Heart Muscle Inflammation (Myocarditis): Symptoms, Diagnosis, and Treatment

Myocarditis is an inflammatory condition in which the tissue of the heart muscle becomes inflamed. This inflammation affects the heart muscle cells and can significantly impair the heart’s function. The condition is also called myocarditis and can occur on its own or in conjunction with inflammation of the pericardium, which is then referred to as perimyocarditis.

Myocarditis can significantly reduce the heart’s pumping capacity. This can lead to heart failure, which in some cases is permanent. Blood flow through the coronary arteries can also be indirectly affected.

A distinction is made between acute myocarditis and a chronic course of the disease. The condition often progresses without typical symptoms, making it difficult to detect in a timely manner.

The causes of myocarditis are varied. Sometimes, for example, certain viruses, fungi, or bacteria are responsible. 

The most common cause is viral infections, which often occur following an infection such as a cold or the flu:

• Viruses: measles viruses, influenza viruses, or herpes viruses
• Bacteria: staphylococci or streptococci

Autoimmune diseases can also lead to myocarditis. In this condition, the immune system turns against the body’s own tissues and attacks, among other things, the heart muscle tissue.

Untreated infections or infections that have not fully resolved pose a major risk. Athletes, in particular, often do not fully recover from a cold or flu-like infection. As a result of this delay, damage to the heart muscle can occur.

In extreme cases, myocarditis can lead to severe symptoms or even be fatal. With this condition, it is important not only to make a diagnosis but also to provide individualized treatment.

The symptoms of myocarditis vary widely. The condition often develops gradually, making it difficult to clearly identify the initial symptoms. Typical early signs of myocarditis include fatigue, reduced exercise tolerance, and a general feeling of illness.

Doctors distinguish between acute and chronic myocarditis.

Acute myocarditis is characterized by:

• Chest pain
• Heart palpitations or irregular heartbeat
• Heart rhythm disturbances or arrhythmias
• Dizziness
• Shortness of breath or difficulty breathing
• Blue discoloration of the skin, as well as
• paleness

These symptoms can be a clear indication of an underlying condition and may point to myocarditis. In advanced cases, signs of heart failure may also be present, such as fluid retention and reduced exercise tolerance.

Chronic myocarditis causes other symptoms. 

Symptoms may include:

• Fatigue
• Loss of strength
• Weight loss or
• limb pain

Diagnosing myocarditis is often difficult because the symptoms are nonspecific. If myocarditis is suspected, the first step is a detailed medical history and physical examination.

Various procedures are used to diagnose myocarditis. These include blood tests, an ECG, and an ultrasound of the heart. These tests can provide important clues and help establish the correct diagnosis.

In severe cases, a biopsy may also be necessary, in which tissue is removed from the heart muscle. This allows for the diagnosis and more accurate assessment of myocarditis. An early diagnosis is crucial for the patient’s prognosis.

The first important indicators for the doctor are if the patient has recently suffered from the following conditions:

• a flu-like infection
• a cold, or
• diarrhea

In addition, the doctor will perform several standard examinations. They will measure blood pressure and body temperature and listen to the heart and lungs.

A blood test can also aid in the diagnosis. If elevated inflammatory markers are detected, these provide further evidence of possible myocarditis.

Chronic myocarditis is much more difficult to diagnose.

If the condition takes a severe or even chronic course, a myocardial biopsy may also be necessary. In this procedure, doctors remove tissue from the heart muscle and examine it clinically.

In addition, however, other standard procedures are part of the diagnostic workup.

These include:

• an ECG or
• an ultrasound examination of the heart

The latter can be performed by a cardiologist who specializes in diseases of the cardiovascular system.

Treatment for myocarditis depends on the cause and severity. In general, strict physical rest is required, especially during the acute phase, so that the inflammation can fully subside and heal.

Antibiotics are used to treat bacterial infections, while supportive care is the primary focus for viral causes. In addition, medications are used to alleviate symptoms and prevent complications. These include treatments for arrhythmias as well as measures to treat heart failure. However, if the patient is prescribed strict bed rest, for example, the risk of thrombosis increases. 

In cases of autoimmune diseases, immunosuppressive therapy may be necessary. Overall, a treatment plan tailored to the individual is crucial for the course of the disease.

If myocarditis is diagnosed, patients should consult experienced physicians. Cardiologists specialize in the diagnosis and treatment of this condition.

Further evaluation often takes place at a medical clinic, especially if it is unclear whether myocarditis is also present or if complications have arisen.

Myocarditis can be prevented primarily by taking a proactive approach to managing infections. It is important to allow an infection to run its full course and to avoid physical exertion during this time.

This is how you can actively help prevent myocarditis.