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What Is Myocarditis?
 

COVID-19 has become a pandemic since it was first reported in China in December 2019. While cardiovascular complications of COVID-19 have initially received less medical attention, myocarditis has now been recognized as the cause of death in some COVID-19 patients. Normally, inflammation is a bodily response to any sort of wound or infection. But sometimes the immune system or another cause of inflammation leads to myocarditis.

So, what is myocarditis? It is an inflammatory disease that affects the heart muscle known as myocardium (the muscular layer of the heart wall). When this muscle becomes inflamed, its ability to pump blood becomes less effective. This causes problems like an abnormal heartbeat, chest pain, or trouble breathing. It can cause blood clots leading to a heart attack or stroke, and in severe cases, myocarditis can produce permanent heart damage with heart failure, or even death.

Exact cause of myocarditis is not found in most cases. When the cause of myocarditis is found, it is usually an infection, such as a viral infection (the most common) or a bacterial, parasitic, or fungal infection, that has made its way to the heart muscle. The immune system will fight the infection, trying to get rid of it. This results in an inflammatory response that may weaken heart muscle tissue.

It is often difficult to determine exactly what is causing the myocarditis, but it can be caused by viruses, bacteria, fungi, parasites, and autoimmune diseases. According to the Myocarditis Foundation, viruses are one of the most common causes of infectious myocarditis. The most common viruses that may cause myocarditis include Coxsackievirus group B (an enterovirus), Human Herpes Virus 6, and Parvovirus B19 (which causes fifth disease). Other possibilities include echoviruses (known to cause gastrointestinal infection), Epstein-Barr virus (causes infectious mononucleosis), and Rubella virus (causes German measles). Often the person has no preceding symptoms of a cold, cough, nasal congestion or rash and only becomes aware of the infection when heart failure occurs.
 

Rarely, myocarditis is a complication of endocarditis, an infection of the heart valves and the lining inside the heart's chambers caused by bacteria. In some people with diphtheria, a toxin produced by Corynebacterium diphtheriae bacteria causes a form of myocarditis that leads to a flabby, stretched-out heart muscle. Because the flabby, enlarged heart cannot pump blood efficiently, severe heart failure may develop within the first week of illness. Corynebacterium diphtheriae is the bacterium that causes diphtheria, an acute infection that destroys tonsils and throat cells.

Yeast infections, molds, and other fungi can sometimes cause myocarditis. Parasites, which are microorganisms that live off of other organisms to survive, can also cause myocarditis. Some autoimmune diseases that cause inflammation in other parts of the body, like rheumatoid arthritis or SLE, can cause the immune system to turn against the heart, resulting in inflammation and myocardial damage.

Chagas' disease, which is caused by the protozoan Trypanosoma cruzi, is transmitted by an insect bite. In up to one-third of people with Chagas' disease, a form of long-term myocarditis develops many years after the first infection. This chronic myocarditis leads to significant destruction of heart muscle with progressive heart failure.

Another type of myocarditis is peri-partum cardiomyopathy. Some women in the very last phase of pregnancy or soon after delivery of the baby develop poor heart muscle function. This condition is unusual, and there are no explained reasons for this

Other causes include certain chemicals or allergic reactions to medications or toxins like alcohol, drugs (such as doxorubicin drugs), lead, spider bites, wasp stings, snakebites, chemotherapy and radiation therapy.

To diagnose myocarditis, doctors usually gather clues from several sources, including their patients’ symptoms and physical examination; the electrocardiogram (ECG) that often shows characteristic changes; and several blood tests that include elevated cardiac enzymes, abnormal blood counts, abnormal rheumatologic screening tests, or viral blood tests.

Identifying and treating the underlying cause should be the first step to treat myocarditis. Many people with myocarditis will recover completely with aggressive treatment. But for some people, the recovery may not be complete, and some degree of cardiac damage may be permanent. In addition, inflammation may continue for months or years, causing gradual worsening of cardiac function.

Date: August 21, 2020

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