Hello, welcome everybody, this is doctor Bolad, board certified physician in cardiology, interventional
cardiology and internal medicine, certified by the American Board of Internal Medicine.
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my subscribers, thank you for your continued support. Today I will talk to you about inflammation
of the heart muscle, medically known as myocarditis. This can be caused by a variety of infectious
and non-infectious conditions.The most commonly known Infectious agents are the viruses. Viral
myocarditis is the most commonly identified cause of myocarditis. There are many viruses
that have been implicated in the causation, the most commonly known viruses include coxsackievirus,
HIV virus and more recently the COVID-19 virus has been implicated. Non-infectious causes
include autoimmune disorders such as systemic lupus erythematosus and giant cell arteritis.
Other non-infectious causes include celiac disease, Crohn’s disease, ulcerative colitis,
alcohol abuse, cocaine abuse, hypersensitivity reaction to certain medications, and radiation
therapy. Myocarditis can be an acute or a chronic disorder.
Acute myocarditis has been defined as a condition with symptoms of heart failure developing
over three months or less, while chronic myocarditis has been defined as developing over greater
than three months. Acute myocarditis can present as either:
1- Acute coronary syndrome with symptoms of a heart attack, with Acute Chest Pain, in
the absence of coronary artery disease on coronary angiogram. Patients present with
acute chest pain that starts within one to four weeks after a respiratory or gastrointestinal
infection and is frequently associated with severe and recurrent symptoms. Likely, there
will be ECG abnormalities, and the echocardiogram shows reduced heart function and the blood
test shows elevatedTroponin levels. 2- Acute myocarditis can present as new onset
or worsening heart failure in the absence of coronary artery disease and known causes
of heart failure over two weeks to three months with symptoms including shortness of breath,
leg swelling, chest discomfort, and fatigue. 3- Acute myocarditis can present as a life-threatening
condition in the absence of coronary artery disease and known causes of heart failure
with either cardiogenic shock or life-threatening arrhythmias and aborted sudden cardiac death.
4- Also, acute myocarditis can present with abnormality of heart beating. A number of
arrhythmias may be seen in patients with myocarditis. Sinus tachycardia is more frequent than serious
atrial or ventricular arrhythmias, while palpitations secondary to premature atrial complex or,
more often, ventricular extrasystoles are common.
When myocarditis is suspected, tests that help with confirm the diagnosis include:
1- Serum cardiac troponin levels. These are commonly elevated in patients with myocarditis,
particularly those with short duration of symptoms of less than one month. Serum troponin
levels are obtained to aid in diagnosis of myocarditis, as recommended by the American
Heart Association and the European Society of Cardiology but absence of troponin elevation
does not exclude myocarditis. Persistent elevations in cardiac enzymes suggest ongoing heart muscle
inflammation and muscle necrosis. 2- ECG changes can be suggestive of acute
myocardial injury, arrhythmia, or global or regional abnormalities of left ventricular
systolic function, particularly if the clinical findings are new and unexplained
3- An echocardiogram is performed in all patients with suspected myocarditis to evaluate regional
and global ventricular function, valvular function, and other potential causes of cardiac
dysfunction. 4- Coronary angiography is indicated in selected
patients with clinical presentation indistinguishable from an acute coronary syndrome, lifestyle-limiting
coronary disease despite medical therapy, or high-risk features for ischemic heart disease
on noninvasive testing. 5- Cardiac magnetic resonance imaging is indicated
in patients with suspected myocarditis with elevated troponin level and/or ventricular
dysfunction without a clear cause such as ischemic heart disease. Cardiac magnetic resonance
imaging often provides supportive evidence of myocarditis when an endomyocardial biopsy
is not performed for whatever reason. 6- An endomyocardial biopsy is performed as
clinically indicated. The decision of whether to proceed with endomyocardial biopsy should
be based upon the likelihood that the heart muscle biopsy significantly impacts patient
management. Treatment of myocarditis includes general
measures common to patients with various types of myocarditis or cardiomyopathy as well as
therapy targeting specific disorders.Patients with myocarditis should receive standard therapy
for acute and chronic heart failure, depending on the clinical presentation. These include
diuretic therapy to remove excess fluid from the body, in addition to beta blockers and
angiotensin converting enzymes inhibitors or angiotensin receptor blockers. Sometimes
the degree of heart failure is so severe that patients might need mechanical support with
external pumps to support the circulation; in rare occasions heart transplantation might
be considered. Things to avoid include Pain killers from the Nonsteroidal anti-inflammatory
group of drugs as they are not effective and might enhance the heart muscle inflammatory
process and increase the likelihood of death. Heavy alcohol consumption should also be restricted
since heavy alcohol intake may enhance the severity of myocarditis. Also, in the acute
phase of myocarditis, physical activity should be restricted to reduce the work of the heart,
especially when there is fever, active systemic infection, or heart failure.
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This is Doctor Bolad, helping you with your heart health, thanks for watching, and talk
to you soon.