Myocarditis is inflammation and damage of the heart muscles. It can occur in otherwise healthy individuals, affecting both children and adults. Myocarditis is an insidious disease and initially it is asymptomatic and becomes symptomatic later during the disease course. When symptomatic, it can present with varied symptoms of shortness of breath, fatigue, chest pain, heart palpitations, arrhythmias, peripheral edema, and lightheadedness, loss of consciousness, stroke, thromboembolism, heart failure and sudden death.
What To Eat And Avoid When You Have Myocarditis?
The primary step at preventing myocarditis is prevention against infections, especially viral since it is the most common cause of myocarditis. Infections can be prevented by maintaining proper hygiene, avoiding close contact with an infected person, washing hands and bathing, avoiding use of shared needles, preventing tick bites, and practicing safe sex. Noticing the signs and symptoms of infection and visiting doctor early for proper treatment without delay can help in preventing myocarditis.
Once a person has acquired myocarditis, it is very important to follow a healthy anti-inflammatory diet. Anti-inflammatory diet includes green leafy vegetables, tomatoes, spinach, broccoli, berries, squash, cauliflower, carrots, asparagus, mushrooms, beans, legumes, herbs, blueberries, cranberries, avocado, grapes, flax seeds, chia seeds, nuts, fishes and olive oil.(2)
It is also important to restrict salt in diet, as sodium is known to worsen myocarditis symptoms, including congestive heart failure by increasing fluid retention and worsening edema. It is advised to avoid foods high in salt, such as processed foods that are processed meats, canned foods, pre-made soups, trans-fats and refined foods. It is also a good idea to restrict fluids in diet, depending on the amount of swelling that can be consulted with the general physician to prevent congestive heart failure. Potassium intake should also be watched as there might be need for either potassium supplementation or reduction in diet depending on the medical therapy, which should be consulted with the doctor. Furthermore, caffeine and alcohol intake should be limited as caffeine is known to increase palpitations and cause tachycardia. While alcohol is known to worsen arrhythmias and weaken heart muscles further.
Patients with underlying autoimmune disease as the etiology should prevent autoimmune flare-ups by maintaining anti-inflammatory diet and preventing stress. Stress can be relieved with various techniques, such as cognitive behavioral therapy, yoga, breathing exercises, meditation, reading, etc.(2)
Although, exercise is good for general health, in myocarditis it is best to rest for faster recovery. Heavy and exertional aerobic exercises should be restricted when suffering from myocarditis for a period of six months or more depending on the severity and recovery of the patient. On recovery, exercise should be reintroduced slowly and cautiously without undue strain on heart muscles. In patients with ongoing systolic dysfunction, lifestyle modification with low sodium diet, fluid restriction and NSAIDs restriction is important.
The cause of myocarditis may either be unknown, bacterial, fungal, protozoal, helminths, hypersensitivity to drugs, autoimmunity, systemic disorders and exposure to environmental toxins; however, viral infection is the most common cause of myocarditis.
The diagnosis of myocarditis includes careful clinical evaluation along with serum levels of cardiac biomarkers (troponin and CK-MB), ECG, echocardiography, endomyocardial biopsy, and cardiac MRI.
The treatment of myocarditis depends on the presenting clinical symptoms. However, symptoms of acute heart failure and dilated cardiomyopathy are best managed by the recommended guidelines by ACCF/AHA/ESC. Patients with symptomatic heart failure and dilated cardiomyopathy are managed with ARB, ACE inhibitors, aldosterone antagonists or beta blockers for decreasing inflammation and improving left ventricular function and heart failure symptoms. Fluid overload is treated with diuretics, symptomatic hypotension is managed with milrinone, dopamine, whereas thromboembolism is managed with anticoagulation therapy.(1)
Antiviral therapy is used for chronic myocarditis in the presence of viral genome. Immunosuppressive and immunomodulating agents, such as prednisone and azathioprine can be used in patients with viral genome negative chronic myocarditis with symptomatic heart failure. Mechanical circulatory support may be required in some patients, usually with sustained ventricular arrhythmias.