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Heart muscle inflammation- Herzmuskelentzündung

Heart muscle inflammation- Herzmuskelentzündung

Myocarditis (inflammation of the heart muscle) is a serious disease. It often develops as a result of flu-like infections. Its symptoms are often barely noticeable, making it difficult to diagnose quickly. In severe cases, myocarditis can cause cardiac insufficiency or severe cardiac arrhythmia. There is then even a risk of sudden cardiac death. Read here how you can recognize an inflammation of the heart muscle, how it develops and how it is treated.

Brief overview

What is heart muscle inflammation? Inflammation of the heart muscle cells and usually also of the surrounding tissue and the blood vessels supplying the heart (coronary arteries). If the inflammation also spreads to the pericardium, this is called perimyocarditis.
Symptoms: often no or hardly noticeable symptoms such as increased palpitations (palpitations) and heart stumbling; possibly chest pain, cardiac arrhythmia and signs of heart failure in advanced myocarditis (such as water retention in the lower legs).
Triggers: In infectious myocarditis, pathogens such as viruses (e.g. cold, flu, herpes, measles or Coxsackie viruses) or bacteria (e.g. the pathogens causing tonsillitis, scarlet fever, diphtheria or blood poisoning) are involved. Non-infectious myocarditis is caused by, for example, faulty immune reactions, radiotherapy or medication.
Risks: Possible consequences are a pathologically enlarged heart muscle (dilated cardiomyopathy) with chronic cardiac insufficiency and severe cardiac arrhythmia. There is a risk of sudden cardiac death.
Treatment: mainly physical rest and bed rest, possibly medication against the pathogens causing infectious myocarditis (such as antibiotics against bacteria); treatment of complications, e.g. heart-stressing medication for cardiac insufficiency (such as beta blockers)
Prognosis: With consistent physical protection, myocarditis usually heals without consequences. Otherwise, there is a risk of long-term consequences such as cardiac insufficiency. The inflammation of the heart muscle is rarely fatal.

Heart muscle inflammation: Symptoms

Heart muscle inflammation is usually caused by viruses or bacteria (infectious myocarditis). The symptoms of such an infection therefore often precede the myocarditis. These can include a cold and cough, fever, headache and aching limbs. If these flu-like symptoms are accompanied by increasing tiredness and exhaustion, weakness, decreasing resilience or difficulty in breathing during exertion, the possibility of infectious myocarditis should always be considered.

In fact, these symptoms are often the only signs at the beginning of an acute heart muscle inflammation. Symptoms such as loss of appetite and weight as well as headaches and aching limbs can be added. Other myocarditis symptoms may include radiating pain in the neck or shoulders.

If you develop possible symptoms of heart muscle inflammation days or weeks after a flu-like infection, you should definitely see your doctor!
Symptoms of the heart

Normally a healthy person does not feel his heart. However, in the case of heart muscle inflammation, some people notice increased palpitations. Some also report a feeling of tightness in the chest (atypical angina pectoris) or heart stumbling. This stumbling expresses the fact that the heart is occasionally briefly out of rhythm:

The heart has a clock that is located in the right atrium. From this so-called sinus node, in a healthy heart the electrical signals spread evenly over the heart muscle and trigger its contraction. As a result, the heart beats in a coordinated manner and pumps the blood evenly into the body’s circulation.

When the heart muscle is inflamed, additional electrical signals are generated or their normal transmission is delayed. Sometimes the impulses are not even transmitted from the atrium to the chambers at all (AV block). The normal heart rhythm is therefore disturbed. In some cases of inflammation of the heart muscle, this leads to tachycardia or irregular heart rhythms with interruptions.

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Heart muscle inflammation: Triggers & Causes

With regard to the causes, a distinction is made between infectious and non-infectious heart muscle inflammation.
This is what happens with myocarditis
myocardium
Myocarditis, which is usually painless, can weaken the heart muscle considerably and cause cardiac arrhythmia.
Infectious heart muscle inflammation

A myocarditis is considered infectious if it is caused by pathogens. In about 50 percent of cases, these are viruses. Thus, infectious myocarditis is often preceded by a banal viral infection (cold, flu, diarrhea). Especially the so-called Coxsackie B virus is often the trigger for viral myocarditis. But many other viruses, such as the pathogens that cause herpes, flu (influenza), mumps, rubella or measles, can also cause myocarditis.

