In
Medicine (
Cardiology ), is
Inflammation of the
Myocardium , the muscular part of the
Heart . It is generally due to
Infection (
Viral or
Bacterial ). It may present with chest pain, rapid signs of
Heart Failure , or sudden death.
The signs and symptoms associated with myocardits are varied, and relate either to the actual inflammation of the myocardium, or the weakness of the heart muscle that is secondary to the inflammation. Signs and symptoms of myocarditis include:
Since myocarditis is often due to a viral illness, many patients give a history of symptoms consistent with a recent viral infection, including fever, diarrhea, joint pains, and easy fatigueability.
Myocarditis is often associated with
Pericarditis , and many patients present with signs and symptoms that suggest concurrent myocarditis and pericarditis.
Myocardial inflammation can be suspected on the basis of
Electrocardiographic results (ECG), elevated
CRP and/or
ESR and increased
IgM (
Serology ) against viruses known to affect the
Myocardium . Markers of myocardial damage (
Troponin or
Creatine Kinase cardiac isoenzymes) are elevated.
The
ECG findings most commonly seen in myocarditis are diffuse T wave inversions; saddle-shaped ST-segment elevations may be present (these are also seen in pericarditis).
The s and
Macrophage s. Focal destruction of myocytes explains the myocardial pump failure.
A large number of different causes have been identified as leading to myocarditis:
- Infectious :
- --- Viral (e.g. Enterovirus , Coxsackie Virus , Rubella Virus , Polio Virus , Cytomegalovirus , possibly Hepatitis C )
- --- Bacterial (e.g. Brucella , '' Corynebacterium Diphtheriae '', Gonococcus , '' Haemophilus Influenzae '', '' Tropheryma Whipplei '', and '' Vibrio Cholerae '').
- --- Spirochetal ('' Borrelia Burgdorferi '' and Leptospirosis )
- --- Protozoa l ('' Toxoplasma Gondii '' and '' Trypanosoma Cruzi '')
- --- Fungal (e.g. Actinomyces , Aspergillus )
- --- Parasitic : ascaris, Echinococcus granulosus, Paragonimus westermani, schistosoma, Taenia solium, Trichinella spiralis, visceral larva migrans, and Wuchereria bancrofti
- --- Rickettsia l
- Immunological :
- --- Allergic (e.g. Acetazolamide , amitriptyline)
- --- Rejection after a Heart Transplant
- --- Autoantigens (e.g. Systemic Vasculitis such as Churg-Strauss Syndrome , Wegener's Granulomatosis )
- Toxic :
- --- Drugs (e.g. Anthracycline s and some other forms of Chemotherapy , Ethanol , and antipsychotics, e.g. clozapine)
- --- Toxin s (e.g. Arsenic , Carbon Monoxide , Snake Venom )
- --- Heavy Metals (e.g. Copper , Iron )
- Physical agents ( Electric Shock , Hyperpyrexia , and Radiation )
Bacterial myocarditis is rare in patients without
Immunodeficiency . Myocardial damage due to
Chemotherapy , most notably the class of
Anthracycline drugs, is fairly common.
The exact incidence of myocarditis is unknown. However, in series of routine
Autopsies , 1-9% of all patients had evidence of myocardial inflammation. In young adults, up to 20% of all cases of sudden death are due to myocarditis.
In
South America ,
Chagas' Disease (caused by ''
Trypanosoma Cruzi '') is the main cause of myocarditis.
Bacterial infections are treated with
Antibiotic s, dependent on the nature of the pathogen and its sensitivity to antibiotics. As most viral infections cannot be treated with directed therapy, symptomatic treatment is the only form of therapy for those forms of myocarditis, e.g.
NSAID s for the inflammatory component and
Diuretic s and/or
Inotrope s for ventricular failure.
ACE Inhibitor therapy may aid in the healing process.
- Feldman AM, McNamara D. ''Myocarditis''. N Engl J Med 2000;343:1388-98. PMID 11070105.
