Symptoms of myocarditis


The heart is a large muscle (heart muscle) and consists of three different layers.

The outer layer, also called the epicardium, consists of connective tissue and is fused with the muscles. The middle layer forms the muscle layer, that too Myocardium is called. The innermost layer, the endocardium, consists of epithelial cells and completely lines the heart. If the heart muscle is inflamed, only the middle layer, i.e. the muscle layer, becomes inflamed. The inflammation can arise either through a bacterial or viral infection or without an infection, for example in the context of rheumatoid arthritis.

General symptoms

The course of an inflammation of the heart muscle (myocarditis) can take many different forms. Most myocarditis has no or mild clinical symptoms.
In extreme cases, the first symptom can be heart muscle inflammation, dangerous cardiac arrhythmias and sudden cardiac death. Chronic myocarditis can trigger dilated cardiomyopathy with associated symptoms. The symptoms that patients with infectious myocarditis show are mostly related to the original effect.
If symptoms occur and the myocarditis becomes clinical, patients usually complain of:

  • fatigue
  • Fatigue (performance kink),
  • Palpitations
  • Palpitations.

The patient can also report an unnaturally fast pulse as symptoms (tachycardia), as well as fever. The heart stumbling indicated by him will presumably be represented by an EKG as extrasystole (cardiac arrhythmia).
In extreme cases, the patients show symptoms of heart failure, which can range from shortness of breath, decreased performance to swollen legs (edema).

Detect heart muscle inflammation

The symptoms of an inflamed heart muscle can be recognized by a relatively large number of blood count parameters and examinations. Most of the time, however, those affected notice a clear "performance kink". The heart cannot pump as much blood as would theoretically be needed.
The blood count shows slightly to moderately increased inflammation parameters such as the white blood cell count or the C-reactive protein. In addition, the death of cardiac muscle cells can be detected in the blood count with a special examination.
With the help of ultrasound, the heart's limited beating capacity can be made visible, and with the help of a so-called biopsy, the inflamed heart tissue can be examined directly.

Read more on the subject at: Myocarditis

The typical symptoms

Flu symptoms

The symptoms of myocarditis are usually very unspecific and do not prompt the patient to go to the doctor immediately. Often the heart muscle inflammation is only noticeable through reduced resilience and rapid fatigue. The consequence or side effect of the viral illness are symptoms of the flu, such as fatigue, tiredness and malaise. In addition, the function of the heart is restricted, which is noticeable in reduced performance.
When interviewing affected patients, however, they very often report colds that occurred prior to the heart muscle inflammation. The patients previously suffered from coughs, runny nose, headaches and aches and pains, as well as fever.

to cough

The symptoms of the flu-like infection can also appear at the same time as the symptoms of myocarditis; the infection does not have to be over for the myocarditis to develop.

Accordingly, an existing cough is only a direct symptom of a flu-like infection, but it can indirectly lead the suspicion of an inflammation of the myocardium if there is an additional reduction in performance and shortness of breath during exercise.

In addition, many patients with heart muscle inflammation complain of frequent cardiac arrhythmias in the form of noticeable "heart stumbling". This can be so pronounced that it provokes an urge to cough.

Furthermore, in the course of the disease there may be pain that radiates into the arms. The pain usually worsens when lying down and can be aggravated by deep breathing and coughing. Symptoms of myocarditis later on can include loss of appetite and weight.

You might also be interested in: Pain in the left arm as a sign of a heart attack

Body aches

Pain in the limbs or muscle pain usually already occurs with relatively common infections and should therefore not be a surprise even with a serious illness such as myocarditis.On the one hand, they arise from the limited removal of pathogens from the body. Since they cannot be drawn out of the body's circulation quickly enough by the liver and kidneys, they begin to be deposited everywhere and are only eliminated from the body when the state of health improves.
Second, the body releases so-called inflammation mediators, which on the one hand help it to detect the bacteria or viruses, but which unfortunately also make the body more susceptible to pain.

Changes in blood pressure

In addition to symptoms like fatigue, rapid fatigue, sudden drop in performance and Racing heart Another landmark symptom of an existing myocarditis may be the occurrence of low blood pressure be.

The doctor describes a low blood pressure as Hypotension, it means blood pressure values ​​below 100/60 mm of mercury. The two values ​​consist of a so-called systolic value and a diastolic value.

The systolic value is the higher value and arises during the ejection phase of the heart, the so-called systole. He is a Measure of the strength of the heartOr rather, the ejection force of the heart with which the heart pumps blood into the body's circulation. The diastolic value is the lower of the two. It arises in the relaxation phase of the heart in which it fills with blood.
He is a Measure of the elasticity of the vessels. Heart muscle inflammation causes damage to the muscle cells in the heart so that they can no longer work properly. This leads to a weakening of the performance of the heart, which is also known medically as heart failure.
In addition, disturbances of the heart rhythm can arise, which can be particularly dangerous. Due to the weakening of the heart muscle, it can no longer pump the blood into the body's circulation as effectively and powerfully during the ejection phase. This can manifest itself in low blood pressure, known as hypotension.
If the heart is weak, the patients also suffer from a more rapid fatigue and reduced performance.


