Definition
Myocarditis is an inflammatory disease that affects the heart muscle, especially the middle layer of the heart wall, or the myocardium.
This disease can affect both adults and children.
Causes
The causes triggering myocarditis can be multiple, including viral or bacterial infections, Chagas disease and inflammatory and autoimmune diseases, such as systemic lupus erythematosus, sarcoidosis, scleroderma and systemic vasculitis.
Furthermore, the disease can also be caused by radiation, exposure to toxic substances (such as chemicals, heavy metals and alcohol), or it can manifest itself as a side effect of some types of drugs.
Symptoms
In milder cases, myocarditis can be asymptomatic and accompanied by a feeling of general malaise. In more serious cases, on the other hand, fever, pain and a sense of chest tightness, cardiac arrhythmias, fluid retention, fatigue, shortness of breath, syncope, heart failure and sudden death may occur.
Patients with viral myocarditis, on the other hand, may also have concomitant pericarditis.
In children, myocarditis is manifested by less specific symptoms, such as feeling of general malaise, loss of appetite, abdominal pain, chronic cough, difficulty breathing, rapid breathing, fever and bluish or grayish coloring of the skin.
Information on Myocarditis - Drugs and Myocardial Care is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Myocarditis - Drugs and Myocarditis Treatment.
drugs
The therapy to be instituted for the treatment of myocarditis varies depending on the cause that triggered the inflammatory pathology. For example, if myocarditis is caused by a bacterial infection, then the doctor will prescribe antibiotics to patients. Furthermore, it is generally advisable to rest and to avoid physical efforts, so as to favor the recovery of the heart.
For the treatment of cardiac symptoms, on the other hand, a treatment can be undertaken based on digoxin, diuretics, ACE inhibitors and beta-blockers, in such a way as to help the heart perform its functions, otherwise compromised by inflammation.
In very severe patients where conventional therapy is ineffective, the doctor may find it necessary to resort to heart transplantation.
Digoxin
Digoxin (Lanoxin ®) is a drug belonging to the class of digitalis glycosides. Digoxin has a positive inotropic effect, ie it is able to increase the strength of contraction of the myocardium which can decrease due to the inflammation that involves it.
It is a drug available in pharmaceutical formulations suitable for parenteral or oral administration. When administered via the latter route, the dose of digoxin usually used in adults and children over 10 years of age is 0.25-1.5 mg a day, to be taken in a single dose, or in divided doses.
In infants and children up to 10 years of age, on the other hand, the dose of drug to be used must be established according to the patient's age and body weight.
In elderly patients and / or those with kidney problems the dose of digoxin administered may be lower than that normally used.
Diuretics
Diuretics may be useful to reduce fluid retention caused by myocarditis which - in turn - causes swelling (edema) in the legs, ankles and feet.
Among the different types of diuretics that can reduce the aforementioned fluid retention, we recall the furosemide (Lasix ®). The dose of medication usually administered orally in adults is 25-75 mg. Depending on the patient's response to therapy, the doctor may decide to administer the drug again after four hours.
In children, on the other hand, the dose usually used is 1-2 mg / kg of body weight per day. However, the exact dosage must be established by the doctor, taking care never to exceed the maximum daily dose of 40 mg / kg of body weight.
ACE-inhibitors
ACE inhibitors perform their action by inhibiting the angiotensin-converting enzyme (English: Angiotensin Converting Enzyme, or ACE). These drugs may be useful in treating heart failure and preventing the symptoms associated with it. Among these, we recall:
- Enalapril (Enapren ®, Converten ®): enalapril is available for oral administration. The usual starting dose is 2.5 mg a day. The doctor will then gradually increase the daily dose, until the most suitable maintenance dose is reached for each patient. Generally, the maintenance dose is around 20-40 mg of enalapril per day.
- Lisinopril (Zestril ®): the usual dose of lisinopril is 5-20 mg a day, to be taken orally. The exact dosage of drug to be administered will be established by the doctor.
- Ramipril (Triatec ®): the initial dose of ramipril usually used orally is 1.25-2.5 mg a day. Subsequently, the doctor may decide to increase the amount of drug to be taken up to a maximum of 10 mg a day.
Beta blockers
Beta-blockers are useful drugs in the treatment of heart failure and arrhythmias that can be caused by myocarditis. Among these, we recall:
- Metoprolol (Seloken ®, Lopresor ®): the dose of metoprolol usually given in adults is 100-200 mg a day, to be taken orally in a single dose, or in 2-3 divided doses.
- Carvedilol (Dilatrend ®): the initial dose of carvedilol usually used orally is 3.125 mg, to be taken twice a day. Subsequently, the doctor may decide to increase the amount of drug to be administered until the optimal dose is reached for each patient. Therefore, the dose of carvedilol must be established by the doctor on a strictly individual basis.
Antibiotics and Antivirals
When the cause triggering myocarditis is a bacterial infection, it is necessary to resort to a therapy based on antibiotic drugs. The bacteria that can promote inflammation of the myocardium are many, therefore, it is essential to identify the type of microorganism responsible for the disease, so as to be able to establish the most suitable therapy to counteract it.
A similar argument can be made if myocarditis is caused by a viral infection. However, in many cases, the use of antiviral drugs has not proved very useful in treating myocarditis.
Therefore, if it is not possible to counteract the virus responsible for the onset of inflammation with specific drugs, the only treatment available remains that of a symptomatic type.
