Myocarditis

definition

Having an inflammation of the heart muscle (Myocarditis) one understands an inflammation of the heart muscle. The heart muscle cells, the cell spaces (Interstitium), as well as the heart muscle vessels.

Signs

60% of all patients with symptoms of an inflammation of the myocardium contracted a flu-like infection a few days to a few weeks before with the typical symptoms of cough, runny nose, fever or headache and body aches. If these symptoms are followed by symptoms such as shortness of breath, tiredness and poor physical capacity, these could be the first signs of the onset of myocarditis.
The weakened heart muscle is no longer able to supply the body with sufficient oxygen. Although the lungs are working properly, there is a feeling of shortness of breath. Above all, decreasing resilience is often the only sign in the early stages of heart muscle inflammation. Loss of appetite and weight can also occur, and chest pain is also possible, although not very common.

Since heart muscle inflammation only occurs a few days after a flu-like infection, the above-mentioned signs should be taken seriously after the illness. Exercising during a flu-like infection further increases the risk of myocarditis.

How can you recognize heart muscle inflammation yourself?

Heart muscle inflammation is associated with very unspecific symptoms and is therefore difficult to detect, even for experts, without using technical aids for diagnosis. Therefore, it is extremely difficult for a layperson to recognize that he is suffering from myocarditis.
Indicative complaints can be tiredness and a decrease in performance. The symptoms very often occur during an infection or in the period afterwards, when one starts to exercise again. The characteristic of these complaints is that they do not go away even after the infection has healed, since the heart muscle inflammation lasts longer. Cardiac arrhythmias can provide another indication of an inflammation of the heart muscle. These are usually best seen in an EKG.
Affected people can sometimes feel so-called palpitations (heart stumbling). Some heartbeats suddenly stand out very clearly from the normal heartbeat. Chest pain can also be indicative of myocarditis. This pain occurs especially when the pericardium (the heart sac) is affected. Most of the time, they are dependent on breathing and are only noticeable when you inhale.

Back pain as an indication of myocarditis

Pain is a rather rare symptom of heart muscle inflammation, but it can occur. Especially when larger parts of the heart are affected and a high proportion of the heart muscles are inflamed, pain also becomes noticeable. In many cases, this pain cannot be directly attributed to the heart. The reason is believed to be that the sensitive (feeling) nerve fibers from the heart arrive in the brain together with those from the back. It can happen that the registered pain is mistakenly perceived in the back.

Symptoms of myocarditis

In most cases, myocarditis does not show any symptoms and therefore often remains undetected. But even with symptomatic courses, there are no key symptoms with which the cause of the complaints can be clearly identified.

Unspecific symptoms such as tiredness and fever, general malaise, heart stumbling (palpitations) and shortness of breath are mostly in the foreground, depending on the extent of the illness. In more than half of the cases, a flu-like infection precedes the illness.

60-70% of those affected may show signs of heart failure, and 5-10% more serious cardiovascular disorders. Heart failure is the pathological inability of the heart to supply the body with sufficient oxygen from the lungs without accepting a significant increase in blood pressure. The main symptom here is shortness of breath, especially during exercise. Edema (Water retention) in the legs can occur.

In 10-30% of cases, pain occurs in the chest area, which is similar to the pain of coronary artery disease (CHD) can be the same in constricted coronary arteries. Furthermore, 5-15% of patients complain of cardiac arrhythmias. Since other diseases of the heart can also be associated with these symptoms and the myocarditis can take on severe courses in some cases, more extensive diagnostics, including ECG and imaging procedures, are important.

Read more on this topic at: Symptoms of myocarditis

Pain as a symptom of myocarditis

Heart muscle inflammation can be accompanied by chest pain. Usually these pains are very unspecific and only indicate a general problem of the heart. A coronary artery disease or a heart attack is often suspected at first. However, pain is not necessarily present in the case of an inflammation of the heart muscle. Instead, a drop in performance and increased fatigue are usually the only signs. The less the heart muscle inflammation, the more non-specific the symptoms become. Therefore, pain in heart muscle inflammation suggests a severe course.

Is myocarditis possible without a fever?

Heart muscle inflammation can occur both with a fever and without an elevated body temperature. Most heart muscle inflammation is the result of a cold or flu. In order to be able to fight the pathogens, the body increases its temperature. The more aggressive the germs are, the higher the fever tends to rise. However, since comparatively harmless pathogens can also cause myocarditis, the absence of fever does not rule out such myocarditis.

Is myocarditis contagious?

