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Myocarditis

myocarditis


Myocarditis means inflammation of the myocardium. The myocardium is the heart muscle. Myocarditis can affect anyone and occur at any age. Causes include the following:

Viral infection

The most common infections causing myocarditis are viruses called Coxsackie B and adenovirus. Other viruses which sometimes cause myocarditis include: echoviruses, influenza (flu), Epstein-Barr virus (glandular fever), rubella (german measles virus), varicella (chickenpox virus), mumps, measles, parvoviruses, yellow fever, dengue fever, polio, rabies and the viruses that cause hepatitis A and C.

Unknown cause (idiopathic myocarditis)

In many people with myocarditis, the cause is not found. However, for the majority of these people it is likely to be caused by a virus that could not be confirmed by a test.

Other causes

Other causes of myocarditis are much less common. They include:

The heart can sometimes become infected by various bacteria, fungi, parasites and other germs. For example:

  • Chagas' disease. This is an infection caused by a protozoan called Trypanosoma cruzi. You can catch this infection from an insect bite in certain tropical countries. With this infection a form of myocarditis develops many years after the initial infection. This leads to a gradual destruction of heart tissue which can cause severe heart failure.
  • Lyme disease. This is an infection caused by a bacterium called Borrelia burgdorferi. You can catch this infection by a bite from an infected tick.
  • Giant-cell myocarditis. The cause is not known but it tends to develop in some people who have a thymoma (a growth of the thymus gland), systemic lupus erythematosus (SLE) - also known as lupus - or thyrotoxicosis (overactive thyroid).
  • Excess alcohol, radiation, certain chemicals and certain poisons.
  • Heart transplant rejection.

What are the symptoms of myocarditis?

If symptoms do develop they can include:

  • Chest pain.
  • Fever
  • A fast heartbeat
  • An irregular heartbeat.
  • Tiredness.
  • Shortness of breath.

Possible complications include:

  • Sudden loss of consciousness (syncope).
  • Cardiac arrhythmias (abnormally fast, slow or irregular heartbeats).
  • Heart failure which can cause shortness of breath, swelling of the legs and tiredness.

How is myocarditis diagnosed?

Your symptoms are likely to lead your doctor to make the possible diagnosis of myocarditis. An ECG test may be done. A chest X-ray may show that your heart is larger than normal. It is also likely you will have some blood tests to test for some of the viruses that can cause myocarditis. An echocardiogram (ultrasound scan of the heart) may also be arranged. Some people need to have an endomyocardial biopsy. This involves taking a very small tissue sample of the heart to investigate for the cause of myocarditis.

What is the treatment of myocarditis?

The treatment of myocarditis will depend on the cause and severity of your myocarditis.

  • Bed rest is usually recommended at the onset of myocarditis and athletic activities should be avoided for six months to avoid putting undue strain on the heart muscle.
  • Painkillers will help to ease chest pain and fever.
  • There is no treatment that will cure a virus infection. However, for most people the illness is self limiting.
  • Medication to treat heart failure or irregular heartbeats.
  • A pacemaker if certain irregular heart rhythms develop.
  • Antibiotics if the cause of the myocarditis is a bacterial infection.
  • Steroid medication if the cause is giant-cell myocarditis.
  • Stopping alcohol if alcohol is the cause.

What is the prognosis ?

In most cases of viral myocarditis, the illness goes away on-its-own and there are no complications. Symptoms may last only a few days or weeks. However, some types of viral infection are more serious and can cause more severe or persistent inflammation and complications.

In some cases, the inflammation and heart damage are so severe that the only treatment option is a heart transplant. Myocarditis is fatal in some cases. In some cases death occurs some time after the diagnosis is made if the condition gets worse and becomes unresponsive to treatment.


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