Myocarditis

GENERAL INFORMATION:

What is myocarditis? Myocarditis (mi-o-kar-DI-tis) is an inflammation (swelling) of the myocardium (heart muscle). The myocardium pumps blood in and out of the heart and to other parts of the body. With myocarditis, the heart muscles are damaged and scars may form in them. This makes the heart weak and work harder to supply oxygen to the rest of your body. Over time, the increased pressure to pump blood may cause the heart to enlarge and become overworked. This may lead to heart failure and a decreased blood flow to the organs. Blood clots may develop and cause other life-threatening conditions, such as a stroke or heart attack. With proper treatment, you have a greater chance of having a full recovery and preventing further problems.

What causes myocarditis? The exact cause of myocarditis is still unknown. The following are possible causes or conditions that may increase your chance of having myocarditis:

• Infection: This is the most common cause of myocarditis. Infections are caused by germs, such as viruses, parasites, or bacteria.
  
  
• Alcohol: Drinking alcohol too much and too often. Alcohol is found in beer, wine, liquor (such as vodka or whiskey), and other adult drinks.
  
  
• Illegal drugs: Street drugs, such as cocaine or amphetamines.
  
  
• Immune system: The immune system is the part of your body that fights infection. Problems with the immune system sometimes make your body attack even its own cells. These problems include diabetes mellitus (high blood sugar), systemic lupus erythromatosus (SLE), or sarcoidosis.
  
  
• Medicines: Antibiotics, vaccines for small pox, and certain medicines for depression and cancer.
  
  
• Physical agents or toxins: Being around certain chemicals a lot may cause myocarditis. These chemicals may include arsenic, lithium, or lead. Radiation therapy may also increase your risk for myocarditis.
  
  
• Others: Snake bites or insect stings.

What are the signs and symptoms of myocarditis?

• Myocarditis may occur as an acute (sudden) or chronic (long-term) heart problem. The symptoms of myocarditis are often related to a recent or ongoing infection you may have. These may include fever, cough, headache, body aches, joint pain, sore throat or vomiting (throwing up). Sometimes, you may already have early symptoms of heart problems, such as a fast heartbeat or trouble breathing.
  
  
• As your heart weakens and fails to pump, you may start to feel chest pain or tightness. Your legs, feet, and abdomen (stomach) may swell, or your neck veins may bulge. You may also have shortness of breath while resting and doing mild activity, such as walking or climbing up the stairs. Caregivers may hear crackling sounds or heart murmurs (abnormal sounds) when listening to your chest. Other symptoms include fatigue (tiredness), dizziness, fainting (passing out), and having a too fast or an irregular heartbeat.

How is myocarditis diagnosed? You may have any of the following:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Imaging tests:
  
  
  • Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
    
    
  • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
    
    
  • Echocardiogram:
    
    
    • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
      
      
    • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a barking or whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
    
    
  • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your chest. During an MRI, pictures are taken of your heart, lungs, muscles, and blood vessels. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.
    
    
  • Nuclear scan: This test uses a small, safe amount of radioactive chemical. After injecting the chemical into your vein, pictures of your heart and its blood vessels are taken. The pictures will tell caregivers how well your heart is working. It can also show how much blood is pumped out of the heart with each contraction (heartbeat).
  
  
• Biopsy: Rarely caregivers may need to remove a small part of your heart muscle. The muscle tissue will then be sent to the lab for tests.

How is myocarditis treated? Caregivers may suggest that you rest in bed and limit your physical activities. This may keep your heart from working too hard. You may also need any of the following:

• Heart device: This device placed in your chest may do all or part of the pumping for your heart. This may also help monitor and control your heart rate and rhythm. It may slow your heartbeat down, speed it up, or make it more regular.
  
  
• Medicines:
  
  
  • Antibiotics or antivirals: Antibiotics or antivirals may be given to help you treat or prevent an infection caused by bacteria or viruses.
    
    
  • Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
    
    
  • Clot busters: This medicine helps break apart blood clots, which may increase blood flow to your heart muscle. It is given in your IV and may be given at the same time as other blood thinners. This medicine may decrease the amount of damage to your heart muscle, and may even save your life. You will bleed and bruise more easily after getting clot busters.
    
    
  • Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
    
    
  • Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Tell caregivers right away if you start feeling discomfort, pressure, burning, or tightness in your chest. Tell caregivers right away if you start sweating, have trouble breathing, or feel discomfort in your arm, back, neck, or jaw. Any of these may be a sign that your heart is not getting enough oxygen, and may need medicine to help.
    
    
  • Others: In some cases, an immune globulin or immunosuppressant may be offered to help treat myocarditis. Ask your caregiver for more information about how these medicines may help you.
    
    
    • Immune globulin: Immune globulin may help your immune system fight infection. This may help if your immune system fights something in your blood or body that it should not.
      
      
    • Immunosuppressant: This medicine prevents the immune system from attacking your body. This may be offered if you have certain immune diseases.
  
  
• Surgery: Caregivers may do different surgeries to fix your heart. A part of the enlarged heart muscle may be removed. The heart valves may also be repaired or replaced. Sometimes, a heart transplant may be needed if your heart is failing. The diseased heart is removed and replaced with a healthy and donated heart.

Where can I find more information? Having myocarditis may be life-changing for you and your family. Accepting that you have myocarditis may be hard. You and those close to you may feel sad, angry, or frightened. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information about myocarditis:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda, MD 20824-0105
  Phone: 1-301-592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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