Myocarditis

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

Symptoms in Adults

• Chest pain or discomfort
• Difficulty breathing or shortness of breath
• Edema (swelling in ankles, legs, or feet)
• Palpitations or abnormal heartbeat
• Infection-related fever
• Flu-like symptoms (sore throat, headache, body aches, joint pain)

Symptoms in Children or Infants

• Poor appetite
• Stomach ache
• Weakness
• Chronic cough
• Rashes
• Fever
• Diarrhea
• Sore throat
• Difficulty breathing
• Joint pain

Myocarditis is a rare health condition. 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, among others.
2. Bacteria
   The bacteria that may cause inflammation of the myocardium include corynebacterium, meningococci, streptococci, and clostridia.
3. Fungi
   Although rare, fungal myocarditis can occur due to infections caused by various fungi, including candida, aspergillus, and histoplasma.
4. Parasites
   Certain parasites, such as Trypanosoma cruzi, Toxoplasma, and Trichinella, can cause myocarditis, with Chagas' disease being the most significant parasitic heart infection.
5. Hypersensitivity or toxic reaction
   Toxic myocarditis may be triggered by medications such as:
   • Dobutamine
   • Phenytoin
   • Antibiotics (ampicillin, cephalosporins, tetracyclines, etc.)
   • Psychiatric medications (tricyclic antidepressants, benzodiazepines, etc.)
   • Recreational/illicit drugs (methamphetamine and cocaine)
   • Heavy metals (copper, lead, arsenicals)
   • Anti-cancer medications (anthracyclines, cyclophosphamide, 5-fluorouracil, etc.)
6. Autoimmune conditions
   Conditions such as systemic lupus erythematosus and rheumatoid arthritis can lead to myocarditis.
7. Idiopathic myocarditis
   When inflammation of the heart muscle develops without any identified cause, it is referred to as idiopathic myocarditis.

The risk factors for myocarditis include the following:

1. Non-modifiable factors
   • Age (can affect all ages, but mostly occurs in young adults)
   • Family history and genetics
   • Gender (men are often more prone to developing myocarditis than women)
2. Medical conditions
   • HIV infections/AIDS
   • COVID-19
   • Eating disorders such as anorexia nervosa
   • Skin injuries caused by burns or infections
   • Diabetes

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3. Lifestyle choices
   • Excessive consumption of alcohol
   • Use of cocaine, amphetamines, or intravenous recreational drugs
4. Other causes
   • Poor dental health
   • Chest injury
   • End-stage kidney disease
   • Chagas disease, prevalent in Central and South America, causes myocarditis and is spread by parasitic insects

Learn about 7 key risk factors for heart disease and how to manage them.

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

1. Blood tests

• Creatine kinase (CK): This blood test checks the level of CK in the blood. Elevated levels may indicate an infection in the myocardium.
• Total leukocyte count: An abnormal white blood cell (WBC) count can help diagnose myocarditis due to infections.
• CRP: Increased levels of C-reactive protein (CRP) serve as an inflammatory marker that can suggest myocarditis.
• ESR: An elevated erythrocyte sedimentation rate (ESR) is another marker for inflammation in the body.
• Troponin levels: Increased levels of circulating troponin in the blood can indicate damage to the heart muscle.

2. Imaging tests

• Electrocardiography: An electrocardiogram is performed to detect the electrical activity of the heart.
• Chest X-ray: A chest X-ray may help check for enlargement of the heart or accumulation of fluid in the heart's sac.
• Echocardiography: This test uses high-pitched sound waves to produce images of the heart. It also aids in blood flow analysis and evaluation of valve problems, heart enlargement, and the presence of clots 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, swelling, inflammation, or scarring of the heart.

3. Biopsy

Cardiac catheterization involves threading a tiny tube into the heart to measure or biopsy 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 caused by blockage in the coronary arteries)

4. Micro-RNA profiling

This test checks small RNA molecules in tissues or blood to understand gene regulation. It is performed to detect acute and chronic myocarditis or to assess the severity of myocardial damage.

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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
   Practicing good hygiene, like washing hands before eating or after using the toilet, is essential. Cleaning cuts or scrapes immediately helps prevent infections. Keep germs at bay with proper hygiene.
3. Dental care
   Along with brushing and flossing your teeth every day, visit the dentist regularly for timely diagnosis and treatment of any dental issues. Oral care is often clouded by myths and misconceptions that can deter us from seeing the dentist.
4. Practice safe sex
   Safe sex practices can prevent an HIV infection, which can weaken the immune system and increase your risk of developing myocarditis. Protect yourself and your partner by practicing safe sex to prevent HIV and reduce health risks.
5. Maintain a healthy weight
   Obesity can directly increase the risk of complications due to myocarditis. A healthy weight can go a long way in keeping the heart healthy.
6. Avoid exposure to ticks
   Certain tick-borne infections, like Lyme disease, can cause myocarditis by triggering heart inflammation. Make sure to wear long pants and cover your 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
   Vaccination can help prevent myocarditis by reducing the risk of viral infections that may cause heart inflammation. Make sure to get vaccinated to prevent COVID-19, influenza, rubella, measles, mumps, and poliomyelitis.

Take care of your heart! Read simple ways to prevent heart disease!

