What is myocarditis
In myocarditis (inflammation of the heart muscle), the heart muscle becomes inflamed. Sometimes the inflammation also spreads to the neighboring tissue. Doctors distinguish between acute and chronic myocarditis. A chronic course of myocarditis means that the symptoms occur over a longer period of time and the cause is unknown. Due to the permanent inflammation of the heart muscle, the heart muscle can dilate irreparably over time (dilated cardiomyopathy), causing it to lose its pumping power. Affected people then suffer from heartfailure and usually have to take medication for the rest of their lives.
Myocarditis: frequency and age
Myocarditis can occur at any age. It is difficult to say how often myocarditis occurs. As the symptoms are often unspecific or only very mild, the disease often goes unrecognized.
Myocarditis: causes and risk factors
Myocarditis can develop due to various causes.
Infections as a cause of myocarditis
An infection with a pathogen is often the trigger. In particular, viral infections that are harmless in themselves (such as a cold or diarrhea) and are not completely cured can lead to myocarditis. More rarely, bacteria such as streptococci or staphylococci cause myocarditis. The pathogens are transported with the blood from their actual source of infection to the heart. In rare cases, fungi, parasites (e.g. threadworms) or protozoa (such as the toxoplasmosis pathogen) can also be the cause of myocarditis.
Other causes of myocarditis
In addition to infectious triggers, there are also non-infectious triggers for myocarditis. Toxic substances can damage the tissue of the heart muscle. These include, for example, medications such as neuroleptics or certain antibiotics, heavy metals such as lead or copper and alcohol if it is regularly consumed in large quantities. In autoimmune diseases such as the connective tissue disease sarcoidosis or rheumatic diseases, the body’s own immune system attacks the cells of the heart muscle and triggers inflammation. Radiotherapy (e.g. in the treatment of cancer) can also lead to myocarditis.
Symptoms: Symptoms are similar to those of heart failure
The signs of myocarditis are similar to those of heart failure. You may feel weak and exhausted for no apparent reason, become tired very quickly during physical exertion and generally be less productive than normal. You may also feel that it is difficult to breathe. In addition, symptoms such as palpitations, irregular heartbeat, noticeable pallor or even bluish-colored skin as well as pain or a feeling of pressure behind the breastbone may occur. Advanced myocarditis can also lead to water retention in the legs.
Sometimes – despite myocarditis – only very slight or no impairments can be detected. This is why myocarditis often remains undetected. For this reason, it is always important to have complaints such as those mentioned above clarified as quickly as possible – especially if the symptoms occur a few weeks after a cold or other infection.
Myocarditis: Diagnosis with us
In order to diagnose myocarditis, we will first have a detailed discussion with you (anamnesis). We ask various questions such as:
- What complaints do you have?
- How long have you had these complaints?
- Did you have an infection such as influenza (flu), a cold (flu-like infection) or gastroenteritis some time ago or do you currently have one?
- Do you have any other pre-existing conditions (especially heart disease or an autoimmune disease such as rheumatoid arthritis) or are you taking any medication?
After the consultation, we will also examine you physically. We don’t just measure your blood pressure and feel your pulse. We also listen to the heart and lungs to detect any abnormal noises. We will then carry out further examinations, for example to check the function of the heart.
Echocardiography for myocarditis
With echocardiography, we can use an ultrasound machine to visualize your heart in an uncomplicated way. This is why this examination is also called cardiac ultrasound. This allows you to take a closer look at the heart chambers, for example, and check whether the heart muscle is functioning properly.
Electrocardiography
Electrocardiography measures the electrical impulses that spread from the so-called sinus node of the heart via the heart muscle. To do this, we use electrodes that are attached to the skin of the person being examined. The resulting measurement curve is also known as an electrocardiogram (ECG). This allows us to determine, for example, how often your heart beats per minute and whether there are any irregularities. If myocarditis is present, not only is the heart rate sometimes increased, but cardiac arrhythmia can also occur.
Blood test
Various blood values can confirm the suspicion of myocarditis. If, for example, so-called cardiac enzymes (e.g. troponin T, creatine kinase) are present in elevated quantities in the blood, this may indicate damage to the heart muscle cells. Elevated inflammation values, such as C-reactive protein (CRP), white blood cells (leukocytes) or erythrocyte sedimentation rate (ESR), can also be a sign of myocarditis.
Cardio-magnetic resonance imaging
Using magnetic resonance imaging of the heart (also known as cardio-MRI), we can detect differences in the tissue of the heart muscle. For example, we can see how badly the heart muscle has already been damaged by myocarditis.
PET/MRI of the heart
PET can be used to visualize metabolic processes in the body. This also applies to inflammatory processes in the heart. In combination with magnetic resonance imaging of the heart, which can be performed simultaneously in the PET/MRI scanner, the doctor can assess whether myocarditis is present or active and how severely the heart muscle has already been damaged by the myocarditis.
Myocardial biopsy for myocarditis
To confirm the suspicion of myocarditis, the doctor may also take a tissue sample of your heart muscle (myocardial biopsy). To do this, he pushes a thin, flexible plastic tube (catheter) through a blood vessel in the neck or groin up to the heart. This process is closely monitored using an X-ray machine. The tissue sample taken is then examined in the laboratory. A myocardial biopsy not only allows myocarditis to be diagnosed beyond doubt. It can also provide information about possible causes (e.g. pathogens, certain inflammatory processes). This is particularly important if you suffer from chronic myocarditis and previous treatment approaches have not been successful.
Myocarditis: prevention, early detection, prognosis
Due to the non-specific symptoms, it is often difficult to recognize myocarditis as such in the early stages of the disease. However, you can minimize the risk of developing myocarditis. The most important thing to remember is that if you have the flu, a cold or another infection, you should make sure you have a good rest. This includes not only not doing any sport during and after the acute phase of the illness, but also generally taking it easy physically.
Another helpful measure is to make sure you are well vaccinated. This will help you to avoid infectious diseases such as diphtheria or influenza, which are often the cause of myocarditis.
Course and prognosis (myocarditis)
In some cases, complications occur during the course of myocarditis. For example, cardiac insufficiency can develop or fluid can accumulate in the pericardium (pericardial effusion). Life-threatening cardiac arrhythmias are also possible. However, acute myocarditis usually heals completely without serious health consequences – especially if the patient takes strict care to take it easy physically. Sometimes slight cardiac arrhythmias may remain, but these are harmless.
Only very rarely does myocarditis take such a severe course that large parts of the heart muscle are permanently damaged. In this case, the patients need a donor heart. Approximately one third of those affected develop chronic myocarditis. The heart’s pumping capacity can then be permanently restricted.
Myocarditis: treatment depends on cause and severity
Various treatment approaches are available for the therapy of myocarditis. Depending on the underlying cause of the disease or the course of the disease, we decide between the individual options.