Related articles: Myocarditis
Definition
Myocarditis is an inflammation of the heart muscle. The disease, in particular, affects the middle layer of the heart wall: the myocardium.
Myocarditis can be caused by infections, systemic diseases (eg metabolic disorders, SLE, sarcoidosis and vasculitis), autoimmune mechanisms, exposure to toxic substances (such as heavy metals, chemicals, toxins and alcohol), allergic reactions or side effects of some drugs.
Most common symptoms and signs *
- Arrhythmia
- Asthenia
- Increase in the ESR
- Cardiomegaly
- palpitations
- Swollen ankles
- Dyspnoea
- Chest pain
- Articolar pains
- Muscle pains
- Edema
- Temperature
- Atrial fibrillation
- Ventricular fibrillation
- Swollen legs
- Hydrops Fetal
- Headache
- Pallor
- presyncope
- Water retention
- Fainting
- Tachycardia
- Pericardial effusion
Further indications
In many cases, myocarditis does not produce obvious symptoms. The patient can at most experience a sense of general malaise and other vague manifestations, similar to those of influenza. When myocarditis is more severe, however, it can induce pain and a sense of chest tightness, shortness of breath, fatigue, abnormal heart rhythm (arrhythmias) and fluid retention with swelling of the legs, ankles and feet. Cardiac output can be greatly reduced. Sometimes, a sudden loss of consciousness can occur (syncope).
Patients with infectious myocarditis may present with concomitant pericarditis (inflammation of the membrane that covers the heart) and symptoms such as headache, fever, joint and muscle pain.
In most patients, the clinical course is self-limiting and myocardial inflammation resolves without causing permanent consequences. In other cases, myocarditis can lead to heart failure and sudden cardiac arrest.
Diagnosis is based on the symptoms and results of the electrocardiogram (ECG), chest X-rays or echocardiography. Final confirmation requires an endomyocardial biopsy, generally performed in the context of an angiography.
Treatment depends on the underlying cause. General measures include rest and use of analgesics, diuretics and anti-inflammatory drugs. The most severe or chronic forms may require hospitalization and treatment with ventricular assist devices, high doses of vasopressors, short cycles of steroids or other drugs that reduce the immune response. If the condition tends to get progressively worse over time, a heart transplant may be necessary.
