Last updated on January 10, 2022
Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review), Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs
Last updated on January 10, 2022
The myocardium is the muscular layer of the heart and myocarditis means inflammation of the myocardium. It can cause significant damage to this vital organ, leading to heart failure, arrhythmias (A problem with the heart rate: When the heart either beats too fast or too slow) and sudden death.
Myocarditis is an uncommon condition, but still affects a lot of people in their lifetime. In 2017, 3.1 million people were affected with myocarditis. The prevalence increases with age as well. Myocarditis usually affects the left side of the heart, which pumps blood to all parts of your body. It can cause a variety of symptoms like chest pain, shortness of breath and swelling in the legs. Myocarditis can be acute or chronic and it can present as either an infectious process (viral, bacterial) or an autoimmune disorder.
This comprehensive guide will discuss myocarditis meaning, what its causes are, how it affects you, the heart muscle pain symptoms and what are the available treatments, among others. So, keep on reading.
The myocardium is the muscular layer of the heart and myocarditis means inflammation of the myocardium. It can cause significant damage to this vital organ, leading to heart failure, arrhythmias (A problem with the heart rate: When the heart either beats too fast or too slow) and sudden death.
Myocarditis is an uncommon condition, but still affects a lot of people in their lifetime. In 2017, 3.1 million people were affected with myocarditis. The prevalence increases with age as well. Myocarditis usually affects the left side of the heart, which pumps blood to all parts of your body. It can cause a variety of symptoms like chest pain, shortness of breath and swelling in the legs. Myocarditis can be acute or chronic and it can present as either an infectious process (viral, bacterial) or an autoimmune disorder.
This comprehensive guide will discuss myocarditis meaning, what its causes are, how it affects you, the heart muscle pain symptoms and what are the available treatments, among others. So, keep on reading.
Written by
BDS, Assistant Manager (Medical Review)
Reviewed by
MBBS, MD (Pharmacology) Head, Medical Affairs
Myocarditis means an inflammation of the heart muscle called the myocardium that can cause significant damage to this vital organ, leading to heart failure (Condition where the heart doesn’t pump blood as well as it should), arrhythmias and even death. It can affect people of any age group but usually affects people in their 50s or older and it can be acute (viral) or chronic (autoimmune). However, chronic myocarditis is more common than acute viral myocarditis. The exact reason for chronic myocarditis is unclear, but chronic inflammatory conditions like autoimmune disorders, (rheumatic fever, lupus), HIV and hepatitis B have been linked to this disease.
Autoimmune diseases cause antibodies to attack your tissues by mistake. Myocarditis can also be caused by an infection in the heart muscle like toxoplasmosis or cytomegalovirus, bacterial infection (Mycobacterium tuberculosis), fungal infection (histoplasmosis) and parasitic diseases like Chagas disease.
More than half of the people who develop myocarditis experience no heart muscle pain symptoms at all. However, some may present with chest pain that worsens on exertion. Other common myocarditis signs include shortness of breath, rapid heart rate, swelling in legs/feet due to fluid retention, fatigue, loss of appetite, vomiting blood if there is bleeding inside the digestive tract, etc depending upon what exactly is causing myocardial inflammation of the heart.
The viral myocarditis diagnosis usually involves an electrocardiograph myocarditis test that records electrical activity within the heart, an echocardiogram (ultrasound of the heart) and blood tests. Myocarditis can be difficult to diagnose because symptoms are common with other conditions like coronary artery disease, congestive heart failure, etc.
Myocarditis may also occur as a complication of another condition like rheumatic fever or diabetes mellitus.
While there are no studies or reports on how many people in India suffer from myocarditis, evidence of myocarditis in COVID-19 patients has been found.
Myocarditis can be classified into many different types. The most important types of myocarditis are covered here:
Acute Myocarditis
Acute myocarditis refers to a type of myocarditis that develops suddenly. This is usually caused by a viral infection. While the symptoms of acute myocarditis might develop rapidly, they may get resolved very quickly as well.
Chronic Myocarditis
Chronic myocarditis is a type of myocarditis that takes a long time to develop. Treating chronic myocarditis also takes a relatively long time and the symptoms may reappear after treatment as well. Chronic myocarditis is often caused by chronic inflammatory conditions, like autoimmune diseases, in which the immune system attacks cells of its own body.
Lymphocytic Myocarditis
Lymphocytic Myocarditis is a dangerous type of myocarditis that can lead to hospitalisation for immediate care. In this type of myocarditis, the lymphocytes (white blood cells) enter the heart muscle and cause inflammation. This can happen after a viral attack.