A Myocarditis often arises from the Spreading a flu-like infection. The patients often report what has occurred in advance to cough, sniff, head- and Pain in the limbs and fever. The inflammation of the heart muscle itself does not necessarily show itself through typical signs of infection, but rather through unspecific symptoms, how reduced resilience, fatigue and Shortness of breaththat occurs with even low physical exertion.

fever is a symptom in inflammatory disease that is the response of the organism to Pathogens/foreign body or other disruptive factors indicates. Accordingly, fever can also occur as a symptom of heart muscle inflammation.

However, it is by no means a mandatory requirement for diagnosing myocarditis. Since the disease presents very few symptoms in many cases, fever is also not one of the most common symptoms of myocarditis.

However, if it does occur, it should physical exertion absolutely avoided become. In general, you should refrain from sporting activities during an infection (regardless of whether you have a fever or not) in order to minimize the risk of subsequent myocarditis.

As soon as one observes symptoms that could be related to heart muscle inflammation during / after a flu-like infection, one should as soon as possible Doctor consulted become. Of the course and the Symptoms The disease can vary from patient to patient vary greatlywhich is why there are no established typical symptoms.

The majority of patients initially notice nothing at all about the disease. If a fever suddenly recurs after a flu-like infection, especially in connection with a drop in performance, shortness of breath and / or Palpitations, this should be a reason to see a doctor. This also applies to a high fever during an infection with additional unusual weakness, shortness of breath and Cardiac arrhythmias.


In principle, a person sweats primarily for the purpose of heat regulation.

The body can release excess heat into the environment via the mechanism of sweating. With this, humans can keep their body temperature the same. In addition to regulating body temperature, sweating can be the result of a stress reaction in the body.
When the body becomes stressed, the so-called sympathetic nervous system, which is part of the autonomic nervous system, plays a key role. This sympathetic nervous system controls the sweat glands and so its activation leads to sweating.

Sweating as a result of stress also occurs in many diseases. So can be short of breath or severe Chest pain in the context of a heart attack or myocarditis lead to a stress reaction of the body, which can cause profuse sweating.
In contrast to the heat emission, in which the patients sweat and are warm, the patients who sweat due to a stress reaction are characterized by cool and moist skin. Another reason that heart muscle inflammation can lead to sweating is the cause of myocarditis. For example, if myocarditis is caused by a bacterial or viral infection, the body's response to an infection is often a fever and sweating.

Back pain

Back pain is a very non-specific symptom of myocarditis. Similar to a heart attack, they can, but do not necessarily have to appear. The pain usually seems to radiate into the back or even to have its origin here. With the help of palpation and light tapping of the spine as well as a circular movement of the spine, however, it can be determined that the pain is neither bony nor muscular in origin, but must have its origin somewhere other than the spine.

Pain in the spleen and liver

Swelling of the liver and spleen can occur as a result of the inadequate pumping capacity of the heart during an inflammation of the heart muscle. The blood backs up into the body, so to speak, because the heart cannot pump as much blood back into the body as the body makes available to the heart again. Since there are blood vessels from the liver and spleen that supply blood to the heart, if the pumping capacity is inadequate, edema also forms back up in these two organs.
The enlargement can be determined by buttons under the right and left costal arches or relatively easily with the help of an ultrasound device.


Similar to myocardial infarction, acute myocarditis also often causes nausea and vomiting. Exactly why vomiting occurs is not really clear, but both of these symptoms can be treated quite well with medication.

Symptoms in Babies

Also Babies can one Myocarditis develop. Since this is a life-threatening clinical picture, it is essential to pay attention to any signs of the disease See a doctor early onas soon as there is such a suspicion.

Heart muscle inflammation can present very differently depending on the age of the child. The baby may not show any symptoms or appear seriously ill. In general, the younger the baby, the higher the risk that the heart muscle will develop into one chronic illness developed. The later the correct diagnosis is made, the worse the prognosis.

Babies with myocarditis may show some symptoms that may raise suspicions about the condition. For example, you can suddenly listless / apathetic act, less or hardly drink anymore and fever develop. Other possible signs are short-term Pauses in breathing (Apnea), increased sweat production and blue lips or one blue tongue (cyanosis). The cyanosis is a sign of an already advanced impairment of the heart muscle, as it is the Lack of oxygen of the fabric.

Does the baby also have symptoms like one very fast heartbeat or new cardiac arrhythmias on, so it should definitely be presented to a doctor. Any evidence of possible myocarditis is there to be taken seriously. The earlier the disease is diagnosed, the sooner adequate therapy can be started and the lower the risk of consequential damage to the heart of the little patient.

Diagnosis of myocarditis

In the case of myocarditis, the anamnesis (medical history) of the doctor is primarily of importance for the diagnosis. It is important for the doctor to find out whether there have been infections in the recent past.

