Myocarditis: A Deep Dive into its Diagnosis and Prevention

Most cases of myocarditis occur in otherwise healthy adults, and rapid progression of the condition marks many cases. There are many potential causes of myocarditis including:

• Viral infection
• Cytomegalovirus, Hepatitis C, Herpes, HIV, and Parvovirus, among others
• Bacterial infection (e.g., Borrelia (Lyme disease), chlamydia, mycoplasma, streptococcal, staphylococcal)
• Certain medications (e.g., chemotherapy and radiation therapy)
• Toxins (e.g., metal poisons, snake bites, spider bites)
• Autoimmune disorders (e.g., lupus, rheumatoid arthritis)

Often, myocarditis has no symptoms at all. If it is a mild case, a person may even recover from the inflammatory condition without ever knowing they had it.

In symptomatic cases, the most common signs and symptoms include:

• Chest pain
• Shortness of breath
• Abnormal heartbeat
• Light-headedness
• A sharp or stabbing chest pain
• Fatigue
• Edema or swelling in the legs
• Sudden loss of consciousness
• Flu-like symptoms: fever, muscle aches, sore throat, upper respiratory infection

As soon as a person experiences chest pain and shortness of breath, a visit to an emergency care center is in order. After getting a full report on your symptoms and history, your doctor may order the following tests:

• Blood tests to measure heart muscle enzyme levels (CPK levels)
• Blood tests to measure white blood cell count for signs of infection
• Electrocardiogram (ECG). To measure cardiac activity
• Chest X-ray. To show the size and shape of the heart, and whether there is fluid in or around the heart.
• Echocardiogram. Cardiac ultrasound to view the heart’s chambers, valves, walls, and blood vessels
• MRI. Cardiac MRI to show the shape, size, and structure of the heart.
• Endomyocardial biopsy.

If an underlying infection causes myocarditis, the patient will most likely first be treated for that infection. Many times, myocarditis resolves once the underlying infection is cleared. If myocarditis is severe or chronic, the patient may be given medication used to treat heart failure. They will most likely be told to rest for up to six months and will be instructed to stay on a low-sodium diet. A patient may be given medication to reduce the heart’s workload, and medication to reduce edema and swelling. In severe cases, patients may be treated with IV medications, vascular assist devices, extracorporeal membrane oxygenation, or even a heart transplant. Patients who have developed arrhythmia may need a pacemaker.

Myocarditis can recur, and in some cases may lead to a permanently enlarged heart. Unfortunately, because myocarditis is rare, there are no known lifestyle changes. Or medical treatments to prevent it.

Patients with acute myocarditis who rapidly recover have a very good outlook. Patients with recurring or chronic myocarditis with damage to the heart tissue are less likely to recover fully, and the prognosis declines as the damage increases. These patients may need to continue taking heart medication indefinitely or have an implanted pacemaker.