Myocarditis: What You Need to Know

Inflammatory heart conditions — like myocarditis — can be silent killers if they go undetected.

It’s a condition that affects millions of Americans in their lifetimes, but many people don’t know which symptoms to look out for or when to seek emergency medical attention.

Catching myocarditis early is key to avoiding long-term complications and maintaining a normal life, so you should know how to recognize its signs.

What is Myocarditis?

Giant cell myocarditis is a condition that develops when the heart muscle — called the myocardium — becomes inflamed.

It can reduce the heart’s ability to pump blood and cause rapid, abnormal rhythms (arrhythmias) that can damage the brain and other organs.

Often, the initial symptoms of myocarditis resemble those of a flu-like illness, which can cause delays in getting proper treatment.

As acute myocarditis advances, symptoms intensify and can become life-threatening if not treated promptly.

Myocarditis symptoms

The symptoms of myocarditis can vary from person to person, ranging from mild to severe. In the early stages of this condition, symptoms may include:

• Sharp, stabbing, or unexplained chest pain that can be mistaken for heart attacks
• Fatigue
• Shortness of breath
• Heart palpitations
• Mild fever
• Sore throat, joint pain, and body aches, depending on the cause

Myocarditis can also affect children, who may experience symptoms like:

• Unexplained abdominal pain
• Unexplained tiredness
• Rapid breathing

What are the Causes of Myocarditis?

Infectious causes

The most common cause of myocarditis is a viral infection caused by organisms that directly or indirectly affect the heart muscle. Viruses that may cause myocarditis include:

• Coxsackievirus
• Adenovirus
• Parvovirus B19
• Human herpesvirus
• Enteroviruses

While myocarditis is most commonly associated with viral infections, it can occasionally be caused by bacterial infections, though this is less common.

Some strains of bacteria that may contribute to the development of myocarditis include:

• Staphylococcus
• Streptococcus
• Borrelia burgdorferi

Although extremely rare, myocarditis can also develop due to fungal and parasitic infections. However, this type of infection usually occurs in people with weakened immune systems.

Fungi, like Candida, and parasites, like Trypanosoma cruzi, can be responsible for this type of myocarditis.

Noninfectious causes

Myocarditis may occasionally develop due to noninfectious factors, such as:

• Autoimmune disorders: Conditions where the immune system mistakenly attacks the body's tissues — such as lupus, rheumatoid arthritis, and sarcoidosis — can lead to myocarditis.

• Allergic reactions: Myocarditis can arise from hypersensitivity to certain drugs, including specific antibiotics, antipsychotics, and diuretics.

• Chemical and environmental exposure: Exposure to certain chemicals and heavy metals — such as carbon monoxide, lead, and arsenic — can cause myocarditis.

• Radiation therapy: Radiation used to treat certain cancers can cause inflammation and damage to the heart muscle, which may result in myocarditis.

• Metabolic disorders: Certain metabolic disorders — such as acidosis or severe malnutrition — can impact the health of the heart muscle and potentially contribute to the onset of myocarditis.

  Other potential causes

In rare cases, myocarditis can occur due to poor lifestyle habits or conditions that negatively impact the heart. These include:

• Alcohol and substance abuse: Chronic alcohol abuse and the use of certain hard drugs — such as cocaine — can lead to myocarditis.

• Physical stress: Severe physical stress — such as that from extreme exercise or trauma — can trigger myocarditis due to increased inflammation.

While uncommon, there are instances where the cause of myocarditis remains unidentified — this is known as idiopathic myocarditis. Treating this form can be particularly challenging.

How is Myocarditis Diagnosed?

It can be challenging to diagnose myocarditis because it shares symptoms with other heart conditions.

In addition, the exact cause of myocarditis isn’t always clear, which can make it difficult to determine what could be responsible for your symptoms.

Doctors generally follow the following process when they diagnose myocarditis:

• Medical and physical evaluations: Your doctor will inquire about your symptoms, medical history, recent infections, and medications. This is followed by a physical exam to look for fluid retention, unusual heart sounds, and other cardiovascular signs.

• Diagnostics tests: After the evaluations, your doctor will likely recommend further testing to provide an accurate diagnosis. These tests typically include blood work and imaging scans — like X-rays, MRIs, or ECGs — which aid in visualizing heart activity and identifying abnormalities.

• Endomyocardial biopsy: In some cases, a biopsy of the heart muscle may be performed to determine if you have myocarditis. This procedure entails extracting a small sample of heart tissue for analysis to detect any signs of inflammation.

Depending on the outcome of these tests, your doctor will recommend various treatment strategies to help you manage your condition.

Can Myocarditis Be Treated?