Myocarditis itself is not contagious. However, it is possible to infect other people with the cause of the disease. Most heart muscle infections are caused by infection. Viral diseases are particularly common, but bacterial infections can also be the cause of myocarditis. Infection with these viruses or bacteria is possible. Droplet infection is the most common way of infection, especially when you have a cold. The pathogens do not necessarily have to trigger an inflammation of the heart muscle in the infected person.

Duration of an inflammation of the heart muscle

Healing from an inflammation of the heart muscle is a tedious process. On average, the duration of illness in the context of myocarditis is about 6 weeks. The exact duration of the inflammation can vary widely and can be between 2 to 12 weeks. After this time, however, the inflammation of the heart muscle has not yet completely healed. In addition, there are a few more weeks during which the person concerned should take it easy. Even if symptoms of myocarditis are no longer felt, it is important to avoid physical exertion in order to avoid subsequent damage to the heart. In the worst case, premature heavy stress on the cardiovascular system can result in heart failure and other consequential damage such as cardiac arrhythmias.

How much time a heart muscle inflammation ultimately needs to heal completely depends to a large extent on the general condition of the patient. Above all, being overweight and inadequate physical fitness have a very negative effect on the duration of the illness. It is also very important for a quick and uncomplicated healing how much the person concerned allows himself and his heart to rest. In general, it is usually stated that 3 months of physical rest are necessary in order to be able to guarantee a full recovery. However, other factors also seem to have an influence on the course of the disease that are not yet fully understood.

While the disease heals spontaneously and without lasting symptoms in about a third of patients, acute myocarditis can develop into a chronic state in some. A connective tissue remodeling process takes place in the heart muscle tissue (Fibrosis) instead, which severely impairs the function of the organ. If the aforementioned remodeling of the fabric has already taken place, it is irreversible (irreversible). A chronic condition of a disease in general is spoken of from 3 to 6 months of an ongoing disease.

Read a lot more information on this topic at: Duration of an inflammation of the heart muscle

How long are you unable to work if you have myocarditis?

Normal myocarditis lasts about six weeks. How long someone is unable to work depends on the one hand on the course and on the other hand on the type of work. For physically demanding jobs, the incapacity to work can last up to three months, as no heavy physical activity is permitted for that time. In less physically demanding jobs, it is possible to return to work much earlier.

If complications arise, the period of incapacity for work can be significantly extended. In the most severe cases (heart failure, possibly necessary heart transplant, cardiac arrest, etc.), it can even lead to a lifelong inability to work.

Peculiarities of cardiac muscle inflammation in children

Heart muscle inflammation occurs in around five to ten percent of cases after a viral infection. Since children are on average more likely to get infections than adults, special care should be taken with them. Especially if a "harmless" infection also has a fever, an absolute ban on sports should be followed for about a week. In this way acute consequences of an inflammation of the heart muscle can be avoided. Especially if a child still feels a little uncomfortable after the infection has healed or the parents still feel unfit, the symptoms of myocarditis should be paid close attention to. Especially in children, the disease is often quite mild, which is why complaints such as tiredness and reduced performance should not be ignored.

Even if heart muscle inflammation in children is often harmless, the disease can become chronic and thus limit the children in the long term. If a child has a more severe form of myocarditis, they should not do sport for a period of about six weeks to three months. After the most difficult courses, competitive sport is forbidden in the long term, as later (sometimes life-threatening) complications cannot be ruled out.

therapy

If myocarditis (inflammation of the heart muscle) has been diagnosed, it is important to act quickly. First of all, the underlying disease that led to the myocarditis should be treated with medication. In most cases, treatment with penicillin or another antibiotic is started intravenously. The patient must be admitted to the hospital for this. If it was possible to classify the causative agent of the infection, in most cases an antibiogram can be made and the basic infection treated.

If the cause is suspected to be a virus, it may be necessary to initiate a so-called drug-based antiviral therapy (e.g. with interferon). If autoantibodies can be detected, the increased activity of the immune system must first be reduced. This is usually done by giving cortisone.

General principles of treatment are physical restraint, the administration of blood-thinning medication (anticoagulation) when there is evidence of cardiomyopathy, and the treatment of any heart failure that may have occurred.

Please also read: Heart failure therapy

homeopathy

Various homeopathic remedies can be used for heart muscle inflammation. Gelsemium sempervirens is primarily used against the causative infection. Crataegus and Cactus are medicines that help treat heart problems. Iberis amara and Kalmia can be taken especially against heart muscle inflammation. Homeopathic remedies can interact with other medicines. Therefore, the attending physician should not only be informed about the use of other medicines, but also about the use of homeopathically active substances.

