Myocarditis

Revising Medical Author: Daniel Kulick, MD, FACC, FSCAI
Revising Medical Editor: William C. Shiel Jr., MD, FACP, FACR

• What is myocarditis?
• What causes myocarditis?
• What are symptoms of myocarditis?
• How is myocarditis diagnosed?
• What is the prognosis (outlook) for patients with myocarditis?
• How is myocarditis treated?

What is myocarditis?

Myocarditis is inflammation of heart muscle.

What causes myocarditis?

Myocarditis can be caused by a variety of infections and conditions such as viruses, sarcoidosis, and immune diseases (such as systemic lupus, etc.), pregnancy, and others. The most common cause of myocarditis is infection of the heart muscle by a virus. The virus invades the heart muscle to cause local inflammation. After the initial infection subsides, the body's immune system continues to inflict inflammatory damage to the heart muscle. This immune response actually prolongs the myocarditis.

What are symptoms of myocarditis?

Myocarditis can be mild and cause virtually no noticeable symptoms. The most frequent symptom of myocarditis is pain in the chest. When myocarditis is more serious, it leads to weakening of the heart muscle. Myocarditis can then cause heart failure (with symptoms of shortness of breath, fatigue, fluid accumulation in the lungs, etc.) as well as heart rhythm irregularities from inflammation and/or scarring of the electrical system of the heart.

How is myocarditis diagnosed?

Myocarditis is diagnosed by detecting signs of irritation of heart muscle. Blood tests for heart muscle enzymes (CPK levels) can be elevated. Electrical testing (EKG) can suggest irritation of heart muscle and demonstrate irregular beating of the heart. Nuclear heart scan testing can show irregular areas of heart muscle.

What is the prognosis (outlook) for patients with myocarditis?

The prognosis for long-term damage is not predictable and only becomes evident as the patient is followed by the doctor over time. After the initial phase of myocarditis, some patients can experience complete recovery, others may develop chronic heart failure due to injured heart muscle. Infrequently, some patients develop fulminant heart failure, a fatal condition without heart transplantation.

Patients who have had myocarditis are at some risk for sudden unexpected, potentially fatal, heart rhythm abnormalities. These can often be prevented with implantable defibrillators if the heart muscle damage is severe.

How is myocarditis treated?

Except in systemic sarcoidosis and immune inflammation (such as from systemic lupus erythematosus) where myocarditis can respond to corticosteroids, no proven effective medications are currently available for treating active myocarditis. Treatment measures mainly involves alleviating heart failure (salt restriction, water pills, ACE inhibitors, beta blockers, etc.) and treating as well as monitoring heart rhythm abnormalities.

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