If viral-related myocarditis is suspected, the virus causing it is only determined in exceptional cases. This would be of little practical use – there are usually no specific drugs against the viruses in question.

Bacteria can also cause heart muscle inflammation. Particularly in the context of bacterial blood poisoning (sepsis), in which the heart valves are already affected, the inflammation can also spread to the heart muscle. Typical pathogens here are so-called staphylococci. Another group of bacteria, streptococci, can also cause myocarditis. These include, for example, the pathogens that cause scarlet fever or tonsillitis.

Another bacterial cause of myocarditis can be diphtheria. Rarely is Lyme disease to blame for an inflamed heart muscle. Its pathogen, the bacterium Borrelia burgdorferi, is transmitted by a tick bite.

Also rare are fungal infections that trigger an infectious heart muscle inflammation: fungi usually only trigger myocarditis when the patient’s immune system is significantly weakened. This is the case, for example, with AIDS, chemotherapy or the use of immunosuppressive drugs.

Other rare pathogens that cause myocarditis are parasites such as the fox tapeworm or unicellular organisms such as the pathogens causing toxoplasmosis or Chagas’ disease.
Non-infectious myocarditis

Likewise rare are fungal infections the trigger of an infectious heart muscle inflammation: Fungi usually only trigger myocarditis when the patient’s immune system is significantly weakened. This is the case, for example, with AIDS, chemotherapy or the use of immunosuppressive drugs.

Other rare pathogens that cause myocarditis are parasites such as the fox tapeworm or unicellular organisms such as the pathogens causing toxoplasmosis or Chagas’ disease.
Non-infectious myocarditis

In the case of a non-infectious heart muscle inflammation, no pathogens are the trigger. Instead, the cause is, for example, a defective regulation of the immune system. The immune system is directed against the body’s own structures, resulting in so-called autoimmune diseases. These include, for example, vascular inflammation, inflammation of connective tissue and rheumatic diseases. Such autoimmune diseases can also lead to inflammation of the heart muscle (autoimmune myocarditis).

Another cause of non-infectious myocarditis is the irradiation of the chest as part of radiotherapy for various types of cancer (such as lung cancer).

Rarely do drugs trigger non-infectious myocarditis. These can be, for example, the antibiotics penicillin and ampicillin, the diuretic hydrochlorothiazide and the antihypertensive drug methyldopa.

If no trigger at all is found for the heart muscle inflammation, the doctor speaks of so-called idiopathic fiddler’s myocarditis.
Heart muscle inflammation – causes
What causes the inflammation in the heart and how you can reduce your risk.
What causes the inflammation in the heart and how you can reduce your risk.
Myocarditis: risks

Inflammation of the myocardium carries serious dangers – especially if those affected do not take sufficient care of themselves or have a damaged heart. Myocarditis can cause severe cardiac dysrhythmia. These have considerable consequences for the circulation. After all, the heart needs a calm, steady rhythm to fill up with blood after each heartbeat for the next powerful contraction. If it beats too quickly or irregularly due to myocarditis, it cannot fill or empty itself properly. The possible consequence is a circulatory collapse with sudden cardiac death.

In about one in six patients, myocarditis triggers conversion processes in the heart, which ultimately lead to chronic cardiac insufficiency: The damaged heart muscle cells are converted into scar tissue (fibrosis) and the heart cavities (ventricles, atria) dilate. Doctors refer to this as dilated cardiomyopathy. The walls of the pathologically enlarged heart muscle are, so to speak, “worn out” so that they can no longer contract powerfully. Thus, a permanent cardiac insufficiency has developed. In severe cases, the pumping capacity of the heart can collapse completely. Sudden cardiac death can therefore also occur here.
Inflammation of the heart muscle: examinations and diagnosis

If heart muscle inflammation is suspected, your family doctor or a cardiology specialist is the right contact person. If necessary, the doctor will refer you to a hospital for further examinations.
Heart muscle inflammation – treatment
Why work and sport are taboo for patients with heart muscle inflammation and who has to take medication.
Why work and sports are taboo for patients with heart muscle inflammation and who has to take medication.
Doctor-patient consultation

The doctor will first talk to you in detail to take your medical history (anamnesis). He will inquire about the exact symptoms and whether these may have been preceded by an infection (cold, flu, diarrhoea, etc.). The doctor will also ask whether you suffer from any underlying diseases (especially heart disease) or whether you have already had heart surgery.
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Physical examination

