Myocarditis or Inflammation of Heart Muscles

Chest Pain needs immediate medical attention to prevent life threatening events. All chest pains are not caused by heart diseases. As a patient one may not be knowledgeable to differentiate cardiac (heart related) or non-cardiac pain. Generally, one is of the opinion that chest pain is caused due to a heart condition, most of the times it is true but not always. There are many medical conditions that can result in development of chest pain. One such medical condition is myocarditis. In this article, we will read in detail about the various causes, symptoms and treatment of myocarditis. We will also look a hands-on experience of a patient who suddenly developed severe chest wall pain and was diagnosed with myocarditis.

Myocarditis or Inflammation of Heart Muscles

How Do We Define Myocarditis?

Myocarditis is the disease caused by inflammation of heart muscle. Myocarditis or inflammation of heart muscles is observed following viral or bacterial infection. Myocarditis is also associated with some of the systemic and autoimmune diseases. Some of the symptoms of fulminant Myocarditis are chest pain, fatigue, and shortness of breath and collection of fluid in the lungs.1 Treatment is usually supportive, antibiotics or antiviral medications. Therapeutic goal is to prevent heart failure with the help of medications and appropriate diet.

Causes of Myocarditis or Inflammation of Heart Muscles

Infections Causing Myocarditis or Inflammation of Heart Muscles

  • Bacterial Infection- Caused by Brucella, C. Diphtheriae, H. Influenza and Gonococcus
  • Viral Infection- Viral infection causes myocarditis in immunosuppressed patients. Viral infection causing myocarditis is Adenovirus, Parovirus, Coxsackie Virus2, Enterovirus, Rubella Virus, Polio Virus,
  • Cytomegalo Virus and Human Herpes Virus.
  • Protozoan Infection- Caused by Trypanosoma Cruzi3 and
  • Fungal Infection- Caused by Aspergillus
  • Parasite Infection- Caused by Ascaris, Echinococcus, Taenia Solium and Wuchereria

Toxic Effects Causing Myocarditis or Inflammation of Heart Muscles

  • Ethanol
  • Chemotherapy
  • Antipsychotic Medications- Clozapine
  • Carbon Monoxide

Drug Allergies Causing Myocarditis or Inflammation of Heart Muscles

  • Acetazolamide

Autoimmune Effects Causing Myocarditis or Inflammation of Heart Muscles

Symptoms of Myocarditis or Inflammation of Heart Muscles

Myocarditis is generally a mild disease and causes literally no appreciable symptoms. Symptoms such as chest pain and fatigue become predominant after few days of myocarditis infection. Myocarditis becomes a potentially serious condition, when mild symptoms are ignored. Disease weakens the heart muscles, which then results in heart failure and arrhythmia.

List of Symptoms Are As Follows-

Symptoms of Myocarditis or Inflammation of Heart Muscles

  • Chest Pain and
  • Palpitation

Symptoms of Myocardial Infarction4 and Heart Failure-

  • Edema
  • Breathlessness
  • Enlarged Liver.

Symptoms of Arrhythmia-

  • Short of Breath
  • Palpitation
  • Dizziness and Fatigue

Diagnosis of Myocarditis or Inflammation of Heart Muscles

Findings of Examinations

  • Chest pain
  • Arrhythmia or Irregular Heart beat
  • Enlarged heart
  • Enlarged liver
  • Pulmonary Edema

Blood Examination

  • COK- increased level of cardiac enzymes

Electrocardiogram

  • Irregular heart beats
  • Enlarged heart

Chest X-Ray

  • Enlarged Heart

Treatment for Myocarditis or Inflammation of Heart Muscles

  • Fever- Treated with Tylenol.
  • Dyspnea or short of breath- Nasal oxygen or Oxygen through mask
  • Arrhythmia- Ace Inhibitors, Beta Blockers
  • Autoimmune Disease- Treated with corticosteroids
  • Edema Feet- Salt restrictions

Prognosis for People Affected With Myocarditis or Inflammation of Heart Muscles

An overall prognosis for Myocarditis cannot be predicted accurately and can only be derived over a period of time with regular followups and testing. Some people show complete recovery from Myocarditis after the initial phase of the disease whereas other people may go on to develop heart failure.

Hands-On Experience of a Person with Symptoms of Myocarditis or Inflammation of Heart Muscles

This is a story of a 24-year-old Samantha in her own words who got terrified with symptoms of chest pain.

"I was 21 years old at that time and all of a sudden one night I woke up having acute chest pressure and was unable to take deep breaths. Immediately, I went to a local hospital and was told that I had indigestion. They discharged me home but I went back again about 3 times before they finally detected enzymes in my blood. I had to spend about a week in the hospital and was diagnosed with myocarditis. Fortunately, I made a full recovery until about six months later when I had the same symptoms again. Again, I went through the same process of going to the hospital and again they found the cardiac enzymes were elevated. I had a recurrence of myocarditis. They were never able to find out the cause of myocarditis. This time it affected my heart rate, so I had a pacemaker inserted. This was about a year ago. Now I have started working out again and started to get back into shape. I felt similar symptoms four weeks ago; I thought symptoms might be secondary to work out so I decided to take rest. I felt better but I also started to get depressed because of possible restriction of activities. I was simultaneously anxious and started experiencing anxiety attacks. I decided to see cardiologist. Now, my doctor says I have posttraumatic stress disorder. I am in constant fear that I will have a heart problem again. About two nights ago, I suddenly woke up with terrible chest pain, the worst that I have ever had. I went to ER and had blood cardiac enzyme test. Enzymes were normal but I was petrified. I took Xanax to calm down and I was at least able to fall back asleep. I realized I had myocarditis and I can perform normal activities as long as it is within the limits. I go to work and look normal but I have to remind myself to limit my strenuous activities.

References:

1. Management of fulminant myocarditis: A diagnosis in search of its etiology but with therapeutic options.

Maisch B1, Ruppert V, Pankuweit S., Curr Heart Fail Rep. 2014 Apr 11.

2. Acute myocarditis associated with coxsackievirus B4 mimicking influenza myocarditis: electron microscopy detection of causal virus of myocarditis.

Ikeda T1, Saito T, Takagi G, Sato S, Takano H, Hosokawa Y, Hayashi M, Asai K, Yasutake M, Mizuno K Circulation. 2013 Dec 24;128(25):2811-2. doi: 10.1161/CIRCULATIONAHA.112.000602.

3. Regulatory effects of IL-18 on cytokine profiles and development of myocarditis during Trypanosoma cruzi infection.

Esper L1, Utsch L2, Soriani FM3, Brant F1, Esteves Arantes RM4, Campos CF4, Pinho V5, Souza DG6, Teixeira MM1, Tanowitz HB7, Vieira LQ8, Machado FS9., Microbes Infect. 2014 Apr 1. pii: S1286-4579(14)00036-7.

4. Clinical features of myocardial infarction and myocarditis in young adults: a retrospective study.

Pellaton C1, Monney P, Ludman AJ, Schwitter J, Eeckhout E, Hugli O, Muller O.
BMJ Open. 2012 Nov 30;2(6). pii: e001571. doi: 10.1136/bmjopen-2012-001571. Print 2012.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: April 1, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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