Myocarditis

Myocarditis is an inflammatory disease of the heart muscle that can be caused by variety of infectious agents, systemic diseases, drugs and toxins.

Infectious myocarditis can be caused by viral, bacterial, fungal or parasitic infection.

Immune-mediated myocarditis can be caused by:

• Allergens, including some drugs
• Systemic diseases, such as sarcoidosis, lupus, rheumatoid arthritis and scleroderma
  
  

Toxic myocarditis can be caused by:

• Drugs
• Heavy metals, including copper, iron and lead
• Radiation
• Electrical shock
  
  

Myocarditis symptoms can range from mild to life-threatening, and symptoms can present in different ways in different people.

Symptoms of myocarditis can include:

• Flu-like symptoms, including fatigue and achiness
• Chest pain
• New onset of heart failure symptoms, including shortness of breath, swelling and fatigue
• Palpitations
• Life-threatening symptoms, including severe heart rhythm abnormalities, heart muscle dysfunction and heart failure
  
  

Cardiac imaging can be useful in diagnosing myocarditis, but an endomyocardial biopsy is the gold standard. Our experts use an endomyocardial biopsy, a catheter-based procedure, to collect heart tissue samples that can be used for laboratory analysis.

Before performing an endomyocardial biopsy, your doctor may use one of the following to help diagnose myocarditis:

• Echocardiogram
• Cardiac MRI
• FDG PET scan
• Biomarker tests looking for inflammatory markers, cardiac markers, viral components or viral-specific antibodies
  
  

Treatment of myocarditis is often targeted toward the immune system, with the goal being to reduce the inflammation. Our experts often use medications such as steroids, immunosuppressive drugs, immunoglobulins and interventions like plasmapheresis.

Sometimes, myocarditis presents in a particularly aggressive manner — called cardiogenic shock. This condition has a profound impact on the heart and immediate care is focused on life-saving support using mechanical pumps. Once stable, treatment becomes focused on reducing inflammation in the heart. In some rarer kinds of myocarditis, called giant cell myocarditis or fulminant myocarditis, you may need a heart transplant  after initial stabilization.