This is followed by a thorough physical examination. The doctor will, among other things, listen to your heart and lungs with a stethoscope, tap your chest and measure your pulse and blood pressure. He will also see if you show signs of beginning heart failure. These include, for example, water retention (edema) in your lower legs.
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ECG (electrocardiography)

Another important examination is the measurement of the electrical activity of the heart muscle (electrocardiography, ECG). This allows changes in the activity of the heart, such as those that occur during myocarditis, to be detected. Typical are an accelerated heartbeat (racing heart) and additional beats (extrasystoles). Cardiac arrhythmias are also possible. Since the deviations usually occur only temporarily, a long-term measurement of the heart activity (long-term ECG) is advisable – in addition to the usual short-term resting ECG.
Heart ultrasound

By means of an ultrasound examination of the heart (echocardiography), the doctor can assess the structure and function of the heart muscle. For example, he can detect enlarged ventricles or pumping weakness. In some myocardial inflammations, fluid also collects between the pericardium and the heart muscle. Such a pericardial effusion can also be detected by ultrasound.
Blood test

Inflammation values in the blood (CRP, BSG, leucocytes) show whether there is an inflammation in the body. In addition, cardiac enzymes such as troponin-T or creatine kinase are determined: they are released from the cells when heart muscle cells are damaged (for example as a result of myocarditis) and are then detectable in the blood in increased quantities.

If antibodies against certain viruses or bacteria are found in the blood, this indicates a corresponding infection. If the heart muscle inflammation is the result of an autoimmune reaction, corresponding autoantibodies (antibodies against the body’s own structures) can be detected.

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X-ray

An x-ray of the chest (chest x-ray) can reveal signs of cardiac insufficiency due to myocarditis. The heart is then enlarged. In addition, a backlog of fluid in the lungs may be visible, which is caused by the weak pumping power of the heart.
Magnetic resonance imaging (MRT)

Using magnetic resonance imaging (MRI), the physician can distinguish between inflamed, damaged heart areas and healthy ones. An MRI of the heart is called cardio-MRI.
Tissue removal by means of a cardiac catheter

Sometimes, in the case of heart muscle inflammation, an examination by means of a heart catheter is also carried out. In this procedure, a small tissue sample of the heart muscle can be taken (myocardial biopsy). It is examined in the laboratory for inflammatory cells and pathogens.
Read more about the examinations

Find out here which examinations can be useful for this disease:

ECG
Pulse measurement

Heart muscle inflammation: Treatment

The treatment of a heart muscle inflammation depends on the symptoms on the one hand, and on the trigger on the other. Physical rest and the treatment of a possible underlying disease are the cornerstones of myocarditis treatment.

In the case of a very severe heart muscle inflammation, the patient must be treated in the intensive care unit. There, vital parameters such as heart activity, pulse, oxygen saturation and blood pressure can be continuously monitored.
Physical protection

It is particularly important in the case of heart muscle inflammation that the patient takes complete physical rest. This means that he must avoid any physical exertion, for example in the household. This is because an inflammation of the heart muscle can leave lifelong damage to the heart muscle and the heart valves if it continues to be fired by exertion.

Patients with severe myocarditis are admitted to hospital.

Even weeks after the acute phase of the disease, the patient must not overexert himself. The doctor decides when full exertion is possible again. As long as there are signs of heart failure, the patient is unable to work. If he strains himself again prematurely, he risks a relapse and permanent damage.

If myocarditis requires prolonged bed rest, there is a risk of blood clots forming (thrombosis). Patients are given anticoagulants as a preventive measure.
Treatment of the cause

The most common pathogens causing infectious heart muscle inflammation are viruses. However, there are usually no antiviral drugs available to treat such viral myocarditis. Treatment here essentially consists of rest and bed rest.

The situation is different in bacterial myocarditis: The doctor prescribes antibiotics against the bacteria that cause it. Targeted medications can also be used against other pathogens which, in rare cases, cause myocarditis. These include antimycotics against fungal infections and antiprotozoals against unicellular parasites (such as the pathogens that cause Chagas’ disease).

