What is Myocarditis?
Myocarditis - a focal or diffuse inflammation of the myocardium - is typically uncomplicated and self limiting. It may be acute or chronic and can occur at any age. In many patients. myocarditis fails to produce specific cardiovascular symptoms or electrocardiogram (ECG) abnormalities. Recovery usually is spontaneous and without residual defects.Occasionally, myocarditis becomes serious and induces myofibril degeneration, right- and left-sided heart failure with cardiomegaly, and arrhythmias.
Causes of Myocarditis
Myocarditis may result from any of the following:
Signs & Symptoms of Myocarditis
Patients with acute myocarditis and chronic myocarditis experience different symptoms. In acute myocarditis, individuals may experience fever, chest pains, a sensation of skipped heart beat (palpitations), dyspnea and fatigue. In patients with chronic myocarditis, fatigue, a sensation of skipped heart beats, shortness of breath and chest pains may be experienced.
The ECG will show transient changes which are usually non-specific and occur in many other cardiac diseases, however, in light of 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.
For most patients, treatment includes anti-infectives for the underlying causative infection, modified bed rest to decrease the heart's workload, and careful management of complications. Left-sided heart failure requires activity restriction to minimize myocardial oxygen consumption, supplemental oxygen therapy, sodium restriction, diuretics to decrease fluid retention, and digitalis compounds to increase myocardial contractility. However, these compounds must be administered carefully because some patients with myocarditis may show a paradoxical sensitivity even to small doses.
Arrhythmias necessitate prompt but cautious administration of antiarrhythmics. such as quinidine or procainamide, to depress myocardial irritability. Thromboembolism requires anticoagulant therapy.
Treatment with corticosteroids or other immunosuppressants is controversial and therefore limited to combating life-threatening complications such as intractable heart failure.
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