Treatment options for myocarditis vary based on the underlying cause and the severity of the condition. The following approaches are commonly used to manage myocarditis:

1. Antibiotics
   If myocarditis is due to an underlying cause, such as a bacterial infection, the doctor may prescribe antibiotics. Some commonly used drugs are:
   • Amoxycillin
   • Doxycycline
2. Corticosteroids
   Autoimmune conditions like lupus can cause myocarditis, and in such cases, doctors may prescribe corticosteroids to reduce the immune response, such as:
   • Ciclosporin
   • Prednisolone
3. Medications for heart failure
   The doctor is likely to prescribe diuretics, beta-blockers, and ACE (angiotensin-converting enzyme) inhibitors to minimize edema and reduce the workload on the heart. These may include:
   • Enalapril (ACE inhibitor)
   • Lisinopril (ACE inhibitor)
   • Metoprolol succinate (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 reduce the severity of the disease and decrease mortality.

If symptoms are severe and medications are not effective, more proactive treatment options might be considered. These include:

• IVIG (Intravenous immunoglobulin): A treatment that helps control inflammation and immune responses by providing antibodies.
• VAD (Ventricular assist device): A mechanical device used to pump an adequate amount of blood from the ventricles (lower chambers) of the heart to other parts of the body.
• Intra-aortic balloon pump: Also known as IABP, it is a therapeutic device that allows the heart to pump more blood and reduces its load.
• Extracorporeal membrane oxygenation (ECMO): A respiratory or cardiac support machine that allows the lungs and heart to function normally.
• Heart transplant: In severe cases where other myocarditis treatments have not been effective, the doctor may suggest heart transplantation surgery.

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Some herbal remedies have shown good results in managing cardiac care. However, it is important to take a doctor's advice before starting any treatment.

• Astragalus: Also known as astragalus membranaceus, this flowering plant has been used for centuries in traditional Chinese medicine. It can support heart health by reducing inflammation and improving circulation.
  How to use it: Brew as tea, take as a supplement, or use in soups for heart health benefits.
• Red sage: Also known as danshen, this traditional Chinese medicine is made from the dried root of the red sage plant. It can enhance blood flow and protect heart muscles.
  How to use it: Consume as a decoction or capsule to improve circulation.
• Ginseng: This supplement has traditionally been used to help boost the immune system. Studies suggest that it can also improve cardiac function.
  How to use it: Take as tea, capsules, or extracts to boost immunity and support heart function.
• Sophora root: This well-known traditional Chinese Mongolian herbal medicine has been utilized in clinical practice. It can help reduce inflammation and support cardiovascular health.
  How to use it: Use in herbal decoctions or supplements to reduce inflammation and support the heart.

Timely treatment of myocarditis has a good prognosis without long-term complications. However, severe cases may result in some permanent complications related to heart muscles, including:

• Heart failure: Myocarditis, if left untreated, can damage the heart muscles, making it inefficient and potentially leading to heart failure.
• Stroke or heart attack: If the heart is unable to pump an adequate amount of blood, there is a risk of blood clot formation. A clot may block an artery in the heart, resulting in a heart attack. If the clot travels to the brain, it can cause a stroke.
• Arrhythmia: Injury or weakness in the heart muscles may lead to arrhythmia, characterized by an irregular heart rhythm.
• Ventricular dysrhythmias: These abnormal heart rhythms cause the lower chambers of the heart to twitch instead of pump, which can limit or stop blood supply to the body.
• Left ventricular aneurysm: This condition occurs when a section of the heart muscle in the left ventricle stretches and becomes very thin.
• Dilated cardiomyopathy: This type of heart muscle disease causes the heart chambers (ventricles) to thin and stretch, leading to enlargement.
• Cardiogenic shock: A life-threatening condition where the heart suddenly cannot pump enough blood to meet the body's needs.
• Sudden cardiac death (SCD): A life-threatening complication where the heart may stop beating due to severe arrhythmia.

Alternative therapies can complement medical treatment in managing symptoms. The following may help with myocarditis and its contributing factors:

• Yoga: Yoga can improve circulation, reduce inflammation, and enhance heart function, benefiting those with myocarditis. Gentle poses can also help lower stress and support overall cardiovascular health. Read This
• Meditation: Meditation can calm the nervous system, reducing stress-related heart strain and inflammation. Regular practice can help stabilize heart rhythms and promote healing. Meditation can do wonders for your body and soul. Read More
• Breathing exercises: Deep breathing can lower blood pressure, enhance oxygen flow, and reduce heart strain. It can also activate the relaxation response, supporting heart recovery and overall well-being. Click Here

Myocarditis can sometimes show no symptoms and may resolve on its own, with many individuals living a normal lifespan. While some may need medications or surgery, a healthy lifestyle and alternative therapies can support heart health.

Here are some home care tips for managing myocarditis effectively:

• 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 doctor which type and amount of physical activity are safe for you.
• Eat a heart-friendly diet
  Foods that are good for your heart include green leafy vegetables, fruits, nuts, whole grains, and low-fat dairy products. Try to limit the consumption of trans fats, salt, saturated fats, cholesterol, red meat, and sugary foods. Want to learn which foods can keep your heart strong and healthy? Click Here
• 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 and the heart. Thus, it is important to keep alcohol intake to a minimum.
• 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. Explore our smoking cessation range that can help you quit smoking. Quit Today
• 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. Your heart health is the key to overall good health. Read tips from cardiologists to keep your heart healthy. Tap Here