What is Myocarditis ?

Often, we heard of young patients collapsing when they are involved in sports activities and the end-result sometimes have been critical and even life threatening. Many have even died before they get any immediate medical attention.

Undoubtedly, this health problem is often experienced by those who are having respiratory problems such as Asthma, Pneumonia, or when he/she is weak after a prolonged sickness.

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[However, accordingly to www.patient.co.uk, they explained it as ......]
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Myocarditis means inflammation of the myocardium. The myocardium is the heart muscle. Myocarditis can affect anyone and occur at any age. There are various causes. Many are mild and some are serious. Causes include the followings :

Viral infection

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Many types of viral infection can affect several parts of the body, including the heart muscle. Myocarditis may develop at the same time as, or more often just after, a viral throat or chest infection. The body's immune system can clear many types of virus. This means that many cases of viral myocarditis go away on their own within a week, or so.

In the UK, the most common infections causing myocarditis are viruses called Coxsackie B and adenovirus. Other viruses which sometimes cause myocarditis include : echoviruses, influenza (flu), Epstein-Barr virus (glandular fever), rubella (german measles virus), varicella (chickenpox virus), mumps, measles, parvoviruses, yellow fever, dengue fever, polio, rabies and the viruses that cause hepatitis A and C.

Sometimes, the inflammation in the heart lasts longer than other features of the infection. The virus may have gone but the immune system may over-react and cause inflammation which persists for a time in the heart.

Unknown cause (idiopathic myocarditis)
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In many people with myocarditis, the cause is not found. However, for the majority of these people, it is likely to be caused by a virus that could not be confirmed by a test.

What are the symptoms of myocarditis ?

The symptoms depend on the cause and severity of the inflammation. Many people with viral myocarditis do not have any heart-related symptoms. The heart inflammation may be suspected by some changes on an electrocardiogram (ECG). Symptoms include :

• Chest pain.
• Fever (raised temperature).
• A fast heartbeat - faster than usual for a normal fever.
• An irregular heartbeat.
• Tiredness.
• Shortness of breath.

What are the possible complications ?

Complications may develop if the inflammation damages the heart muscle, or damages the fibres that conduct the electrical impulses in the heart. Complications develop quickly in some cases following acute (sudden-onset) symptoms listed above. Some cases of myocarditis develop gradually (such as in Chagas' disease) and have no acute symptoms. It may be that the complications are the first indication that you have had myocarditis in the past.

Possible complications include :

• Sudden loss of consciousness (syncope).
• Cardiac arrhythmias (abnormally fast, slow or irregular heartbeats).
• Heart failure which can cause shortness of breath, swelling of the legs and tiredness. (See separate leaflet called 'Heart Failure'.)

How is myocarditis diagnosed ?

Your symptoms are likely to lead your doctor to make the possible diagnosis of myocarditis. An ECG test may be done. This is a tracing of the electrical activity of the heart. A chest X-ray may show that your heart is larger than normal. It is also likely you will have some blood tests to test for some of the viruses that can cause myocarditis. An echocardiogram (ultrasound scan of the heart) may also be arranged.

Some people need to have an endomyocardial biopsy. This involves taking a very small tissue sample of the heart to investigate for the cause of myocarditis. Newer tests which are more sensitive at diagnosing some of the viruses are currently being developed.

What is the treatment of myocarditis ?

The treatment of myocarditis will depend on the cause and severity of your myocarditis. Bed rest is usually recommended at the onset of myocarditis and athletic activities should be avoided for six months to avoid putting undue strain on the heart muscle. Painkillers will help to ease chest pain and fever.

There is no treatment that will cure a virus infection. However, for most people with viral myocarditis, the virus clears away on its own without any treatment, often within a week, or so.

In the past, the use of steroids has been tried. However, there are no clinical studies which demonstrate steroids as being beneficial other than for giant-cell myocarditis. Different treatments for myocarditis are currently being investigated in other clinical studies.

For the more uncommon causes, or if complications develop, a range of treatments may be needed. For example :

• Medication to treat heart failure, or irregular heartbeats.
• A pacemaker, if certain irregular heart rhythms develop.
• Antibiotics, if the cause of the myocarditis is a bacterial infection.
• Steroid medication, if the cause is giant-cell myocarditis.
• Stopping alcohol, if alcohol is the cause.

What is the prognosis (outlook) ?

In most cases of viral myocarditis, the illness goes away on its own and there are no complications. Symptoms may last only a few days or weeks. However, some types of viral infection are more serious and can cause more severe or persistent inflammation and complications.

Complications are more likely with the more uncommon causes of myocarditis. Sometimes the inflammation clears but the heart is left with some permanent damage and you may be left with a degree of heart failure which may require long-term medication.

In some cases, the inflammation and heart damage are so severe that the only treatment option is a heart transplant.

Myocarditis is fatal in some cases. In some cases, death occurs some time after the diagnosis is made, if the condition gets worse and becomes unresponsive to treatment. Also, some cases of sudden death in a previously healthy person are due to an acute myocarditis, that develops rapidly.