Heart muscle inflammation (myocarditis): causes, symptoms, treatment

Inflammation of the heart muscles is not something to be trifled with. Although it often goes unnoticed, it is not uncommon to find it in the autopsy of people with unknown  causes of death  . The symptoms are often quite unspecific – which is precisely why heart muscle inflammation (myocarditis) is so difficult to recognize. Nobody knows exactly how often myocarditis occurs – the number of undetected cases is very high. What are the symptoms of heart muscle inflammation, what are the underlying causes of the disease and how is it treated?

Causes of heart muscle inflammation

The causes of heart muscle inflammation are varied. It can be triggered by an infection with a wide variety of pathogens – viruses, bacteria, protozoa, parasites and  fungi  . This is then referred to as  infectious myocarditis. Viruses are the most common triggers.  A well-known example is the common cold. Anyone who  does  sport  despite  a cold and does not take enough care of themselves runs the risk of the pathogens migrating through the body to the heart and causing inflammation there.

Non-infectious myocarditis can also be caused by an   excessive immune response (autoimmune reaction), chemical, potentially toxic substances (e.g. drugs or medication such as chemotherapeutics) or physical stimuli (e.g. radiation). Sometimes the inflammation also spreads to the sac around the heart (pericardium) – this is referred to as perimyocarditis. In the context of myocarditis, the inflammation causes the affected muscle tissue to dissolve.

Recognize symptoms of heart muscle inflammation

The symptoms of myocarditis are quite unspecific – this makes the diagnosis so difficult. Those affected often report a previous infection of the upper respiratory tract with corresponding symptoms.

Heart-specific symptoms  caused by  cardiac arrhythmia , irritation of the pericardium and limited cardiac output (insufficiency) do not always occur  :

  • accelerated pulse (even without physical exertion)
  • palpitations  or palpitations
  • shortness of breath on exertion
  • Chest pressure or pain
  • dizziness and fainting spells

The myocarditis itself can also manifest itself through  general symptoms  :

  • loss of performance and a feeling of weakness
  • fatigability
  • Fever
  • restlessness
  • joint and muscle pain

These are all complaints that are similar to a  flu  or a cold and are then often attributed to a respiratory infection. In addition, other symptoms that affect the heart are also possible. The most common of these symptoms are fatigue and shortness of breath, followed by heart palpitations and chest pain.

Myocarditis: Severe course possible

In the worst case – in a very acute form – life-threatening  heart failure can develop within a short time  ; pronounced cardiac arrhythmias can also lead to sudden cardiac death.

In another third, the acute form turns into a chronic form, so it does not heal completely and permanently impairs the heart function. The rest of those affected recover completely or mostly from the myocarditis.

Diagnosis of myocarditis

Important examinations for the diagnosis of myocarditis are, in addition to the examination of the heart and lungs or measuring the pulse and blood pressure, the electrocardiogram (ECG) and the echocardiography (heart ultrasound):

  • The  ECG  shows in particular cardiac arrhythmias and other changes, which are not specific to myocarditis, but also occur in other heart diseases.
  • With  echocardiography  , enlargement of the heart cavities and disturbances in the coordination of heart movement can be detected and the performance of the heart can be measured; In the case of inflammation of the pericardial sac, a typical accumulation of fluid between the pericardium (pericardium) and the heart muscle (myocardium) can be detected, the so-called pericardial effusion. But the ultrasound findings only provide pieces of the puzzle, but are not specific.
  • Tests of  blood, stool or a throat swab  may show signs of inflammation, viruses or defense cells (antibodies) formed by the body against them. Important  blood values  ​​for heart muscle inflammation include leukocytes and the  protein  CRP .
  • Another examination is scintigraphy ,  in which inflamed cells are less active and therefore store less of an injected substance. 
  • Nuclear spin tomography  ( cardiac  MRI) can be used to show areas of inflammation and scarring of the muscle tissue.
  • If the suspected diagnosis is still not certain after these examinations, a  tissue sample is taken  from the heart muscle (myocardial biopsy) and/or fluid is taken from the pericardium.

Which diagnostic measures are taken depends on the condition of the person concerned, their age, the concomitant diseases and the possible consequences for the therapy.

treatment of myocarditis

Doctors estimate that in the majority of cases, myocarditis goes unnoticed and heals on its own. But in the remaining cases, life-threatening complications can sometimes occur, which is why the right therapy is crucial.

As there are few specific symptoms, myocarditis cannot be specifically treated. Instead, general measures are in the foreground: bed rest, later physical rest (no sport, no heavy physical work) until the findings have normalized. If necessary, the underlying disease or infection is treated for this purpose.

If the myocarditis has affected the heart function, these symptoms are treated with drugs to treat cardiac insufficiency and cardiac arrhythmia. In the case of severe forms, treatment methods with special drugs up to and including heart transplantation are carried out – but only in specialized clinics.

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