Myocarditis

Myocarditis is an inflammatory process of the heart muscle, also called myocardium, that can cause heart failure. The heart muscle is weakened and is not able to pump blood efficiently. Usually, the inflammation is causes by an infection by a virus or bacteria. It is the inflammation of the heart muscle, the myocardium. It is most often caused by an infection, but can also be causes by other factors such as autoimmune reactions, some drugs, and certain chemicals, including medication. So the condition can lead to a wide variety of cardiac symptoms, including fainting, heart failure, arrhythmia, heart murmur, and stroke. But myocarditis is a disease and inflammation of the heart muscle. An infection of the heart muscle (myocardium) by a virus, such as Coxsackie, is call infectious myocarditis. Lyme disease can also lead to myocarditis. Non-infectious myocarditis can be causes by certain medications, such as heart medications and antibiotics.

It is a condition in which the heart muscle (myocardium) becomes inflamed. Myocarditis can cause serious complications and even death. Many people who have myocarditis have no symptoms, or symptoms that are so mild they seem like part of the normal flu. But, although myocarditis is rare, it is also potentially deadly. So those people who do have symptoms, they can range from mild to severe. However, most people who develop myocarditis do not die from it.

Symptoms

Some people with early myocarditis have no symptoms. Others have milder symptoms.

Common symptoms of myocarditis include:

1. Chest pain
2. Fatigue
3. Swelling in the legs, ankles, and feet
4. Fast or irregular heartbeat (arrhythmia)
5. Shortness of breath, while at rest or during an activity
6. Feeling light-headed or feeling like you might faint.
7. Flu-like symptoms such as headache, body aches, joint pain, fever, or sore throat
8. Sometimes, the symptoms of myocarditis are similar to those of a heart attack. If you have unexplained chest pain and shortness of breath, get emergency medical help.

Myocarditis in Children

When myocarditis develops in children, symptoms may include:

1. Difficulty breathing
2. Chest pain
3. to pass out
4. fever
5. Breathing fast
6. Fast or irregular heart rhythm (arrhythmia)

Types

There are many types of myocarditis; Some examples include:

Acute myocarditis

It describes a relatively recent or rapid onset of myocarditis and is usually causes by a viral infection. Acute myocarditis may develop suddenly, and symptoms may resolve rapidly.

Chronic myocarditis

Chronic myocarditis occurs when the disease takes longer to heal than usual or when symptoms recur after the condition has been treated. It can be caused by more common inflammatory conditions such as autoimmune disorders, in which your immune system attacks healthy cells and tissues in your body.

Lymphocytic myocarditis

Lymphocytic myocarditis is a rare form of myocarditis that can result in hospitalization for intensive care. This happens when white blood cells (lymphocytes) enter and cause inflammation in the heart muscle.

Causes

Common cause of myocarditis is Viral Infection.

When you have one, your body makes cells to fight the virus. So these cells release chemicals. If disease-fighting cells enter your heart, some of the chemicals they release can cause inflammation of your heart muscle.

Some things that can cause myocarditis to include:

1. Coxsackie B virus
2. Epstein-Barr virus (EBV)
3. Cytomegalovirus (CMV)
4. Hepatitis C
5. Herpes
6. HIV
7. Parvovirus
8. Chlamydia (a common sexually transmitted disease)
9. Mycoplasma (bacteria that cause lung infections)
10. Streptococcal (strep) bacteria
11. Staphylococcal (staph) bacteria
12. Treponema (causes fever)
13. Borrelia (causes Lyme disease)
14. Fungal and parasitic infections.

Other causes include allergic reactions to certain chemicals or drugs or toxins such as:

1. Wines
2. Drugs
3. Lead
4. spider bite
5. Wasp sting
6. snake bite
7. Chemotherapy and radiation therapy

Diagnosis

Unfortunately, to the dismay of parents and doctors, there is no specific test for myocarditis. This is mostly a clinical diagnosis where the doctor must rely on the history provided by the family and the physical examination of the child.

There are several tests that can be done to help diagnose myocarditis.

1. The most common test is a chest X-ray. Often the heart is enlarged, the blood vessels in the lungs are enlarged, and fluid can enter the lungs.
2. An electrocardiogram can also provide helpful clues if the diagnosis is suspected. However, results may be non-specific. Abnormal heartbeats may also occur with this disease.
3. An echocardiogram, or ultrasound of the heart, may be used to look at the size and overall function of the heart. This helps confirm the clinical diagnosis as well as rule out the presence of blood clots within the heart. Blood clots can form when blood does not move easily through the heart.
4. Other blood tests can help check how well the liver and kidneys are working. Blood counts and specific tests for infection may also be done.
5. The most accurate way to diagnose this disease is to perform a heart biopsy during cardiac catheterization. This involves using a long catheter that passes through a large blood vessel in the leg. Once the catheter is in the heart, a small piece of the heart muscle is taken and sent to a pathologist to look at under a microscope.

Results vary, but it is diagnoses by this method up to 65 percent of the time. Biopsy results are not 100% accurate because areas of the heart affectes by inflammation are often faint and may be missed.

Treatment

Often, myocarditis gets better on its own or with treatment. Treatment for this disease focuses on the cause and symptoms of the heart defect.

Medicines

People with mild myocarditis may need only rest and medication. Medications to treat myocarditis may include:

• Corticosteroids. These drugs suppress the immune system. They can be uses to treat some rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis.
• Heart medications. If myocarditis is causing severe heart failure or irregular heartbeats, medications may be given to reduce the risk of blood clots in the heart. For a weak heart, medications can help remove excess fluid from the body and reduce pressure on the heart. Some types of drugs that may be given are diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs).
• Medicines to treat chronic conditions. Sometimes another health condition, like lupus, causes myocarditis. Treating the underlying condition can help reduce heart muscle inflammation.

Some people with myocarditis may only need medication for a few months and then make a full recovery. Others may have long-term, permanent heart damage that requires lifelong medication. After a diagnosis of myocarditis, regular health check-ups are important to check for possible complications.

Surgery and Procedures

If you have acute myocarditis, you will need aggressive treatment, which may include:

• IV medications. Medicines given through an IV are uses to quickly improve the heart’s pumping ability.
• Ventricular assist device (VAD). A VAD helps pump blood from the heart’s lower chambers (ventricles) to the rest of the body. It is a treatment for weak hearts or heart failure. A VAD may be uses to help the heart function while waiting for other treatments, such as a heart transplant.
• Intra-aortic balloon pump. This device helps to increase blood flow and reduce the pressure on the heart. So a heart doctor (cardiologist) inserts a thin tube (catheter) into a blood vessel in the leg and leads it to the heart. But a balloon attaches to the end of the catheter is inflates and released into the main artery leading from the heart (aorta) to the body.
• Extracorporeal membrane oxygenation (ECMO). An ECMO machine works like a lung. It removes carbon dioxide as well as adds oxygen to the blood. If you have severe heart failure, this device can deliver oxygen to your body. During ECMO, blood is removes from the body, passed through a machine, and then returned to the body.

• ECMO may be uses to help the heart recover or while waiting for other treatments, such as a heart transplant.
• Heart transplant. An urgent heart transplant may be needes for people with very severe myocarditis.