, systemic lupus erythematosus and connective tissue diseases can also favor the development of myocarditis. In addition, certain medications such as antibiotics like penicillin, anti-seizure medications and illegal drugs can cause certain toxic reactions which can lead to inflammatory reactions in the myocardium of the heart.
The exact incidence of myocarditis is not known. From the available data, it has been estimated that the condition causes about 1 to 10 cases per 100,000 individuals. The median age of onset of the disease is about 42 years. It has also been estimated that, 5 to 20% of sudden death among young adults occurred due to onset of myocarditis. About 50% of individuals with HIV develop myocarditis as a secondary complication  .
The condition of myocarditis occurs due to response to an infection which causes the middle layers of the heart muscles to undergo inflammation. Such a type of disease can also strike healthy individuals and it may rapidly progress to arrhythmia and heart failure. Myocarditis can further be classified into the following 4 categories which include:
- Fulminant myocarditis primarily occurs due to viral infection causing ventricular dysfunction. The condition can either resolve spontaneously or it can even turn fatal.
- Acute myocarditis also causes ventricular dysfunction, which progresses to dilated cardiomyopathy.
- Chronic active myocarditis is characterized by ventricular dysfunction accompanied by chronic inflammatory changes.
- Chronic persistent myocarditis, wherein there is no ventricular dysfunction but persistent histologic infiltrate .
The following steps can to certain extent help in preventing the onset of myocarditis:
- Promptly treating all type of viral infections and preventing contact with those suffering from the same until they have completely recovered.
- Following good personal hygiene can help in preventing infections.
- Getting regular immunization shots would also go a long way in prevention against the types of viruses that may cause myocarditis.
Myocarditis is also referred to as inflammatory cardiomyopathy. It may present with mild symptoms that resolve on their own seldom requiring treatment. However, in many cases it can also cause severe symptoms and devastating complications. This may occur when the pumping action of the heart weakens to such an extent that it is no longer capable of pumping blood to the rest of the body. In addition, clots can also develop which would in turn pave way for development of heart attack or stroke .
- Definition: Myocarditis is inflammation of the myocardium of the heart. It is mostly caused due to viral infections that cause the muscles of the heart to undergo inflammation.
- Cause: Most commonly, viral infections are the major cause. In addition, allergic reactions to certain antibiotics, anti-seizure drugs or illegal drugs can also cause development of myocarditis.
- Symptoms: Symptoms of myocarditis include difficulty in breathing, shortness of breath at rest and during physical activity, chest pain, fatigue, fever, headache and body ache.
- Diagnosis: Myocarditis is diagnosed using electrocardiogram, holter monitor and imaging studies such as X-ray and MRI. In addition to these methods, blood tests, cardiac catheterization, biopsy and echocardiogram are also indicated.
- Treatment: Antibiotics form the preliminary basis of treatment regime if bacterial infections are the source of myocarditis. In addition, medications such as ACE inhibitors, beta blockers, diuretics are also administered for relieving the symptoms and correcting the underlying disease condition. Heart transplantation may also be required if there is severe damage to the heart muscles.
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