If a patient answers yes, a heart disease must also be considered. In most cases, the physical examination by the doctor will not reveal anything abnormal.
Only eavesdropping (Auscultation) the heartbeat may indicate tachycardia (resting heart rate over 100 beats / minute) and an irregular heartbeat (arrhythmia). It is important to prepare an ECG for every patient suspected of having myocarditis. As one of the most important diagnostic criteria, the evaluation of the development of excitation of the heart muscle can give important indications of myocarditis. A long-term ECG should also be considered.

Also read: EKG for an inflammation of the heart muscle

The patient's blood test is also important. The following parameters are usually examined:

  • CK / CK-MB
  • Troponin (the increase in these values ​​actually speak for a heart attack, but can also be increased with myocarditis).

Furthermore, inflammation parameters in the blood are checked in order to detect an infection (sedimentation rate / ESR and C-reactive protein / CRP value).

Bacteriological and virological tests can also be helpful. Either a stool sample from the patient is examined for bacteria or a blood sample is taken and this is incubated in the laboratory. The hormone BNP indicates progressive heart failure, which, as already described, can result from myocarditis (inflammation of the heart muscle).

The doctor can order an ultrasound of the heart, an X-ray of the chest or a magnetic resonance tomography as imaging procedure. The ultrasound often gives an inconspicuous picture of myocarditis (inflammation of the heart muscle). Occasionally, however, an effusion of the pericardium and movement disorders of the heart muscle can be seen here.
In the case of heart failure, the X-ray would show a corresponding enlargement of the heart shadow and pulmonary congestion.

Read more on the topic: Chest x-ray (chest x-ray)

Magnetic resonance imaging (MRI) of the heart may reveal delayed contrast enhancement as a sign of myocarditis. In this case, an increase in the signal in the cardiac MRI would indicate edema in the area of ​​the heart muscle.
The MRI of the heart also offers the possibility of taking a specific sample biopsy from the heart muscle in order to look at it from a histological point of view. In extreme cases, a myocardial sample biopsy through a cardiac catheter examination may be necessary.

Read more on this topic at:

  • Diagnosis of myocarditis
  • How do you recognize myocarditis?

Myocarditis and exercise

Sports activities or even competitive sports can be very dangerous in the context of myocarditis.

The heart is clearly attacked by the inflammation and cannot react properly to the increased physical activity, so that in the worst case it can lead to sudden failure.
In principle, sporting activity should therefore be avoided for some time in the context of a flu-like infection or a general febrile infection in order to prevent the risk of developing myocarditis.

One possible symptom of the onset of myocardial inflammation, which may only show itself at the beginning, in the context of increased physical activity or competitive sports, is one significantly faster fatigue. So it can happen that you can no longer cope with your usual route while running or that you need significantly more time for it.
Possibly there may be increased body aches after exercise. Other symptoms of myocardial inflammation, which can show up or worsen during exercise, are new cardiac arrhythmias, increased heart palpitations or a significantly faster heartbeat.
Pain in the chest area can also be a sign of the onset of myocarditis. Depending on the severity of the inflammation, there may also be increased shortness of breath and shortness of breath.
At the beginning of the disease, only heavy physical exertion such as sport usually leads to shortness of breath. In the further course of the disease or if the disease worsens significantly, shortness of breath can occur even with light physical exertion such as climbing stairs.


Under one Myocarditis (inflammation of the heart muscle) one understands the inflammation of the heart muscle. In most cases, this is caused by viruses (50% of all myocarditis).
A distinction is made between infectious causes, including:

  • Viruses
  • bacteria
  • Mushrooms
  • Protozoa
  • Parasites

The second form is triggered by non-infectious causes (rheumatic diseases, inflammation of the vessels (vasculitides), radiation-induced myocarditis and drug intolerance).
It can too Inflammation of the heart muscle by a Overreactivity of the immune system come.
In this case, antibodies can usually be detected in the blood. Inflammation of the heart muscle usually run without major symptoms, but this does not reduce the possible danger. Hermuscle inflammation often occurs after infections in the recent past. The so-called beta-hemolytic streptococci are particularly important here.
If myocarditis triggers symptoms, patients often complain of tiredness, fatigue, fever, cardiac arrhythmias and even severe symptoms of heart failure. In addition to the anamnesis, in which the doctor asks about previous infections, he needs a blood count of the patient, which can give him information about whether an infection is present or whether autoantibodies are detectable. The Ultrasound image of the heart can provide information about edema of the pericardium and movement disorders of the heart. The Magnetic resonance imaging (MRI) can also be used to depict the heart.

The basic infection / cause is treated first. Usually antibiotics are used here. Since in most cases there is a viral infection, the use of antiviral therapy (interferon) may be necessary. Complications should be treated symptomatically, the patient should be given rest and, if necessary, the accompanying diseases caused by the myocarditis (inflammation of the heart muscle) should be treated.

In 80% of cases, inflammation of the heart muscle (myocarditis) heals. Only harmless cardiac arrhythmias can persist in many cases. Despite the high cure rate, a Myocarditis not underestimated and must be consistently treated as an inpatient.