The situation is different in bacterial myocarditis: The doctor prescribes antibiotics against the bacteria that cause it. Also against further pathogens, which cause in rare cases a heart muscle inflammation, one can usually use specific medicines. These include antimycotics against fungal infections and antiprotozoals against unicellular parasites (such as the pathogens that cause Chagas’ disease).

In certain cases, other therapies may be considered for myocarditis (in some cases only within the framework of studies). This could be the administration of cortisone, for example. It has an anti-inflammatory effect and suppresses the immune system. This can be useful in myocarditis, where antibodies are formed against the body’s own structures (autoantibodies) due to a misregulation of the immune system.
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Treatment of complications

A possible complication of myocarditis is heart failure. Then the doctor can prescribe various drugs, for example ACE inhibitors, AT1 receptor antagonists or beta blockers. They relieve the weak heart. The same is done by water-impelling drugs (diuretics).

Sometimes the heart beats so irregularly and rapidly in myocarditis that a life-threatening cardiac arrhythmia such as ventricular tachycardia or ventricular fibrillation is imminent. In this case, patients may be temporarily treated with an external shock generator (defibrillator). In case of ventricular fibrillation, the device automatically delivers a strong electrical impulse to restore normal heart rhythm. Fortunately, this measure is rarely necessary.

If fluid has accumulated in the pericardium during a heart muscle inflammation (pericardial effusion), it should be aspirated with a thin, fine hollow needle (pericardiocentesis).

In the worst case, myocarditis can cause such severe and permanent damage to the heart that it can no longer maintain its function. Then the patient needs a donor heart (heart transplantation).
Read more about the therapies

Read more about therapies that can help:

Resuscitation for adults
Transplantation

Heart muscle inflammation: course of disease and prognosis

Myocarditis can occur at any age and can also affect young, heart-healthy people. If patients consistently take care of their bodies, the course of the disease and prognosis are generally good. Overall, heart muscle inflammation heals in more than 80 percent of cases without causing permanent damage. This is particularly true in the case of viral myocarditis. In some patients, harmless extra beats of the heart can then be found in the ECG (electrocardiogram).

The problem with myocarditis is that it sometimes causes hardly any symptoms. Many patients therefore do not spare themselves sufficiently. This is observed especially in young people who do sports despite myocarditis. The possible consequence is severe cardiac arrhythmia, which can lead to sudden cardiac death. However, this happens only rarely.
Myocarditis: Duration

An acute heart muscle inflammation lasts on average about six weeks. In individual cases, the duration of the disease depends on the extent of the inflammation and the patient’s general health.

It is also very difficult to say when a heart muscle inflammation has really healed completely. Even if a person affected feels completely healthy again after surviving myocarditis, he or she should take it easy for a few more weeks and avoid physical exertion. This is the only way to avoid serious long-term consequences (such as cardiac insufficiency).
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Chronic heart muscle inflammation

In some patients the inflammation of the heart muscle is chronic. The heart muscle or ventricle (especially on the left side) is dilated (dilated cardiomyopathy). The chamber walls are remarkably thin and can no longer provide the necessary pumping force. Consequently, the heart is restricted in its function – a cardiac insufficiency has developed. Even minor exertion (such as climbing stairs) causes the affected person to experience shortness of breath (dyspnoea). Heart failure must usually be treated with medication.
Inflammation of the heart muscle: Prevention

Heart muscle inflammation: Symptoms

Inflammation of the heart muscle can be prevented by vaccination against the infectious diseases that cause it and by having these vaccinations refreshed as prescribed. The recommendations of the Standing Vaccination Commission (STIKO) at the Robert Koch Institute should be followed. For example, vaccination against diphtheria is advisable. This bacterial infectious disease carries not only the risk of heart muscle inflammation but also other dangers such as severe pneumonia. In childhood, the vaccination is usually administered together with those against tetanus and polio.

It is also very important to cure flu-like infections properly. Physical exertion should be consistently avoided whenever there is a fever. The same applies even to a cold that seems harmless. If you “carry off” such an infection, the pathogens (viruses or bacteria) can easily spread to the heart and cause heart muscle inflammation.

People who have already had myocarditis are at particular risk of developing it again (relapse). They should therefore be particularly careful. Above all, the combination of physical strain, stress and alcohol should be avoided. Bacterial skin and mucous membrane inflammations should also be treated with antibiotics at an early stage. Such illnesses are often the trigger for a renewed inflammation of the heart muscle.

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