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When it comes to myocarditis causes, many factors can cause this disease in an individual. While the majority of cases are not exactly known, there have been a few studies on the common cause of myocarditis and risk factors all over India.
Viral: Viral infections like Coxsackie B viruses, Epstein-Barr virus, Cytomegalovirus, Hepatitis B and C, COVID-19, etc can trigger myocarditis. Myocarditis can also be caused due to the Human Immunodeficiency Virus (HIV). Viral myocarditis causes the patient to become more vulnerable to developing heart failure.
Bacterial: Myocarditis is caused due to bacterial infections such as Streptococci, meningococci, clostridia, Corynebacterium, mycobacteria, Staphylococcus aureus (methicillin-resistant), Mycobacterium marinum (fish tank granuloma), etc. It is important to note that bacterial myocarditis can lead to severe heart failure if not treated well on time.
Fungal causes: Infectious myocarditis is also caused due to fungal infections like Histoplasmosis, Candidiasis (systemic), Pneumocystis jirovecii pneumonia, among others. Fungal myocarditis can lead to the formation of abscesses (a painful collection of pus) in the heart muscle. Myocarditis caused by fungi is often resistant to treatment and leads to severe damage if not managed properly.
Autoimmune diseases: Myocarditis can be triggered by autoimmune diseases like HIV, connective tissue disease, rheumatic fever, Sjogren’s syndrome, Systemic Lupus Erythematosus, etc.
Other causes: Myocarditis causes can be some prescription drugs that include amiodarone, nitrofurantoin, methysergide, penicillamine, etc. A high dose of steroids can also lead to myocarditis in some cases. Conditions like preeclampsia and eclampsia are often responsible for causing myocyte injury (injury to the muscle cells) while giving birth leading to myocardial necrosis. Myocardial necrosis is a rare complication during pregnancy or childbirth where the mother may suffer from toxaemia (tissue death). It has also been reported that pregnant women who have suffered from hypertensive disorders are at an increased risk of infectious myocarditis. On the other hand, spider and snake bites can also lead to myocarditis.
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Symptoms of myocarditis in adults depend on the severity and type of myocardial inflammation. Viral myocarditis symptoms range from being completely asymptomatic to myocarditis heart failure symptoms that can even prove fatal if not treated at an early stage.
Chest pain: Viral myocarditis symptoms include chest pain and discomfort. These signs may be felt on one side of the patient’s chest or even both sides. The symptoms can lead to cardiac ischemia (inadequate blood supply to heart muscles), which results in shortness of breath, fainting spells, etc. It is important to get an early diagnosis prognosis from the doctor to rule out any severe symptoms.
Irregular heartbeat: Infectious myocarditis also causes irregular heartbeat or a rapid heart rate due to inflammation. This can lead to cardiac ischemia. Irregular heartbeat is also a sign of high blood pressure leading to signs of heart damage that can even prove fatal. Other cardiac arrhythmias like atrial fibrillation, supraventricular tachycardia, etc may be experienced by the patient when suffering from myocarditis. These heart rhythm issues are often caused due to inflammation of the myocardial tissue and reduced blood supply to the heart muscles (ischemic heart disease).
Fatigue: Myocarditis can cause extreme fatigue that could make the patient feel very weak and tired all the time. It is important to consult a doctor immediately if you are experiencing sudden weakness because it is a common sign of heart disease, which could prove fatal in some cases.
Swelling of ankles and legs due to fluid build-up: Myocarditis can also cause a rapid accumulation of fluid in the patient’s ankles and legs. Myocardial inflammation leads to heart failure, which results in poor blood flow through vessels, which reduces oxygen supply to various parts of your body, including your feet and hands. The reduced availability of oxygenated blood makes it difficult for the kidneys (which are responsible for removing waste products from the body), resulting in the accumulation of fluids like water around your lower limbs due to gravity.
Shortness of breath: Myocarditis often results in shortness of breath, dizziness and fatigue as the patient starts suffering from chronic myocardial ischemia (inadequate blood supply). In certain cases where myocarditis has been triggered by an autoimmune disease like lupus, patients can suffer from swelling caused due to fluid accumulation around the body leading to weight gain, etc which makes it difficult for them to breathe properly.