Home remedies

Heart muscle inflammation is a life-threatening disease that cannot be treated with home remedies alone. Therefore, a doctor should always be consulted and his therapy should be carried out. However, additional home remedies can alleviate some symptoms. Above all, it is important to strengthen the heart, so those affected should eat consciously. In addition, tobacco and alcohol consumption are very harmful. In order to avoid consequential damage, sport should be avoided. Reducing stress through yoga, meditation or massage can be beneficial for the heart. Home remedies that help against the offending infection are also suitable.

forecast

In over 80% of cases, myocarditis (inflammation of the heart muscle) heals. However, cardiac arrhythmias are just as often left over for life. However, these are harmless and do not require any further treatment. Dilated cardiomyopathy with heart failure occurs in 15% of cases (especially in viral myocarditis).
A fulminant (aggressive) course with acute cardiac arrhythmias or conduction disorders occurs relatively rarely, which in the worst case can be life-threatening.

What can the long-term consequences / consequential damage be?

The severity of the consequential damage depends heavily on how severe the myocarditis is. The size of the affected heart region also plays a role. The larger the area, the more severe the consequential damage can be. If heart muscle inflammation is not recognized and treated in good time or if the necessary sports break is not observed, consequential damage occurs much more frequently.

If the heart muscle inflammation is accompanied by cardiac arrhythmias in the acute situation, it is possible that these will persist. If the cardiac arrhythmias occur permanently, drug therapy is necessary. If many cells are destroyed in the myocarditis, the heart may not be able to maintain its pumping capacity. In the most severe cases, sudden cardiac death (especially during exercise) can occur. Heart failure (heart failure) is also a possible long-term consequence.

Some people even need a heart transplant after an inflammation of the myocardium, as the heart cannot pump enough power over the long term. About 15% of myocarditis turn into a so-called dilated cardiomyopathy. This is a disease of the heart muscle cells that causes the chambers of the heart to enlarge. Heart failure also follows from this disease at some point.

Can myocarditis be fatal?

Myocarditis is a very serious disease that can be fatal. If the disease is not recognized, sudden cardiac death can result. This occurs especially during physical exertion. If large parts of the heart are affected by the inflammation, heart failure can occur. Depending on the severity of the heart muscle inflammation, a fatal outcome is also possible here. If the danger is recognized in good time, the consequences can be mitigated by early therapy. A heart transplant may even be necessary.

Exercise for heart muscle inflammation

Strict bed rest applies during heart muscle inflammation! Sports and other physical activities are absolutely taboo during this time. Even if those affected have no symptoms whatsoever (asymptomatic), they absolutely have to forego sport. Because the weakened heart muscle is no longer fully efficient due to the acute inflammation and reaches its limit much earlier. Doctors usually recommend a three-month break from exercise after recovering from myocardial inflammation.
In connection with cardiac muscle inflammation and exercise, it is not uncommon for people to speak of "sudden cardiac death". Young, sporty people are particularly affected!

But why is that so?

In the case of viral or bacterial infections, e.g. Flu or gastrointestinal infections, there is often the possibility that the inflammation will spread to the heart muscle. In many cases this happens unnoticed and heals without any problems.However, if those affected ignore the warning signs of their body and do sport despite a great feeling of illness, life-threatening cardiac arrhythmias can occur. In the worst case, the patients die. Young athletes in particular overestimate their resilience in the event of illness.
Of course, strict bed rest does not apply to every cold. However, if you are unsure whether exercise is allowed again after having overcome the flu, ask your doctor for advice!

Forms and causes of myocarditis

On the one hand, a distinction is made between infectious myocardial inflammation and non-infectious myocardial inflammation. The infectious form can be triggered by viruses (in 50% of cases), as well as bacteria, fungi, protozoa and parasites.

The most common bacterial pathogens are:

• Enterococci
• Staphylococci
• Group A beta-hemolytic streptococci

The most common viral pathogens are:

• Coxsackie Virus B1-B5 and A.
• Parvovirus B 19
• human herpes virus 6 (HHV 6)
• Epstein Barr Virus (EBV: virus causing glandular fever)

The non-infectious course of myocarditis (inflammation of the heart muscle) can be caused by rheumatoid arthritis, collagenosis (inflammation of the collagen tissue) or by vasculitis (inflammation of the blood vessels). In rare cases it can also be triggered after tissue irradiation, e.g. as part of chemotherapy. Intolerance reactions to drugs (e.g. clozapine) can also result in inflammation of the heart muscle.

