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Myocarditis

Inflammation - heart muscle

 

Myocarditis is inflammation of the heart muscle.

The condition is called pediatric myocarditis when it occurs in children.

Causes

 

Myocarditis is an uncommon disorder. Most of the time, it is caused by an infection that reaches the heart.

When you have an infection, your immune system produces special cells to fight off disease. If the infection affects your heart, the disease-fighting cells enter the heart. However, the chemicals made by these cells can also damage the heart muscle. As a result, the heart can become thick, swollen, and weak.

Many cases are caused by a virus that reaches the heart. These can include the influenza (flu) virus, coxsackievirus, parovirus, cytomegalovirus , adenovirus, and others.

It may also be caused by bacterial infections such as Lyme disease, streptococcus, mycoplasma, and chlamydia .

Other causes of myocarditis include:

  • Reactions to certain medicines, such as certain chemotherapy drugs
  • Exposure to chemicals in the environment, such as heavy metals
  • Infections due to fungus or parasites
  • Radiation
  • Autoimmune disorders that cause inflammation throughout the body

Sometimes the exact cause may not be discovered.

 

Symptoms

 

There may be no symptoms. Symptoms may be similar to the flu. If symptoms occur, they may include:

  • Chest pain that may resemble a heart attack
  • Fatigue or listlessness
  • Fever and other signs of infection including headache, muscle aches, sore throat, diarrhea, or rashes
  • Joint pain or swelling
  • Leg swelling
  • Pale, cool hands and feet (a sign of poor circulation)
  • Rapid breathing
  • Rapid heart rate

Other symptoms that may occur with this disease:

  • Fainting , often related to irregular heart rhythms
  • Low urine output

 

Exams and Tests

 

Myocarditis can be hard to diagnose because the signs and symptoms often mimic those of other heart and lung diseases, or a bad case of the flu.

The health care provider may hear a rapid heartbeat or abnormal heart sounds while listening to the child's chest with a stethoscope. A physical exam may detect fluid in the lungs and swelling in the legs in older children.

There may be signs of infection, including fever and rashes.

A chest x-ray can show enlargement (swelling) of the heart. If the provider suspects myocarditis based on the exam and chest x-ray, an electrocardiogram may also be done to help make the diagnosis.

Other tests that may be needed include:

  • Blood cultures to check for infection
  • Blood tests to look for antibodies against viruses or the heart muscle itself
  • Blood tests to check liver and kidney function
  • Complete blood count
  • Heart biopsy (the most accurate way to confirm the diagnosis, but not always needed)
  • Special tests to check for the presence of viruses in the blood (viral PCR)

 

Treatment

 

Treatment is aimed at the cause of the problem, and may involve:

  • Antibiotics to fight bacterial infection
  • Medicines called steroids to reduce swelling
  • Intravenous immunoglobulin (IVIG), a medicine made of substances (called antibodies) that the body produces to fight infection, to control the inflammatory process
  • Diuretics to remove excess water from the body
  • Low-salt diet
  • Reduced activity

If the heart muscle is weak, your provider will prescribe medicines to treat heart failure. Abnormal heart rhythms may require the use of other medicines. You may also need a device such as a pacemaker, or implantable cardioverter-defibrillator's to correct an irregular heartbeat. If a blood clot is in the heart chamber, you will also receive blood thinning medicine.

Rarely, a heart transplant may be needed if the heart muscle has become very weak or you have other health problems.

 

Outlook (Prognosis)

 

The outcome can vary, depending on the cause of the problem and a person's overall health. Some people may recover completely. Others may have lasting heart failure.

 

Possible Complications

 

Complications may include:

  • Cardiomyopathy
  • Heart failure
  • Pericarditis

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of myocarditis, especially after a recent infection.

Seek medical help right away if:

  • Your symptoms are severe.
  • You have been myocarditis, and you have increased chest pain , swelling , or breathing problems .

 

Prevention

 

Treat conditions that cause myocarditis promptly to reduce the risk.

 

 

Open References

References

Cooper LT, Knowlton KU. Myocarditis. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 67.

Knowlton KU, Narezkina A, Savoia MC, Oxman MN. Myocarditis and pericarditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 86.

McKenna WJ, Elliott P. Diseases of the myocardium and endocardium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 60.

 
  • Cardiomyopathy overview

    Cardiomyopathy overview

    Animation

    •  

    Cardiomyopathy overview - Animation

    Types, causes, symptoms, health risks, and treatment of cardiomyopathy.

  • Myocarditis

    Myocarditis - illustration

    Myocarditis is inflammation and weakness of the heart muscle usually caused by a viral infection that reaches the heart, such as the influenza (flu) virus, Coxsackie virus, and adenovirus. Myocarditis can damage the heart muscle causing it to become thick and swollen. This leads to symptoms of heart failure. Myocarditis may also occur during or after other viral or bacterial infections such as polio, rubella, Lyme disease, and others.

    Myocarditis

    illustration

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Lymph tissue in the head and neck.

    Lymph tissue in the head and neck. - illustration

    Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if the infection is trivial or not apparent.

    Lymph tissue in the head and neck.

    illustration

  • Cardiomyopathy overview

    Animation

    •  

    Cardiomyopathy overview - Animation

    Types, causes, symptoms, health risks, and treatment of cardiomyopathy.

  • Myocarditis

    Myocarditis - illustration

    Myocarditis is inflammation and weakness of the heart muscle usually caused by a viral infection that reaches the heart, such as the influenza (flu) virus, Coxsackie virus, and adenovirus. Myocarditis can damage the heart muscle causing it to become thick and swollen. This leads to symptoms of heart failure. Myocarditis may also occur during or after other viral or bacterial infections such as polio, rubella, Lyme disease, and others.

    Myocarditis

    illustration

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Lymph tissue in the head and neck.

    Lymph tissue in the head and neck. - illustration

    Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if the infection is trivial or not apparent.

    Lymph tissue in the head and neck.

    illustration

Tests for Myocarditis

 
     

    Review Date: 2/24/2016

    Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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