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Myocarditis is an inflammation of the heart muscle (myocardium), but may affect any layer of the heart wall. It can present acutely or have been present for a longer duration, unknown to the patient. The inflammation may be present in a small or large (diffuse) area of the heart. It can weaken the heart, causing it to fail in supplying an adequate blood supply throughout the body. Severe cases can lead to heart failure and life-threatening arrhythmias.
The immune system fights infection in the body. When infection affects the heart, the cells that fight the infection can cause damage to the heart.
Myocarditis can be caused by an infection from a virus or a pathogen, such as bacteria and fungi.
Some of the viruses that can cause myocarditis include:
Bacteria that can cause myocarditis include:
Fungi that can cause myocarditis include:
Some diseases and medications also can cause myocarditis. In many cases, a clear cause is not identified.
Symptoms can include chest pain, a rapid heartbeat, swelling in the lower extremities, difficulty catching your breath, unusual tiredness and flu-like symptoms.
Some people who have severe myocarditis may require temporary support with a ventricular assist device (VAD), also known as a heart pump. Once stabilized, the ventricular assist device could be removed. The Ohio State University Wexner Medical Center’s ventricular assist devices program has grown by 179 percent for implanted devices in recent years. The Wexner Medical Center was one of the nation’s leading enrollers in a randomized multi-center trial testing the effectiveness of a second-generation ventricular assist device that is smaller, lighter and longer-lasting than previous models. The device recently received Food and Drug Administration approval as a destination therapy for heart failure patients.
The most severe cases of myocarditis may result in the need for a heart transplant. Since completing our first heart transplant in 1986, The Ohio State University Wexner Medical Center is the only adult heart transplant center in central Ohio.
Tests to diagnose myocarditis include:
Some cases of myocarditis resolve without treatment.
Cases that are caused by bacterial infection may be treated with antibiotics.
Patients whose symptoms include irregular or rapid heartbeats may need medication to regulate the heartbeat. These include angiotensin-converting enzyme (ACE) inhibitors, diuretics, beta blockers and angiotensin II receptor blockers (ARBs), which may be prescribed to treat pulmonary hypertension.
In some cases, drugs that reduce the immune response may be used, but these cases are rare.
Patients who have more severe cases may need surgical or other intervention, including:
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