Read more on the subject at: Causes of myocarditis

Inflammation of the heart muscle after a cold

Heart muscle inflammation usually occurs after infection. Such an infection can present itself as a simple cold, for example. Both viral colds and colds caused by bacteria are able to cause heart muscle inflammation. Heart muscle inflammation occurs much more frequently (in about one to five percent of cases) after a viral disease. The most common viral pathogens are the Coxsackieviruses. But the parvovirus B19 (which causes rubella), the herpes virus and various adenoviruses can also be responsible for heart muscle inflammation.

Inflammation of myocardia after flu

The heart muscle inflammation after the flu is similar to that after a cold. Possible triggers are all types of germs, with viruses being the triggers much more frequently than bacteria. People with additional underlying diseases are particularly susceptible to myocarditis after infectious diseases. Especially those who have a weakened immune system due to a previous illness (after chemotherapy, HIV / AIDS, etc.) are at risk. As with the common cold, the most common triggers are the coxsackieviruses.

Myocarditis from exercise

The heart muscle inflammation itself is not triggered by exercise. Usually an infection with viruses or bacteria is the cause. This infection can take the form of a harmless cold or the flu. If the germs also attack the heart, the heart muscles become inflamed. Often this inflammation is not noticeable because the only symptoms are increased fatigue and reduced performance. If you start exercising too early after the infection, you can force the still inflamed heart muscle cells to perform at their best. Then the heart muscle inflammation becomes noticeable. In the worst case, it can cause immediate cardiac arrest.

Read more on the subject at: Myocarditis from exercise

Inflammation of the heart muscle caused by alcohol

It is now accepted that excessive alcohol abuse leads to a general inflammatory response in the body. In this context, there are indications that inflammation in the heart muscle (Myocarditis) can come. As a rule, this does not apply to “normal”, moderate alcohol consumption.

However, one finds healed or acute myocarditis in many alcoholic patients. In addition to the directly damaging effect of alcohol itself, it also suppresses the body's defenses in the long term (immunosuppressive). Bacteria, viruses and fungi have an easier time.

Basically, alcohol should be completely avoided during the healing and therapy phase of myocardial inflammation. Because in many cases the body is very weak and needs all its resources to heal. In addition, dangerous interactions between drugs and alcohol can arise.

Can you get myocarditis from stress?

Heart muscle inflammation is triggered by pathogens such as viruses and bacteria. Therefore, stress is out of the question as the sole cause of the disease. However, stress can damage the heart in other ways, making the heart muscles more prone to heart inflammation. Stress is especially harmful if it is permanent. Chronic stress, for example, can promote a heart attack, it increases blood pressure and also damages blood vessels. These factors have a negative effect on the entire cardiovascular system and can thus make the heart more susceptible to diseases over the long term.

Epidemiology

Viruses that can potentially trigger myocarditis cause 1% of myocarditis. The number of unreported cases is very high, as there are also many clinically normal myocarditis that cause sudden cardiac death in young people and are only discovered during autopsy.
Viruses make up the most common cause of heart muscle inflammation at 50%. Myocarditis caused by viruses is in some cases caused by what is known as cross antigenicity. The cause here is an overreaction of the immune system between the viral structures and the heart muscle cells. In these immune-related myocardial inflammations, so-called antimyolemmal antibodies (AMLA) of the IgM type, antisarcolemmal antibodies (ASA) of the IgM type, as well as IgM antibodies and complement factors C3 are found in the biopsy of the heart muscle in 70-80% of cases.
All of these factors indicate that the immune system is particularly active, although no infection may be affecting the patient at this point.

Measurable symptoms

In the EKG (electrocardiogram) are mostly cardiac arrhythmias up to dangerous ventricular tachycardias to be recognized. Findings such as the so-called S-T segment elevations can be similar to those of a heart attack.
In severe, rapidly developing (fulminant) disease courses, an enlarged heart can be seen radiologically. A pericardial effusion (pericardial effusion) can be detected in 20% of cases by means of echocardiography (Cardiac ultrasound) to recognize.

