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Myocarditis is an inflammatory condition of the myocardium. Myocardium is the middle layer of heart wall. Various signs and symptoms including chest pain and abnormal heart rhythms can be caused by this condition, but rarely happens.

In severe cases of myocarditis, heart pumping action will be weakened and the heart will not be able to supply the entire body with enough blood. This can lead to the development of heart attack or stroke, and can form clots within the heart.

Viral infections usually cause myocarditis. Treatment of myocarditis conducted focused on the cause.

Cause

Rheumatic fever is a common cause of myocarditis, but usually there are other causes of myocarditis. Myocarditis most often develops because of infections caused by, among others, by:

1. Parasite
Toxoplasma and Trypanosoma cruzi, including some parasites that are transmitted by insects and can cause a condition called Chagas disease. The most common cause of congestive heart failure was Chagas disease.

2. Bacterium
Including tick-borne bacterium that causes Lyme disease and Staphylococcus aureus, which can also cause infection of the heart valve called endocarditis. More than a quarter of all people with bacterial infections diphtheria, also occurs myocarditis.

3. Mushrooms
Some causes of myocarditis is rare, aspergillus, fungal infections such as candida, and other fungi such as Histoplasma. Histoplasma is commonly found in bird droppings.

4. Virus
Coxsackievirus B, which can cause symptoms similar to mild cases of flu, is the virus most often associated with myocarditis. However, other causes of myocarditis include rash called 'fifth disease' caused by parvovirus B19, mononucleosis caused by Epstein-Barr virus, measles is caused by rubella, digestive tract infections caused by echovirus, and viruses that cause influenza (adenovirus). The heart muscle can also be directly infiltrated by HIV, the virus that causes AIDS.

Some conditions that can lead to the development of myocarditis, among others:

1. Drugs that can cause allergic reactions
Antibiotics such as penicillin and sulfonamide drugs, as well as some illegal drugs like cocaine.

2. Some chemicals
Substances such as hydrocarbons and arsenic.

3. Other diseases
Inflammation of blood vessels (vasculitis), lupus, connective tissue disorders, and rare inflammatory conditions such as Wegener's granulomatosis.

Symptom

Depending on the cause and severity of illness, signs and symptoms of myocarditis may vary. The following is included in the most common signs and symptoms:

1. Fluid retention with swelling of the ankles and feet
2. Chest pain that may feel like a heart attack or angina
3. Shortness of breath at rest or during physical activity
4. Fatigue
5. Rapid heartbeat or abnormal (arrhythmia)

While the signs and symptoms are less common, among others:

1. Fainting or sudden loss of consciousness
2. Other symptoms associated with viral infections such as fever, joint pain, diarrhea, headache, sore throat, or body aches.

Pericarditis, which is an inflammation of the membrane covering the heart (pericardium), can sometimes develop in people with myocarditis. Sharp pain over the center of the chest may be caused by pericarditis. Myocarditis may not have obvious symptoms in mild cases.

Signs and symptoms that may be experienced by children when it leads to the development of myocarditis, among others:

1. Discoloration of the skin becomes bluish or grayish
2. Difficulty in breathing
3. Loss of appetite
4. Fever

Treatment

Treatment focuses on the cause myocarditis, such as certain infections that may have caused inflammation of the heart. Coxsackievirus B is the most common types of viruses that cause myocarditis. There has been a special treatment of myocarditis, in addition to relieving pain and other symptoms.

1. Treatment of mild cases

To help the body fight infections that cause myocarditis, the doctor may prescribe medication and tell the patient to rest until the heart is recovering. If the cause is bacterial infection, then antibiotics will be prescribed.

To suppress the immune system, certain rare types of viruses, such as giant cell and eosinophilic myocarditis, respond to corticosteroids or other drugs.

Treatment will be directed at the underlying disease if the condition is caused by chronic diseases such as lupus. Avoiding tobacco, alcohol and strenuous exercise and limit the amount of salt in the diet can also be recommended to patients.

2. Treatment to help the heart work

A person may be admitted to hospital if you experience symptoms, such as heart beat too fast or irregular. To regulate the heartbeat, the patient can take certain medications.

Drugs that are prescribed to reduce the workload of the heart, can help patients eliminate excess fluid, or strengthen the heart's pumping ability in the case of a weak heartbeat.

These drugs, among others:

a. Digoxin, which can increase the strength of heart muscle contractions and tends to slow the heart rate
b. Beta blockers such as carvedilol and metoprolol, which works in a variety of ways to treat heart failure and helps to control irregular heart rhythms or fast
c. Angiotensin converting enzyme (ACE) inhibitors, such as lisinopril, ramipril, enalapril and captopril, which relax blood vessels in the heart and helps blood flow more easily
d. Diuretics such as furosemide, which can relieve fluid and sodium retention

3. Treatment in severe cases

Some of these treatments can be used to treat severe myocarditis:
a. The use of temporary artificial heart
b. Drug intravenously (IV) to improve heart function
c. Consideration of heart transplantation
d. Pump placement in the aorta (intra-aortic balloon pump)

Some people need medication just a few months and then recover completely. While others may have a chronic and permanent damage to the heart muscle that requires lifelong medication. It is difficult for doctors to predict how long patients need the drugs, as this is the variability in the disease.

Sources: Epharmapedia