Myocarditis is an inflammatory process that involves the myocardium, the
middle most portion layer and the thickest layer of the heart which is mostly made up of compact cardiac muscle, occurs when there is thrombus formation and heart dilatation, infiltration of circulating blood cells surrounding coronary vessels and between the muscle fibers.
Myocarditis if left untreated can lead to significant degeneration of the muscle fibers leading to a compromise in the contractility and pumping action of the heart . Mortality widely varies depending on the severity of the presenting signs and symptoms experienced by the individual Most patients generally develop mild to moderate symptoms and usually recover completely. However, untreated and recurrent infections affecting the myocardial layer of the heart can result in cardiomyopathy and heart failure.
Pathophysiology of myocarditis
Myocarditis typically results from viral, fungal, parasitic or protozoan infection. It may also result from an acute systemic infection such as rheumatic heart fever, patients receiving immunosuppressive therapy, chemotherapy, radiation therapy. Moreover, myocarditis may also result from an immune action an idiosyncratic interaction of pharmacological agents used in the treatment of other diseases or radiation (more specifically radiation sites over the left chest and upper back). It may begin in one small area of the myocardium and later spread to the entire layer. The degree of myocardial effect determines the level of the hemodynamic effect as well as the resulting signs and symptoms.
Clinical manifestations of myocarditis
The presenting signs and symptoms of myocarditis is highly dependent on the type of infection, or causative agent that causes the existing infection of the myocardium. Moreover, other factors that will depend on the clinical manifestations of myocarditis include the degree of myocardial damage, the present health status and condition of the individual such as his/her age, immune status which affects the individual’s ability to recover. Patients may be asymptomatic and the infection may resolve on its own. However, they may develop mild to moderate symptoms including fatigue, difficulty in breathing, palpitations, occasional discomfort in the chest and upper abdomen. The most common symptoms are generally flu-like which in rare cases may result in sudden cardiac death or severe congestive heart failure.
Medical management of myocarditis
Patients are given specific treatment for the underlying cause if it is known (antibiotics for specific bacterial infection causing microorganisms) and are placed on bed rest to decrease cardiac workload. Bed rest also helps decrease myocardial damage as well as the complications it may bring . In young patients with myocarditis, activities, especially strenuous activities such as sports should be limited for at least 6 months or at least until the heart size and functioning have returned to normal. If heart failure or irregular heart rhythm develops management is essentially the same as to all causes of heart failure and dysrhythmias. Moreover, the use of NSAIDS such as aspirin and ibuprofen should not be used during the acute phase of myocarditis because these medications can further aggravate myocardial damage.