Blood pressure

Our blood pressure is made up of the systolic (“first”, “higher”) and the diastolic ("Second", "lower") Worth together. The systolic value describes the pressure in the large arteries while the heart pumps blood into the circulation. In contrast, the diastolic value describes the pressure during the filling phase of the heart. In the ideal case, the blood pressure, depending on age and constitution, is around 120/80 mmHg. If the heart muscle is inflamed, the blood pressure can change, but this is not absolutely necessary.
A decrease in blood pressure (Hypotension), especially if viruses are the cause of the heart muscle inflammation. Systolic values ​​below 100mm Hg are not uncommon. Nevertheless, a low blood pressure alone does not constitute evidence of the disease. However, if an increased heart rate at rest (> 100 beats / minute) is added, the symptoms can be groundbreaking.

fever

A fever is an increase in body temperature above about 37 degrees Celsius. The standard values ​​vary individually and are dependent on the measurement method. In addition, daily fluctuations can be observed.
It is not uncommon for those affected by myocarditis to report a previous fever. It mostly occurs as part of viral infections and is accompanied by flu-like symptoms such as Body aches or weaknesses. The height of the fever can vary and is not linked to the severity of the myocarditis. In principle, the illness does not necessarily have to be accompanied by a fever. In severe, untreated cases, the inflammation can spread to the whole body and cause so-called sepsis (blood poisoning) with a high fever.

diagnosis

To diagnose "Myocarditis"To secure, various examinations may be necessary:

1. Anamnesis: First, the patient is asked about his current symptoms and his previous medical history. In the foreground are e.g. recently experienced flu infections or attacks of fever
2. Resting ECG: Deviations can be an indication of an inflammation of the heart muscle
3. Blood tests: Typical are e.g. increased levels of inflammation and special heart muscle enzymes
4. Echocardiography: reduced heart function can be made visible
5. Imaging tests: X-rays or cardiac MRI provide an overview of the extent of the inflammation
6. Biopsy: In particularly severe cases, a tiny sample of tissue from the heart may be required

Further information on the subject can be found at:

• Diagnosis of myocarditis
• How do you recognize myocarditis?

Blood count

In many cases of heart muscle inflammation, the levels of inflammation in the blood are increased. These include the CRP value (C-reactive protein), ESR (sedimentation rate) and leukocytes (white blood cells). However, the values ​​mentioned do not necessarily have to be increased! Conversely, increased inflammation levels alone do not provide sufficient evidence for the diagnosis. In addition, the level of CRP, ESR and leukocytes does not reflect the severity of myocardial inflammation.

Especially in the initial phase, an increase in cardiac enzymes can often be measured in the blood: If the heart muscle is caused by e.g. If an inflammation is damaged, it secretes more of the enzyme creatine kinase-MB (CK-MB). However, the enzyme creatine kinase can also be found in other forms, including in the brain and skeletal muscle. In order to be able to make a more precise statement, the troponin T / 1 concentration in the blood is often measured. Troponin-T / 1 is a protein that is normally found inside heart muscle cells. If the cells are damaged, it is released into the blood and can be detected there.

Recently, so-called myocardial antibodies can also be determined if heart muscle inflammation is suspected. They denote small, endogenous proteins, which can be detected especially when the cause is viral. In addition, the blood can be examined for individual disease-causing viruses (e.g. Coxsackie A + B, Influenza A + B, adeno, hepatitis, herpes or poliovirus).

Read more on the subject at: Blood counts in case of an inflammation of the heart muscle

EKG

Using an electrocardiogram (EKG) statements about the rhythm, activity, frequency and type of position of the heart can be made. In the case of myocarditis, any type of arrhythmia can occur, depending on which part of the heart is affected. They are therefore also called unspecific.

The observable changes in the ECG can include e.g. counting:

• Supraventricular extrasystoles: beats outside or in addition to the normal heart rhythm, whose origin lies in the atrium
• Ventricular extrasystoles: beats outside or in addition to the normal heart rhythm
• Tachycardia: heart rate over 100 beats / minute
• Arrhythmias: atrial fibrillation, ventricular fibrillation. Characteristic is an irregular, usually too fast (tachycardia) Heartbeat. Depending on where the cause of the irregular frequency lies, a distinction is made between ventricular and atrial fibrillation
• T-wave depression, ST segment changes: If the T wave or the ST segment changes in the ECG, this can be an indication of reduced blood flow (Ischemia) be in parts of the heart

Please also read our article on the subject: EKG for an inflammation of the heart muscle

What can you see of the heart during an MRI?

An MRI of the heart is primarily suitable for characterizing the severity of myocardial inflammation. The first indications are wall movement disorders and limitations of the pumping function. An MRI can be used to display the force of contraction, i.e. the force with which the heart muscles contract. These provide valuable information about the functionality of the muscles. The more limited the pumping function, the more inflammatory the heart muscle is. A further assessment of myocardial inflammation can be made by showing cardiac edema. This water retention can also be seen particularly well in the MRI

Read more on the subject at: MRI of the heart