Myocarditis: Treatment, symptoms, advice and help
This is an acute inflammatory condition that may complicate a wide variety of infections. Myocarditis may occur several weeks after the initial viral infection and susceptibility is increased by corticosteroid treatment, immunosuppression, radiation, previous myocardial damage and exercise.
Myocarditis: Incidence, age and sex
No racial or sex predilection is observed in humans. No age predilection is noted. Younger patients, especially newborns and infants, and immunocompromised patients may have increased susceptibility to myocarditis.
Signs and symptoms of myocarditis: Diagnosis
The clinical picture ranges from a symptomless disorder, sometimes recognised by the present of an increased heart rate or abnormal ECG, to fulminant heart failure. Myocarditis may be heralded by a “flu’ – like illness. ECG changes are common but non-specific. Biochemical markers of myocardial injury (e.g. troponin I and T, creatine kinase) are elevated in proportion to the extent of damage. Echocardiography may reveal left ventricular .If the diagnosis is uncertain it can be confirmed by endomyocardial biopsy.
Causes and prevention of myocarditis
The main culprits are the Coxsackie viruses (35 cases per 1000 infections) The other infecting organisms include Adenovirus (most commonly types 2 and 5) ,Cytomegalovirus ,Echovirus,Epstein-Barr virus, Hepatitis C virus ,Herpes virus, Human immunodeficiency virus ,Influenza and parainfluenza ,Measles Mumps, associated with endocardial fibroelastosis (EFE),Parvovirus B19, Poliomyelitis virus, Rubella and Varicella.
Death may occur, due to a ventricular arrhythmia or rapidly progressive heart failure. Some forms of myocarditis may lead to chronic low-grade myocarditis or dilated cardiomyopathy.
In most patients the disease is self-limiting and the immediate prognosis is excellent. Only supportive therapy is available. Treatment for cardiac failure or arrhythmias may be required and patients should be advised to avoid intense physical exertion because this can induce potentially fatal ventricular arrhythmias. Other measures for acute failure may be required, and precipitating factors, such as infection and anemia, require attention. Anticoagulation may be required in the presence of thromboembolic complications. Cardiac transplantation may be recommended for patients with end-stage disease.