Myocarditis

What Is Myocarditis?

Myocarditis is a rare condition that may cause local or widespread inflammation of the heart (myocardium). Myocarditis can cause irregular heartbeats, but it may potentially lead to heart failure.

Causes of Myocarditis:

• Infection - from viruses (the most common form of myocarditis), bacterium, parasites, or fungus
• Chemical - due to drugs or toxic substances that may damage and cause inflammation to the heart muscle
• Certain diseases - Of the immune system, such as Systemic Lupus Erythematosus (SLE, or Lupus)

Symptoms of Myocarditis:

• If your myocarditis is caused by infection, you may have fever or chills
• Some people may have no symptoms, or their symptoms may be very mild if caught early
• You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities.
• Myocarditis often follows a respiratory infection if caused by a virus
• You may have "coughing spells", or a long-term (chronic) cough, if your myocarditis results in a certain type of heart failure (such as congestive heart failure).
• You may experience sudden or gradual shortness of breath, either at rest or while performing any type of activity. This may include walking to the door, or climbing stairs.
• If you have gradual shortness of breath, you may have trouble lying flat in bed, and you may have to sleep on 2 or more pillows. Your shortness of breath may cause you to wake up in the middle of the night.
• Your legs may be swollen, especially in your feet and ankles. You may gain "water" weight easily, or feel bloated.
• You may feel anxious, or "stressed out." You may feel your heart pounding in your chest or throat, which may cause pain or mild discomfort. You may also feel your heart "fluttering," and it may seem as if it is skipping a beat.
• Some people may have chest pain in addition to palpitations, sweating, or feelings of impending doom. This may be a sign of heart muscle damage, or a heart attack. The chest pain may range from excruciating, to a mild discomfort. The severity of pain does not indicate how severe the damage to the heart muscle may be. If you experience chest pain or palpitations, seek emergency help immediately.
• An EKG, Chest x-ray, and echocardiogram (ECHO) will be performed. The EKG and ECHO will often show heart abnormalities, such as an enlarged heart, or problems with the heart muscle as it squeezes (contracts).

Things You Can Do for Myocarditis:

• Myocarditis may cause your heart muscle to work ineffectively (heart failure), and may lead to serious problems. If you think you are having a heart attack, with symptoms of chest pain, irregular heartbeats, or palpitations, it is important to seek emergency assistance immediately. Damage to the heart muscle can be decreased if you act quickly. It is better to be safe.
• Not all forms of chest pain are life threatening, but it is important that you have your chest pain evaluated by a healthcare provider. The goal of chest pain is to relieve the cause.
• Severe shortness of breath needs to be evaluated by a healthcare provider. Do not wait for it to improve, especially if you are having shortness of breath at rest.
• Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).
• Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.
• Notify your healthcare provider if you have a family history of heart disease, stroke, high blood cholesterol, or high blood pressure, in a first or second-degree relative.
• If you experience heart failure as a result of myocarditis, you may be told to reduce the amount of salt you are eating in a day. Many times, it may be restricted to about 2 grams of sodium per day. You should discuss this with your healthcare provider how you can specifically use your diet to control your symptoms of heart failure.
• You should try to exercise, as tolerated, to maintain your optimal level of functioning. Discuss with your healthcare provider how you can create a specific exercise program to suit your needs during your illness.
• You should restrict the amount of alcohol you take in, or avoid it all together. Alcohol may adversely interact with many medications.
• If you are ordered a medication to treat this disorder, do not stop taking any medication unless your healthcare provider tells you to. Take the medication exactly as directed. Do not share your pills with anyone. If you miss a dose of your medication, discuss with your healthcare provider what you should do.
• If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
• Keep all your appointments for your treatments.

Drugs That May Be Prescribed by Your Doctor:

Depending on your overall health status and your overall condition, many drugs may be used to treat myocarditis. These include:

• Antibiotics - If your doctor or healthcare provider suspects that a bacterial infection has caused your myocarditis (not a viral), he or she may order antibiotics, usually intravenous (IV). If you are prescribed antibiotics, you may need to be admitted to the hospital unit for evaluation.
• ACE inhibitors - These drugs work by opening, or dilating, your arteries. They will lower your blood pressure, and improve blood flow to your kidneys, and throughout your body. Your healthcare provider may also prescribe these medications if you have diabetes or protein in your urine, to protect your kidneys. You may also receive these drugs if your heart is not working well, as a result of the myocarditis. Some examples of this medication may include: enalapril maleate (Vasotec^®), lisinopril (Zestril^®), and fosinopril sodium (Monopril^®)
• Antianxiety medications - If you have symptoms of anxiety, your healthcare provider may prescribe an anti-anxiety medication, called an anxiolytic. These medications will help you to relax. These may include lorazepam (Ativan^®), or alprazolam (Xanax^®). It is important to take these medications only when you are feeling anxious. Do not operate heavy machinery, or drive an automobile while taking these. If these medications do not control your symptoms, discuss this with your doctor.
• Anticoagulants - These medications prevent your blood from clotting. You may be ordered these medications if your heart is beating irregularly as a result of your myocarditis. Each of them works in a variety of ways. Depending on your overall health status, the kind of chemotherapy you are receiving, and the risk for a blood clot, your healthcare provider may suggest warfarin sodium (Coumadin^®), or enaxoparin (Lovenox^®).
• Aspirin - depending on your overall health status, and the type and severity of your irregular heartbeat from the myocarditis (arrhythmia), your healthcare provider may prescribe aspirin as a "blood thinner." Aspirin works by preventing platelets in your blood from forming blood clots (anti-platelet).
• Beta-blockers - can be used to slow down your heart rate, and improve blood flow through your body. You may take this drug if you have been diagnosed with irregular heartbeats, palpitations, thyroid problems, heart failure or high blood pressure. Some examples of this medication may include: metoprolol (Lopressor^®), propanolol (Inderal^®), and atenolol (Tenormin^®).
• Calcium Channel Blockers - These medications may be given to treat chest pain, high blood pressure, or irregular heartbeats. A few common drugs include verapamil HCL (Calan^®), and diltiazem (Dilacor XR^®).
• Diuretics - may be known as "water pills" as they work to prevent heart failure by making you urinate out extra fluid. Some examples of this medication may include furosemide (Lasix^®), and hydrochlorthiazide. You may receive this medication alone or in combination with other medications, if your myocarditis has resulted in heart failure.
• Digoxin - Also called digitalis, this medication works by slowing down the heart rate, and making it beat more effectively. This will pump blood throughout the body better. It is also called Lanoxin^®.
• Vasodilators -are drugs that work by opening up or "dilating" the vessels. These may include isosorbide dinitrate, or Isordil^®.
• Do not stop any of these medications abruptly, as serious side effects may occur.

When to Contact Your Doctor or Health Care Provider:

• Fever of 100.5° F (38° C), chills, sore throat (possible signs of infection).
• Sudden or gradual shortness of breath, chest pain or discomfort; swelling of your lips or throat should be evaluated immediately
• If you feel your heartbeat rapidly (palpitations), and have not noticed this before
• Any new rashes on your skin, especially if you have recently changed medications
• Any unusual swelling in your feet and legs, or weight gain of greater than 3 to 5 pounds in 1 week.
• Any new rashes on your skin

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.