Signs of a viral infection: Symptoms like fever, diarrhoea, sore throat, etc are signs of myocarditis caused due to a viral infection. It must be noted that myocarditis symptoms can also vary depending on the type of virus or infectious agent responsible for triggering the inflammation and injury, as myocarditis is an immune response triggered by these pathogens in certain susceptible individuals with weakened heart muscles.
According to myocarditis meaning, it is a condition that worsens with time and can lead to signs of heart damage if severe symptoms are left untreated. The patient may experience shortness of breath, fatigue, etc due to myocardial infarction (heart attack), which could prove fatal in some cases without the right treatment at the right time.
Thus, it is important to consult a doctor if symptoms are being experienced despite the use of over-the-counter medications, as it could be a severe case. Myocarditis prognosis depends on several factors like underlying cause, age and severity of the symptoms, so you must seek immediate medical care from an expert cardiologist in India who will help in getting an early myocarditis diagnosis and treatment before any major myocarditis complications arise.
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If myocarditis and cardiomyopathy are suspected, a detailed physical examination and medical history of the patient will be taken before any myocardial damage occurs.
You should consult a doctor immediately if myocarditis symptoms are experienced, as it could be a severe case. The sooner myocarditis is diagnosed, the better the chances for recovery. If myocarditis is suspected or you experience myocardial damage, then you must take immediate steps to get tested by visiting an emergency department, cardiology department at one of the best viral myocarditis treatment centres in India.
Medical myocarditis diagnosis includes a series of myocarditis tests and analyses to confirm the condition. That is, myocarditis can be diagnosed with a single test or it may take several tests to confirm. The following are some tests issued by the doctor to check whether a patient has myocarditis:
Clinical Examination and history – Your doctor will ask about your complete medical history, ongoing medications, other illnesses to get an understanding of the condition. A thorough clinical exam is another important step in the diagnosis. Your doctor will also listen to your heart sounds and breathing with the help of a stethoscope.
Blood tests: Blood tests can help determine myocardial damage by checking for myoglobin, troponin (both substances are proteins released into the bloodstream when the heart muscle has been damaged).Certain markers of inflammation like CRP or hs- CRP and tests to rule out underlying causes eg- ANA and reflex panel for autoimmune disorders can be advised by your doctor.
Chest X-ray: A chest x-ray will show signs of fluid accumulation around the lungs and damage to the heart.
MRI Scanning: Magnetic Resonance Imaging (MRI) scanning helps diagnose myocarditis through imaging that creates images using a magnetic field An MRI scan works by producing high-quality images that help doctors see any abnormalities present inside your body with a fair amount of clarity.
ECG: An Electrocardiogram (ECG) records the electrical impulses that cause your heart muscles to contract and pump blood throughout your body. An Electrocardiogram uses electrodes (small discs) with wires that are attached to your skin, which transmit signals to an ECG machine.
Echocardiogram: An echocardiogram is an ultrasound test that uses sound waves to create images of the heart and chambers, which can help detect signs of myocarditis like an enlarged heart.
Biopsies: Myocarditis can also be diagnosed through myocardial biopsy, which is a procedure in which the doctor inserts a thin needle into your heart via a catheter to extract a tiny sample of heart muscle for testing. This is a rarely used diagnostic procedure.
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Myocarditis treatment involves several interventions that aim to treat myocardial inflammation and damage myocarditis treatment in India depends upon the underlying cause. It may include the following methods:
Primary step in the treatment of myocarditis, is to identify the underlying cause of inflammation. Treating the underlying cause will help in reducing further damage to the myocardium.
The doctors may ask you to reduce your salt intake and prescribe a healthy nutrition plan depending on your body. An activity plan will be prepared by a heart specialist after the damage has been measured through imaging tests. Therefore, you need to be mindful of what you eat during the recovery period. Also, the doctor may suggest you not engage in strenuous activities that can cause your heart to exert.
Several medications can help reduce the symptoms of myocarditis and help avoid further complications. Your doctor will prescribe certain medicines based on your age, your underlying conditions and the severity of your symptoms. Do not self-medicate at any point in time. Make sure to follow the instructions and dosage prescribed by your doctor.
The patient may be hospitalised for certain medical procedures if needed. Some patients may require the use of
Pacemakers: Myocarditis treatment in India may include myocardial pacemakers, which are surgically implanted devices that provide electrical impulses to the heart muscles and control your heart rate. These implants help restore the normal function of the heart muscles by enabling them to properly communicate with each other again.
