MYOCARDITIS

Types

There are many types of myocarditis. These include the following

• Viral myocarditis caused by Coxsackie B virus, enterovirus, adenovirus, influenza, and many others
• Bacterial myocarditis caused by Streptococci, meningococci, clostridia, Corynebacterium, mycobacteria, and many others
• Fungal and parasite myocarditis caused by Candida, aspergillosis, Cryptococcus, schistosomes, filaria, malaria, toxoplasma, and many others
• Lymphocytic myocarditis, in which the heart muscle is infiltrated with lymphocytes
• Eosinophilic myocarditis, in which the heart muscle infiltrated with eosinophils
• Autoimmune myocarditis which is caused by autoimmune diseases, such as lupus
• Fulminant myocarditis which is caused by an inflammatory process in the heart muscle that leads to acute severe heart failure
• Idiopathic myocarditis which is an inflammatory process in the heart muscle with no known cause
• Acute myocarditis, in which symptoms appear rapidly and usually decrease after a week or two
• Chronic myocarditis, which is the slow appearance of symptoms that lasts more than two weeks

Symptoms

Myocarditis may have the following signs and symptoms:

• Chest pain
• Rapid or abnormal heart rhythms (arrhythmias)
• Shortness of breath
• Swelling of the legs, ankles and feet
• Fatigue
• Other signs and symptoms of a viral infection, such as a headache, body aches, joint pain, fever, a sore throat or diarrhea
• Fever
• Fainting

DIAGNOSIS

Myocarditis is diagnosed by medical interview, physical exam and the following tests:

• Blood tests for heart muscle enzymes (CPK levels)
• ECG
• Nuclear heart scan
• Chest X-rays
• MRI
• Echocardiogram
• Cardiac catheterization
• Heart muscle biopsy (endomyocardial biopsy)

MEDICATIONS/TREATMENT

Myocarditis treatment is based on its cause. Sometimes, myocarditis may resolve on its own. In case of infections, antibiotic, antiviral or antifungal treatments may be needed.

In more severe cases of myocarditis, more specific medications or even hospitalization may be needed. Medications may include the following:

• ACE inhibitors
• Beta blockers
• Angiotensin receptor blockers
• Diuretics
• Nitrates