MYOCARDITIS –
Myocarditis is the inflammation of the heart muscle.
MYOCARDITIS EPIDEMIOLOGY-
More common in younger age group people and males are more prone to develop myocarditis.
ETIOLOGY-
It can be divided into three types which are – 1) Infectious, 2) Autoimmune, and 3) Drug-induced
1) INFECTIOUS –
A) Bacteria- Beta hemolytic streptococci, staphylococcus, campylobacter jejuni, chlamydia, gonococcus, salmonella, and many more bacteria.
B) Viruses – Adenoviruses, Hepatitis B and C, Herpes simplex, polio, Mumps, influenza, rubella, and other viruses.
C) Fungi – Candida, Aspergillus, Actinomyces, etc.
D) Rickettsia, protozoa, and helminths are also known to cause infective myocarditis.
2) AUTOIMMUNE – These can be due to cytokines, autoimmune disease, or dressler’s syndrome.
3) DRUG INDUCED – Cocaine, Cannabis, Amphetamines, paracetamol, and Paraphenylene diamine which is present in hair dyes.
PATHOGENESIS:
Viral infection can lead to lymphocytic myocarditis.
Some studies have shown that virus enters the cardiac muscle which leads to the activation of the innate immune system. After this, the virus replicates in the body leading to activation of the acquired immune system to protect the body against the virus, and sometimes it can cause damage to the heart muscle.
CLINICAL FEATURES-
History taking is very important to make a diagnosis of myocarditis especially in young patients presenting with congestive heart failure. Patients should be enquired about any recent flu-like symptoms such as fever, cough, or cold.
Most patients complain of fatigue, breathlessness, and swelling in lower limbs, while some patients can feel chest pain.
INVESTIGATION-
1) As mentioned earlier, history taking is the first and most important part of making the diagnosis.
2) serum cardiac biomarkers such as troponin, and creatine phosphokinase are also elevated.
3) complete blood count, liver function test, kidney function test, erythrocyte sedimentation rate, and C-reactive protein should also be done.
4) ECG should be done which can show QT wave changes.
5) An echocardiogram is done which can show cardiac chamber enlargement which can result in reduced contractility in turn leads to the reduced pumping action of blood out of the heart which leads to heart failure.
6) A chest x-ray is also important as it can reveal cardiomegaly.
7) Cardiac MRI is one of the most important tests that should be performed to find if the patient is suffering from acute myocarditis or infarction but cardiac MRI is not much reliable in chronic myocarditis cases.
8) An endomyocardial biopsy can be done if the patient is not improving from initial treatment.
MANAGEMENT-
1) In the acute phase of illness antiviral treatment is started by the doctor if viral etiology is suspected. In some trials, antivirals have shown some beneficial effects.
2) when the disease has progressed from the acute early phase, then immunosuppressive therapy is started by a doctor, and data from trials have shown beneficial effects.
3) In the case above treatments are not working or the patient is not improving then an endomyocardial biopsy is done to look for inflammation and virus.
If inflammation and virus results come negative then it is better to wait and continue symptomatic treatment.
If inflammation is present but the viral report comes negative then the doctor may start immunotherapy such as corticosteroid, or azathioprine.
If inflammation and virus, both report comes positive then antiviral therapy such as interferon beta, ganciclovir, and other newer drugs can be tried.
TAKE HOME MESSAGE-
1) If someone is having flu-like symptoms then it should be ignored and better to get a check with your doctor.
2) It is important that children should get properly vaccinated to prevent viral infections.
3) Old age people should consult the doctor to check if they need to get an influenza virus vaccination.
4) Always include healthy food and fruits in the diet to improve health and immunity.
STAY HEALTHY AND SAFE.
COMMENTS ARE WELCOME.
