Understanding Myocarditis: Causes, Symptoms, and Diagnosis

Myocarditis is an inflammation of the heart muscle that typically affects younger individuals. While many cases of myocarditis cause mild or no symptoms, severe cases can damage the heart muscle, impair its electrical function, and reduce its ability to pump blood effectively. In such cases, treatment may require medication and even more invasive approaches to manage the symptoms and support heart function.

What Are the Different Types of Myocarditis?

There are several types of myocarditis with varying common causes and treatment options. Common types include:

• Acute MyocarditisThis type of myocarditis develops suddenly, often due to a viral infection. However, it may also result from autoimmune conditions, medications, or vaccinations. Symptoms often start with flu-like signs before progressing to chest pain, palpitations, shortness of breath, and, in rare cases, fainting. With proper treatment, symptoms usually resolve quickly.
• Chronic MyocarditisThis type of myocarditis occurs when the symptoms last longer or recur after initial treatment, often due to autoimmune diseases. It may also progress from an acute infection, depending on the patient’s immune response to infections, chemicals, or heart injuries.
• Lymphocytic MyocarditisThis is a rare type of myocarditis that results from an inflammation of the heart muscle caused by the lymphocytes (white blood cells). In some cases, it may also result from a viral infection. Managing lymphocytic myocarditis often requires hospitalisation for effective treatment.

What Causes Myocarditis?

Myocarditis may result from various factors, including infections and non-infectious causes:

• Infectious Causes of Myocarditis Most cases of myocarditis occur due to viral infections. Common virus strains include those of common colds, flu, and COVID-19. As the body tries to fight off infection, it releases chemicals that may aggravate the heart muscle and lead to inflammation. In some cases, these infections may also result from bacteria, parasites, and in rare cases, fungi.
• Non-Infectious Causes of Myocarditis Myocarditis may stem from autoimmune diseases such as lupus, sarcoidosis, and rheumatoid arthritis. It may also occur due to exposure to chemicals, environmental toxins, and radiation. Additionally, myocarditis may also be a side effect of certain medications, such as antidepressants, antibiotics, diuretics, and other heart medicines.

Who Are at Risk of Myocarditis?

Certain factors place individuals at greater risk of developing myocarditis. These include:

• Males
• Young adults
• Poor inflammatory response
• Excessive alcohol consumption
• Certain medical conditions (e.g., HIV/AIDS, diabetes, kidney disease, skin or chest injuries, eating disorders)
• Certain medical treatments (e.g., radiation, implanted heart devices, dialysis)

What Are the Symptoms of Myocarditis?

Some cases of myocarditis do not present any symptoms. However, they may also present more serious symptoms, especially in severe cases. Common symptoms include:

• Flu-like symptoms like fever, body aches, headache, vomiting, or sore throat
• Shortness of breath, both at rest and during exercise
• Heart palpitations and abnormal heart rhythm (arrhythmia)
• Chest pain or pressure
• Fatigue, weakness, and inability to perform exercise
• Light-headedness and fainting
• Swollen lower extremities (legs, ankles, and feet)

It is worth noting that these symptoms may also present in other viral infections and cardiac problems. If you experience these symptoms, you should consult a cardiologist for a detailed assessment and accurate diagnosis to manage your condition properly. You may call us at 9155 2942 to schedule an appointment with our heart specialist in Singapore.

How Is Myocarditis Diagnosed?

Because myocarditis symptoms can resemble other conditions, a comprehensive evaluation is essential to establish an accurate diagnosis. This may include an evaluation of medical history and symptoms and other diagnostic tests, depending on the patient’s symptoms. Common tests include:

• Electrocardiogram (ECG/EKG): This test measures the heart’s electrical activity using electrodes attached to the skin. Sometimes, a 24-hour Holter monitor may be used to record heart activity for a longer period.
• Echocardiography: This test utilises sound waves to create images of the heart and analyse blood flow.
• Chest X-ray: This imaging test uses radiation to evaluate the size and shape of the heart.
• Cardiac MRI: In rare cases, a cardiac MRI may be used to create images of the heart and identify myocarditis.
• Cardiac Catheterisation: This is an invasive test that uses a tiny tube (catheter) to evaluate heart function, detect blockages, and confirm the presence of other heart conditions.
• Blood Tests: These tests can help detect infection, high levels of inflammation in the body, and damage to the heart tissue.
• Cardiac Muscle Biopsy: In some cases, a tissue sample is taken from the heart to confirm myocarditis.

What Are the Treatment Options for Myocarditis?

Most cases of myocarditis resolve on their own. However, some individuals may require treatment, ranging from medications to long-term management. Additionally, the cardiologist may recommend lifestyle changes such as reducing sodium intake, refraining from rigorous activities, limiting alcohol intake, and smoking cessation.

Acute Management

A “symptomatic treatment” plan will be employed to manage specific symptoms, depending on their severity. This may include:

• Medications for elevated blood pressure and abnormal heart rhythm (arrhythmia)
• Diuretics to decrease fluid congestion
• Corticosteroids to reduce inflammation

Long-Term Management and Treatment

In serious cases of myocarditis, other treatments will be given to prevent complications. These may include:

• Extracorporeal membrane oxygenation (ECMO) machine that removes carbon dioxide and supplies oxygen to the blood.
• Ventricular assist devices (VADs) to help the weakened heart pump blood.
• Intra-aortic balloon pump that assists the heart in pumping blood more efficiently.
• A pacemaker implanted near the heart to help regulate heart rhythm.

In more severe cases, myocarditis can lead to a chronically enlarged heart (dilated cardiomyopathy), which may cause heart failure. In such cases, a heart transplant may be needed.

What to Expect After Myocarditis Treatment

Most patients with myocarditis can lead fulfilling lives following treatment. Recovery typically takes several months. While many patients recover fully, some may require ongoing management. In rare instances, myocarditis can recur.

What Are the Potential Complications of Myocarditis?

Left untreated, myocarditis can lead to potential complications, including:

• Cardiomyopathy
• Lung issues
• Arrhythmia
• Fainting
• Heart failure
• Heart attack
• Sudden cardiac death

Recognise the signs of myocarditis early and act. If you experience any symptoms related to myocarditis, consult a cardiologist promptly. Symptoms like chest pain, shortness of breath, and fatigue can mimic other conditions, making early diagnosis crucial. Remember, early detection and treatment can prevent complications and help you manage your condition effectively.

Our heart clinic offers a comprehensive evaluation to diagnose myocarditis and assess its severity. Consult our heart specialist to determine the appropriate treatment for your case. Prioritise your heart health by seeking expert care. Give us a call at 9155 2942 to schedule an appointment today.