What Myocarditis is

The Heart is the most vital organ in the body perfusing and supplying life saving essential oxygen to each and every part. It beats non stop, 24 hours of the day without stopping even for a moment throughout life. Once the heart stops beating, life ends. Therefore, any kind of damage to the heart, can critically damage the owner’s health. Myocarditis is a state of inflammation of the middle layer of the heart. It can occur due to a wide variety of infections. Viral infections like HIV, Epstein virus, cytomegalo virus, polio virus, e.t.c can acutely affect the myocardium. Apart from this, viral infections can also induce an immunological reaction damaging the myocardium. My friend lost her husband due to viral myocarditis a few months ago. The condition exists but there is lack of awareness about it. Bacterial infections due to salmonella, gonococci, haemophilus influenza, vibrio cholera, e.t.c. are also implicated in myocarditis. Protozoal infections like tape worm, trypanosomiasis, toxoplasmosis, fungal infections like aspergillosis, histoplasmosis, can cause inflammation of the myocardium. These infections, are commonly secondary to infection elsewhere in the body, for example a viral infection of the throat can affect the heart due to germs passing through the circulation. But primary infections of myocardium like bacterial or fungal can also occur, although not very common. Immune deficient patients are more prone to it. Allergic reaction to some drugs, collagen vascular diseases like rheumatoid arthritis, systemic lupus erythromatosis, toxins like arsenic, snake venom, all these have been identified as etiological agents that cause myocarditis. Alcohol causes damage to many parts of the body including the myocardium. Exposure to radiation is hazardous in many ways, and is also known to cause inflammation of the myocardium. Electric shock can affect the conduction system of the heart, and lead to myocarditis. Persistent high fever due to any cause may affect the myocardium. Myocarditis can occur at any age in both men and women. But symptoms in children are less typical. Symptoms of acute myocarditis resemble myocardial infarction or heart attack because the damaged myocardium, leads to sudden impairment of the heart function. There is severe chest pain at the affected site. Sudden breathlessness develops because of reduced perfusion of the heart and lungs. Stress induced in the body leads to sweating, nausea, vomiting. Cardiac failure may develop acutely or slowly depending on the cause. Complications like shock, arrhythmias, pericarditis, will follow as in case of heart attack. Inflammation of the myocardium can spread to the outer or inner layer of the heart as well, thus deranging the heart function further. Cardiac failure may develop acutely in case of acute infections. But chronic conditions can cause chronic heart failure due to inflammation of the myocardium. In about 80% of cases, there will be preceding history of the infection like sore throat, fever in case of viral infections. In collagen vascular diseases, there are characteristic associated features like joint pains or rash which aid in the diagnosis. A high degree of suspicion is needed to diagnose myocarditis to be the cause for the cardiac symptoms. Unsuspected, the diagnosis may be missed leading to delay in definitive treatment. Definite diagnosis is by biopsy of the heart which is avoided being a hazardous procedure. Coronary angiography if done in such cases suspecting them to be a myocardial infarction shows remarkably normal coronary arteries. This, points to the diagnosis of myocarditis. Cases of viral or toxin induced myocarditis, may recover spontaneously in days to weeks, as happens in viral infections elsewhere, provided the myocardium is not damaged extensively. Majority of other infections need specific treatment. Once heart failure sets in, it needs to be treated by specific drugs. One should try to keep a high level of personal immunity by taking a balanced diet and adequate exercise, so that the body is capable of dealing with any infectious germs entering the body. Toxic substances like alcohol and tobacco should be avoided. No infection in the body should be neglected lest it becomes a source infecting the myocardium and deranging function of the heart. Specialist internal medicine rachna212002@yahoo.co.uk