Myocarditis

What is myocarditis?

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.

Myocarditis causes 

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:

• Coxsackie
• Herpes
• HIV
• Hepatitis C
• Parvovirus
• Mononucleosis
• Measles

Bacteria that can cause myocarditis include:

• Chlamydia
• Streptococcus
• Staphylococcus

Fungi that can cause myocarditis include:

• Candida
• Histoplasma
• Schistosomiasis
• Aspergillus

Some diseases and medications also can cause myocarditis. In many cases, a clear cause is not identified.

Myocarditis symptoms

Symptoms can include chest pain, a rapid heartbeat, swelling in the lower extremities, difficulty catching your breath, unusual tiredness and flu-like symptoms.

Why choose Ohio State for myocarditis treatment?

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.

Myocarditis diagnosis

Tests to diagnose myocarditis include:

• Blood tests – Studies to detect enzymes that leak into the blood when the heart has been damaged and to detect infection and antibodies.
• Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine.
• Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart.
• Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
• Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating.
• Endomyocardial tissue biopsy – A procedure to obtain a sample of heart muscle tissue for biopsy to check for signs of infection and inflammation. The tissue sample is obtained via cardiac catheterization, in which a long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart.

Myocarditis treatment

Some cases of myocarditis resolve without treatment.

Medications

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.

Surgery and other treatment

Patients who have more severe cases may need surgical or other intervention, including:

• Ventricular assist device (VAD) – A type of heart pump used when the heart cannot pump enough blood. Some are placed inside the body, and others have parts inside and outside the body. Ohio State Wexner Medical Center was one of the nation’s leading enrollers in a randomized multi-center trial testing the effectiveness of a second-generation VAD 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.
• Intra-aortic balloon pump – A machine that helps the heart pump blood throughout the body. It is used when the heart is not able to pump enough blood by itself. The balloon is put in place via cardiac catheterization through an artery in the groin and threaded up to the aorta. The machine helps move the blood by inflating and deflating the balloon with each heartbeat.
• ECMO (extracorporeal membrane oxygenation) – This treatment circulates blood through a machine to increase its oxygen content, and returns the oxygenated blood to the body.
• Heart transplantation may be necessary in very severe cases.