The term Myocarditis implies inflammation of the heart muscle. It is
usually due to a viral illness and the most commonly implicated viruses
are Coxsackie B and Echo virus. Viral Myocarditis is relatively common
and most cases are very mild and therefore never come to the attention
of the doctor or are never detected clinically. Some cases are severe
and lead to considerable impairment in the capacity of the pump
efficiency resulting in severe heart failure. Sudden death is a
recognised complication, usually occurring during or just after
exertion. It is the result of poor contraction of the heart or
electrical instability of the heart due to the inflammation of the heart
muscle.
Top of the page
Symptoms
Most patients feel feverish and have generalised aches and pains as
with any other viral illness. When the heart is severely affected the
patients feel tired and breathless. Chest pain and palpitations are
relatively common.
Top
of the page
Signs
Apart from a rapid heart rate, the doctor may not find any other
abnormalities when examining the patients with mild Myocarditis. However, in severely affected individuals there is evidence of heart
failure.
Top of the page
How
is Myocarditis diagnosed?
The ECG will show transient changes which are usually non-specific
and occur in many other cardiac diseases. However, the
patient’s symptoms and the presence of a fever may raise the suspicion
of Myocarditis. An echocardiogram (ultrasound of the heart) will reveal
an enlarged heart which is poorly contracting. In very mild cases both
the ECG and the echocardiogram may be normal and in these situations one
should exercise caution and not participate in any sporting activity
when symptoms of a flu-like illness are present. In patients presenting
with florid cardiac symptoms and signs, the diagnosis can be confirmed by
a biopsy (small specimen of the heart) taken from the right ventricle.
Top of the page
Treatment
Complete rest is indicated in all patients! Patients with heart
failure and complicated electrical disturbances of the heart require
hospital admission to manage these complications. The use of steroids in
reducing inflammation of the heart is reserved to very sick patients who
have clear evidence of the condition on the biopsy.
Top of the page
Prevention of Sudden Death
Refrain from sporting activity until all symptoms have subsided and
the ECG and echocardiogram appearances are normal.
Generally athletes are advised to refrain from
sporting activities during flu-like illness - or even during common cold
- until the symptoms settle, as the majority of cases of Myocarditis
produce no cardiovascular symptoms.
Top of the page
Clinical
outcomes
Over 75% of the patients improve within two weeks without any
complications. Approximately 10% of patients proceed to develop Dilated
Cardiomyopathy and require life long treatment with heart failure
medication.
Top of the page
With special thanks for the Medical Information
that has been
provided by our team
of experts
|
