Myocarditis may develop as a complication of an infectious disease, usually caused by a virus. It can occur in people of all ages and is diagnosed more often in men than in women. Treatment depends on the underlying cause. Myocarditis is an inflammation of the myocardium, the thick muscular layer making up the major portion of your heart. The condition can result in vague chest pain, an abnormal heartbeat, congestive heart failure and other signs and symptoms.
When this uncommon condition is severe enough, the pumping action of your heart weakens and your heart is unable to supply the rest of your body with enough oxygen-rich blood. Clots can form as well, potentially leading to a stroke or heart attack.
Signs and symptoms
The signs and symptoms of myocarditis may vary, depending on the cause and the severity of the disease. The most common signs and symptoms include:
Vague chest pains
A rapid or abnormal heartbeat (arrhythmia)
Shortness of breath, particularly during physical activity
Fluid retention with swelling of your legs, ankles and feet
Other signs and symptoms may occasionally occur as well, such as:
Myocarditis can be accompanied by pericarditis, which is an inflammation of the membrane covering the heart (pericardium), and may cause sharp pains over the center of your chest.
In mild cases, myocarditis produces no noticeable symptoms. People may be ill with the general symptoms of a viral infection and never realize that their heart is affected. Some people may never seek medical care and may recover without ever knowing they had myocarditis.
When children develop myocarditis, they can experience the following signs and symptoms:
Years ago, rheumatic fever was a common cause of myocarditis. But today, there are usually other reasons for myocarditis, most often when it develops secondary to an underlying infection caused by:
Myocarditis also sometimes occurs when a person is exposed to:
When to seek medical advice
Call your doctor immediately if you have any of the signs and symptoms of myocarditis, particularly chest pain and shortness of breath. If you've had an infection that sometimes leads to myocarditis, be alert for the symptoms of myocarditis and let your doctor know at once if they occur. When the symptoms are severe, go to the nearest emergency room.
Screening and diagnosis
Your doctor may suspect myocarditis if you've had a viral or other type of infection within six weeks of developing symptoms that suggest an inflamed heart muscle. To make the diagnosis, your doctor begins by taking a medical history and then performs a physical examination. Your doctor will listen to your heart with a stethoscope, listening for abnormal heart rhythms and sounds, including murmurs.
To make or confirm a diagnosis of myocarditis and determine its severity, your doctor may also order one or more tests, most commonly:
Your doctor also may recommend a cardiac (heart) catheterization, in which a small tube (catheter) is inserted into a vein in your leg or neck, and then is threaded into your heart. A special instrument can remove a tiny sample of heart muscle tissue (biopsy) for analysis in the laboratory to see if there are signs of inflammation or infection.
When myocarditis is severe, it can leave your heart muscle permanently impaired. As its pumping action weakens, strain is put on your heart, causing progressive heart failure. Your heart becomes unable to pump efficiently enough to supply your body with the oxygen-rich blood it requires. It can also trigger the formation of blood clots, leading to a stroke or a heart attack. People with myocarditis may develop serious heart arrhythmias, which occasionally cause sudden death. In very advanced cases, myocarditis-related cardiac failure requires a heart transplant.
Management of myocarditis involves trying to treat the underlying cause, such as the particular infection that may have set the stage for your heart inflammation.
There's no specific therapy for coxsackievirus B — the most common type of virus that causes myocarditis — other than treatment to relieve pain and other symptoms.
In mild cases of inflammation, your doctor may advise rest and prescription medications to give your body a chance to fight off the underlying infection. If bacteria are causing the infection, your doctor will prescribe antibiotics. Certain rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis, respond to steroids or other medications to suppress the immune system. In some cases the treatment is directed at the underlying systemic disease, such as lupus.
Once your heart inflammation has subsided, you can gradually resume a more active lifestyle. In the meantime, your doctor may recommend that you limit the amount of salt in your diet, and avoid alcohol, cigarettes and vigorous exercise. Taking these steps can reduce the workload on your heart.
When tests indicate that the myocardial inflammation is severe, your doctor may prescribe corticosteroid drugs to reduce the inflammatory response.
If you have rapid or irregular heartbeats as a symptom, your doctor may advise hospitalization, where you'll receive anti-arrhythmia drugs and your heartbeat will be monitored until it normalizes. If heart failure develops, your doctor may prescribe medications to strengthen the pumping ability of your heart, reduce your heart's workload or help you eliminate excess fluid. These medications may include:
In many cases, the myocardial inflammation subsides, leading to a complete recovery. In people without symptoms, their hearts get better spontaneously. Even people with very severe congestive heart failure may improve dramatically, often in just a few days. In some severe cases, however, aggressive therapy may be necessary, such as:
Some people may have chronic and irreversible damage to the heart muscle requiring lifelong medications, while other people need medications for just a few months and then recover completely. This variability in the disease makes it difficult for your doctor to predict how you'll do.
Most cases of myocarditis can't be prevented easily. However, you can take some steps to decrease your risk and the risk to others.
MRSA - Methicillin - resistant Staphylococcus Aureus
Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems.
For information about MRSA in hospitals and healthcare facilities, link to:
background, prevention, surveillance, ...
MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are know as CA-MRSA infections.
For information about MRSA acquired outside of hospitals and healthcare facilities, link to:
athletic facilities, correctional facilities, ...