Treatment options for mild cases

If you’ve been diagnosed with a mild case of myocarditis, your treatment will usually focus on managing your symptoms and monitoring your condition. This may involve:

• Resting and avoiding strenuous activities
• Regularly monitoring heart function
• Using medications to relieve symptoms like pain, fever, and inflammation
• Treating underlying conditions that are causing your symptoms
• Making beneficial lifestyle changes, including following a heart-healthy diet, quitting smoking, and implementing stress management techniques

Depending on your response to the treatment, your doctor may recommend further testing or suggest more aggressive management strategies, like prescription medication or surgical interventions.

Treatment for moderate to severe cases

For moderate to severe cases of myocarditis, a more comprehensive treatment approach will be needed to help you manage this condition. This approach may involve:

• Heart medications: These can include ACE inhibitors, beta-blockers, and diuretics to help reduce the workload on the muscle and manage heart failure symptoms. This can also help reduce the risk of potentially life-threatening cardiac events.

• Corticosteroids and immunosuppressants: In cases where myocarditis is caused by an autoimmune response, these medications can be used to reduce inflammation and suppress the immune system.

• Antiviral or antibiotic therapy: Should a particular infectious agent be identified as the cause of your myocarditis, your doctor will prescribe suitable antiviral or antibiotic therapies to eradicate the bacteria.

Your doctor will monitor your response to these treatments and adjust any dosages as necessary to ensure the best results.

Advanced treatment options

For patients with severe cases of myocarditis, more advanced treatments may be necessary. These may include:

• Intravenous (IV) medications: These can be used to support heart function and blood pressure and are usually administered in a hospital setting, ensuring close monitoring and immediate response to any changes in the patient’s condition.

• Mechanical support devices: In critical cases, medical interventions may involve the use of a ventricular assist device (VAD) or an intra-aortic balloon pump (IABP). These are used to help the heart pump blood, thereby helping to prevent life-threatening complications.

• Heart transplant: In rare instances where the heart is severely damaged and other treatments are ineffective, a heart transplant is also an option. However, this high-risk procedure is a last resort.

It’s important to note that this level of myocarditis treatment is relatively uncommon since most cases aren’t that severe.

Early detection and mild to moderate treatment options are usually enough to help you manage your symptoms and live a normal life.

What are the Risks and Complications Associated with Myocarditis?

Short-term complications

Short-term complications tend to develop in mild cases of myocarditis and may include:

• Arrhythmias: Myocarditis can disrupt the normal electrical pathways in the heart, leading to irregular heart rhythms (called arrhythmias). Some arrhythmias may be life-threatening if left untreated.

• Chest pain and myocardial infarction: In rare cases, myocarditis can mimic symptoms of a heart attack, including chest pain and discomfort in the jaw and arms.

• Pericarditis: This is a condition that develops when the pericardium — the sac-like covering of the heart — becomes inflamed. It can occur concurrently with myocarditis.

In severe cases, myocarditis may also lead to heart failure and cardiogenic shock — a form of heart failure where the heart suddenly can't pump enough blood to meet the body's needs.

These cardiac events are emergencies and require immediate medical attention.

Long-term complications

If your myocarditis is severe or not treated properly, you may develop long-term complications. These may include:

• Dilated cardiomyopathy (DCM): A condition where the heart chambers enlarge and weaken, reducing the heart's ability to pump blood efficiently.

• Chronic heart failure: Some patients may develop chronic heart conditions as a result of damage to the heart muscle from myocarditis. This can lead to heart failure.

• Sudden cardiac death: Although rare, severe myocarditis can lead to cardiac death — a sudden and complete loss of heart function — which can be fatal if it’s not treated immediately.

Your doctor will typically evaluate your risk for long-term complications and suggest strategies to help you prevent them.

Risk factors for severe complications

While anyone can develop myocarditis, there are a number of factors that can increase your risk. These are:

• Pre-existing heart damage or inflammatory conditions
• Underlying health conditions, like diabetes, HIV/AIDS, or eating disorders
• A weakened immune system
• Delaying diagnosis or treatment of cardiovascular conditions
• Autoimmune diseases
• Overconsumption of alcohol
• Using intravenous drugs
• Poor dental health

Inflammatory heart conditions like myocarditis are also more prevalent in older adults, men, and individuals with a family history of cardiovascular conditions.

It’s important to inform your doctor if you fall into any of these categories so that they can recommend appropriate risk management strategies.

Should You See a Doctor About Myocarditis?

If you suspect that you have myocarditis — especially if you experience symptoms like chest pain, shortness of breath, irregular heartbeat, or extreme fatigue — schedule an appointment with your doctor.

These symptoms can indicate a serious condition and require prompt medical attention to diagnose the root cause.

You should also consult your doctor if you've recently had a viral infection and are experiencing cardiac symptoms, as this could be a sign of myocarditis.

Where Can You Learn More About Managing and Living with Myocarditis?

If you’re concerned about your heart health or want to know more about myocarditis, LifeMD is here to help.

LifeMD can connect you to a team of medical professionals who can provide information and guidance on managing myocarditis while avoiding further complications.

Make an appointment today to get started.