IV Medications: Myocarditis treatment may also involve IV medications that can help reduce myocyte damage and inflammation by fighting infection and removing harmful antibodies from the circulatory system. A single dose of IV medicine has shown to provide an immediate improvement for some patients, especially those suffering from signs of acute heart failure and myocarditis.
ECMO: Extracorporeal Membrane Oxygenation (ECMO) is a life support system that provides myoglobin removal, myocyte restoration and respiratory assistance. ECMO consists of an external pump with tubing attached to the patient’s airway through the neck or chest wall. It helps provide myoglobin clearance by circulating your blood outside of your body into an artificial lung machine where carbon dioxide is removed from the myocytes. Then it returns cleansed blood back to the heart for re-oxygenation before being circulated throughout your body again.
Implantable cardioverter-defibrillator (ICD): Myocarditis treatment also includes ICDs which help in restoring the heart’s electrical activity.
Myocarditis treatment is a complex process. Myocyte damage can be extensive and myocardial scarring may result from this condition, which could affect the heart’s cardiac performance later on. Therefore, you need to watch your diet during the recovery period. Also, the doctor may suggest you not engage in strenuous activities that put your heart under strain.
Diet and activity restrictions: Patients are advised to take certain precautions when it comes to their diet and lifestyle during the recovery period. A diet plan and physical activity will be advised by your doctor and rehab experts.
Medical follow-ups: Patients must take regular follow-ups with their doctor to ensure that they are progressing towards recovery and not the other way around.
Caring for a loved one with myocarditis: Proper care must be provided to myocarditis patients, even if it is moral support.
The prognosis of people with myocarditis is generally good. Even people with severe myocarditis can completely recover with almost no complications. However, damage to the heart is also possible. Myocardial scarring may worsen the heart’s cardiac performance later on, so post-treatment monitoring and medical checkups are essential to ensure that no complications are occurring for patients. Some myocarditis complications may include:
Cardiomyopathy: Cardiomyopathy is a complication of the heart muscle that makes it difficult for the heart to pump blood.
Pericarditis: Myocarditis also affects the heart’s outer layer, called the pericardium. Myocyte inflammation may cause this condition to occur in some patients after treatment has finished successfully.
Stroke: Stroke is a complication of myocarditis, where a blood vessel in the brain becomes blocked and prevents oxygen from reaching that portion of the muscle. This condition may cause permanent damage to cells of the heart muscles if not treated immediately.
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Myocarditis of some types can be prevented by following a healthy lifestyle and eating a balanced diet. Here is what you need to know:
Maintaining good personal and oral hygiene: You must maintain good personal hygiene by following a regular oral care routine, including flossing daily and brushing your teeth twice per day with an antibacterial mouthwash.
Reducing exposure to viral infection: The most common cause of myocarditis is a viral infection. Reduce your chances of contracting viruses by staying away from crowded places and washing your hands regularly with soap and water or an anti-bacterial solution.
Practising safe sex to reduce the chances of getting HIV-related myocarditis: Myocarditis can be caused by diseases like HIV. So, practice safe sex and do not share needles with other people to minimize your chances of contracting HIV/AIDS.
Being vaccinated from diseases like Rubella and influenza that can cause myocarditis: The most common cause of myocarditis is viral diseases like Rubella and influenza. To avoid contracting these, get vaccinated against them.
Reducing exposure to insect bites: Myocarditis can also be caused by snake bites, spider and tick bites. So, to help prevent myocarditis, avoid being in contact with high grass and shrubs where ticks likely live.
Myocarditis is a condition that needs to be treated immediately to prevent any further complications to the heart. Patients need to follow their doctor’s orders carefully, including taking medical checkups regularly and adhering to dietary restrictions at all times while they recover from this disease.
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Myocarditis cure depends upon the underlying cause. If the damage is reversible and the cause is curable, myocarditis can be cured to some extent. But if the underlying condition cannot be cured or myocardial damage is irreversible, myocarditis symptoms can only be managed well with treatment from a good cardiologist.
Myocarditis is not always a fatal disease but can become life-threatening if left untreated.
Myocarditis may not heal completely, but the heart’s cardiac function returns to normal after a few months of treatment.
Myocarditis may not heal completely, but the heart’s cardiac function returns to normal after a few months of treatment.
Yes, taking antibiotics can help control myocarditis that is caused due to some bacterial infection. However, it is mandatory to consult your doctor before you take any medicines.
Damage caused by myocarditis may or may not be permanent, but some patients may experience a relapse of the disease.
Untreated myocarditis inflammation may cause heart failure, which can become life-threatening if not treated immediately.
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