Myocarditis

Symptoms Of 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

Causes Of Myocarditis

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, to name a few. 

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

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, and arsenicals)

• Anti-cancer medications (anthracyclines, cyclophosphamide, 5-fluorouracil, etc)

6. Autoimmune conditions

• Systemic lupus erythematosus

•  Rheumatoid arthritis
  
  

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. 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).

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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 cocaine, amphetamines, or intravenous recreational drugs
  
  

4. Other causes

• Poor dental health
  
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• Chest injury

• End-stage kidney disease

• Chagas disease, prevalent in Central and South America, causes myocarditis and is spread by parasitic insects

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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:

1. 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 help diagnose myocarditis due to infections.

• CRP: Increased levels of CRP (C-reactive protein) act as an inflammatory marker which can suggest myocarditis.

• 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 can indicate damage to the heart muscle.

2. 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 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, and shape, as well as 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 that is caused due to blockage in the coronary arteries).
  
  

4. Micro-RNA profiling

• It checks small RNA molecules in tissues or blood to understand how genes are controlled.

• This test is done to detect acute and chronic myocarditis or 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

• Practicing good hygiene, like washing hands before eating or after using the toilet, is essential. 

• Cleaning cuts or scrapes immediately helps prevent infections.

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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.

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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.

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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. 

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Specialist To Visit

Always remember, that the symptoms of myocarditis are similar to those of a heart attack. Specialists who can help diagnose and treat myocarditis include:

• General physician

• Cardiologists

• Cardiothoracic surgeons

A general physician can diagnose myocarditis and provide initial treatment, including symptom management and refer to a specialist.

A cardiologist specializes in advanced diagnostics, medical management, and monitoring of myocarditis-related heart issues.

A cardiothoracic surgeon handles severe cases of myocarditis requiring surgical interventions.

When to see a doctor?

Make sure to get in touch with your doctor if you experience:

• Persistent chest pain

• Shortness of breath, especially at rest or during mild activity

• Unexplained fatigue

• Rapid or irregular heartbeats

• Fainting or dizziness

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Treatment Of Myocarditis

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, like 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 the workload on the heart. These may include the following:

• 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.

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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:

• IVIG (Intravenous immunoglobulin): is a treatment that helps control inflammation and immune responses by providing antibodies.

• 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. 

• Intra-aortic balloon pump: Also known as IABP, it is a therapeutic device that allows the heart to pump more blood and reduce its load.

• Extracorporeal membrane oxygenation (ECMO): ECMO is a respiratory or cardiac support machine that allows the lungs and heart to function normally. 

• 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.

Home-care For Myocarditis

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

1. Astragalus: Also known as astragalus membranaceus is a type of flowering plant that 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.

2. Red sage: Also known as danshen, it is a traditional Chinese medicine 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, capsule,to improve circulation.

3. Ginseng: It is a supplement that 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.

4. Sophora root: It is a well-known traditional Chinese Mongolian herbal medicine that 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.

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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:

• 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.

• 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.

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

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

• 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. 

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

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

• Sudden cardiac death or SCD: It is a life-threatening complication in which the heart may stop beating due to severe arrhythmia.
  
  

Alternative Treatment For Myocarditis

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

1. 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.

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2. Meditation

• Meditation can calm the nervous system, reducing stress-related heart strain and inflammation. 

• Regular practice can help stabilize heart rhythms and promote healing.

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3. 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.

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Living With Myocarditis

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:

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 doctor which type and amount of physical activity are safe for you. 
  
  

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. 
  
  

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3. 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.

4. 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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5. 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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