myocarditis n : inflammation of the myocardium (the muscular tissue of the heart) [syn: myocardial inflammation]
In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. It is generally due to infection (viral or bacterial). It may present with chest pain, rapid signs of heart failure, or sudden death.
Signs and symptomsThe signs and symptoms associated with myocarditis are varied, and relate either to the actual inflammation of the myocardium, or the weakness of the heart muscle that is secondary to the inflammation. Signs and symptoms of myocarditis include:
- Chest pain (often described as "stabbing" in character)
- Congestive heart failure (leading to edema, breathlessness and hepatic congestion)
- Palpitations (due to arrhythmias)
- Sudden death (in young adults, myocarditis causes up to 20% of all cases of sudden death)
- Fever (especially when infectious, e.g. in rheumatic fever)
Since myocarditis is often due to a viral illness, many patients give a history of symptoms consistent with a recent viral infection, including fever, diarrhea, joint pains, and easy fatigueability.
Myocarditis is often associated with pericarditis, and many patients present with signs and symptoms that suggest concurrent myocarditis and pericarditis.
DiagnosisMyocardial inflammation can be suspected on the basis of electrocardiographic results (ECG), elevated CRP and/or ESR and increased IgM (serology) against viruses known to affect the myocardium. Markers of myocardial damage (troponin or creatine kinase cardiac isoenzymes) are elevated.
CausesA large number of different causes have been identified as leading to myocarditis:
- Viral (e.g. enterovirus, Coxsackie virus, rubella virus, polio virus, cytomegalovirus, possibly hepatitis C)
- Bacterial (e.g. brucella, Corynebacterium diphtheriae, gonococcus, Haemophilus influenzae, Actinomyces, Tropheryma whipplei, and Vibrio cholerae).
- Spirochetal (Borrelia burgdorferi and leptospirosis)
- Protozoal (Toxoplasma gondii and Trypanosoma cruzi)
- Fungal (e.g. aspergillus)
- Parasitic: ascaris, Echinococcus granulosus, Paragonimus westermani, schistosoma, Taenia solium, Trichinella spiralis, visceral larva migrans, and Wuchereria bancrofti
- Physical agents (electric shock, hyperpyrexia, and radiation)
Bacterial myocarditis is rare in patients without immunodeficiency.
EpidemiologyThe exact incidence of myocarditis is unknown. However, in series of routine autopsies, 1–9% of all patients had evidence of myocardial inflammation. In young adults, up to 20% of all cases of sudden death are due to myocarditis.
TherapyBacterial infections are treated with antibiotics, dependent on the nature of the pathogen and its sensitivity to antibiotics. As most viral infections cannot be treated with directed therapy, symptomatic treatment is the only form of therapy for those forms of myocarditis, e.g. NSAIDs for the inflammatory component and diuretics and/or inotropes for ventricular failure. ACE inhibitor therapy may aid in the healing process.
myocarditis in German: Myokarditis
myocarditis in Spanish: Miocarditis
myocarditis in French: Myocardite
myocarditis in Italian: Miocardite
myocarditis in Japanese: 心筋炎
myocarditis in Polish: Zapalenie mięśnia sercowego
myocarditis in Portuguese: Miocardite
myocarditis in Finnish: Sydänlihastulehdus
myocarditis in Swedish: Hjärtmuskelinflammation
myocarditis in Vietnamese: Viêm cơ tim