Myocarditis, or heart muscle inflammation, is a serious disease in which the heart muscle tissue is inflamed. It is often caused by viral infections such as influenza viruses or coxsackievirus, but can also be caused by bacteria, fungal infections or autoimmune reactions. The symptoms range from fatigue and shortness of breath to chest pain and cardiac arrhythmia (abnormal heart rate or rhythm). Timely diagnosis and appropriate treatment are crucial to prevent complications such as heart failure or sudden cardiac death.
The heart muscle at a glance
The heart muscle, also known as myocardium, is the middle layer of muscle tissue in the heart. It enables the heart to pump and therefore keeps blood circulating around the body. It is made up of specialised heart muscle cells that pump blood through the body by rhythmic contraction and relaxation. Healthy heart muscle function is crucial for supplying oxygen and nutrients to every organ in the body. With myocarditis, this sensitive tissue is attacked by inflammation, which impairs the heart’s ability to pump blood and can lead to serious complications.
Causes and risk factors
A distinction is made between infectious and non-infectious myocarditis, depending on whether the inflammation is caused by pathogens or other factors. Both types of myocarditis can be either acute or chronic.
Infectious myocarditis
Infectious myocarditis is mainly caused by viruses, such as the Coxsackie virus, herpes viruses, adenoviruses, enteroviruses or parvovirus B19. These and other viruses can directly attack the heart muscle tissue and trigger an inflammatory response. In addition to viruses, bacteria such as streptococci and staphylococci, fungi and parasites can also cause myocarditis. The pathogens usually reach the heart via the bloodstream and trigger the inflammatory processes there.
Patients who do not sufficiently recover after an infection and return to intensive physical activity too soon may have an increased risk of developing myocarditis.
Non-infectious myocarditis
In non-infectious myocarditis, the cause of the inflammation is not an infection. Autoimmune diseases such as lupus or rheumatoid arthritis can attack the heart muscle tissue and cause inflammation. Certain medications, toxins or radiotherapy can also trigger myocarditis.
Symptoms
The symptoms of myocarditis are varied and can be similar to the symptoms of other heart diseases, but can also be similar to flu or general cold symptoms. It is important to note that not all patients may experience the symptoms listed; they may not even experience any of them.
Fatigue and weakness
In many cases, people with myocarditis feel unusually exhausted and weak.
Shortness of breath
Those with myocarditis may become short of breath during physical exertion in particular, but also when at rest.
Chest pain
Patients may experience chest pain, which can be a sharp, stabbing sensation and is often mistaken for a symptom of a heart attack.
Cardiac arrhythmia
Heart muscle inflammation can lead to cardiac arrhythmia, such as irregular heartbeat, palpitations or tachycardia.
Dizziness and fainting
Impaired heart function can lead to insufficient blood flow to the brain, which can cause dizziness and fainting spells.
Fluid retention
Swelling in the legs, ankles or feet can be a sign of heart failure caused by myocarditis.
Because myocarditis often goes unnoticed, it is extremely important to have any symptoms like the ones described above checked out by a doctor as soon as possible – especially if these symptoms occur a few weeks after a cold or other infection. Resuming sports activities too early can cause serious complications.
Diagnosis
Myocarditis is usually diagnosed by a cardiology specialist. In addition to the attending doctor taking a comprehensive medical history and performing a clinical examination, such as listening to the heart, various other diagnostic tests can be carried out, including:
Electrocardiogram (ECG)
An electrocardiogram, also known as an ECG, measures the electrical activity of the heart and can detect abnormalities in the heart rhythm.
Echocardiogram
An echocardiogram helps to assess the structure and function of the heart, which includes identifying myocarditis.
Blood tests
A blood test can provide certain blood values such as inflammation markers or specific antibodies that can indicate inflammation in the body.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging of the heart can provide detailed images of the heart and reveal inflammation in the heart muscle tissue.
Rest and recuperation
The most important way to treat myocarditis is the strict avoidance of physical exertion. It is also critical to avoid even minor stresses in everyday life. The inflamed heart muscle must not be unduly stressed until the inflammation has completely gone away. This can take several weeks in some cases.
Drug therapy
This may include the administration of anti-inflammatory drugs or corticosteroids to reduce the inflammatory response in the heart muscle. Medication may also be prescribed to support heart function, control the heart rhythm or prevent blood clots. Antibiotics are generally only used to treat myocarditis if the cause is a bacterial infection.
Monitoring and follow-up care
Patients with myocarditis require regular medical check-ups to monitor the progress of the disease, assess heart function and identify any complications at an early stage.
Inpatient treatment for severe cases
In severe cases, especially acute myocarditis with serious heart problems, the patient may need to be hospitalised and closely monitored in intensive care. In some cases, a heart transplant may also be considered if the heart function is irreversibly impaired.
The treatment of myocarditis therefore requires an individualised and comprehensive approach to ensure the best care for each patient.
Prevention
The prevention of myocarditis is primarily focused on avoiding infections, as viral infections are the most common cause of this disease. Some preventive measures include:
Healthy hygiene habits
Healthy hygiene habits, such as regular hand washing, can help prevent the spread of viruses that can cause myocarditis.
Vaccination
Some infections that can cause myocarditis, such as influenza or measles, can be prevented by vaccination.
Avoid overexertion
Excessive physical exertion, especially if a viral infection is present, can increase the risk of myocarditis.
Avoiding sources of infection
Contact with people suffering from acute infections such as flu or colds should be avoided to reduce the risk of infection.
Healthy lifestyle
A balanced diet, sufficient sleep, stress management and avoiding smoking and excessive alcohol consumption help to strengthen the immune system and can help to reduce the risk of infections and therefore myocarditis.
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