Myocarditis/Pericarditis

Myocarditis (my-oh-kar-DYE-tis) is inflammation of the heart muscle, and pericarditis (per-ih-kar-DYE-tis) is inflammation of the smooth sac surrounding the heart.

What Are Myocarditis and Pericarditis?

Myocarditis, or inflammation of the muscular walls of the heart, is most commonly caused by viruses, however, it can also be caused by bacteria, parasites, and fungi. Other causes of the condition include radiation, chemicals, cocaine use, and prescription medications. Conditions that affect several parts of the body, such as autoimmune diseases ^* , also can be associated with both myocarditis and pericarditis.

When the pericardium (per-ih-KAR-dee-um), the smooth, double-layered sac-like covering that surrounds the heart, becomes inflamed—known as pericarditis—fluid usually accumulates in the space between its layers. As the amount of fluid increases, the buildup puts pressure on the beating heart and can limit its ability to function. Many of the same infections that cause myocarditis can cause pericarditis as well, and the two often appear together. In addition to the infectious causes of pericarditis, heart surgery or a heart attack ^* can lead to an inflamed pericardium and accumulation of fluid around the heart.

How Common Are Myocarditis and Pericarditis?

Myocarditis and pericarditis are uncommon complications of many infectious diseases. Many cases of myocarditis are mild and go undetected when the person is sick. In fact, it is difficult to determine exactly how many people develop myocarditis or pericarditis. However, some evidence of myocarditis is found in 1 to 4 percent of autopsies ^* . In almost all of these cases, there were no symptoms of the disease while the person was alive.

Are Myocarditis and Pericarditis Contagious?

Neither condition is directly contagious. However, many of the organisms that cause infections that can lead to myocarditis or pericarditis are spread from person to person by coughing or sneezing. It is not clear why myocarditis or pericarditis develops in some people but not in others. A combination of the infection, a person's genes ^* , and an individual's immune response probably determines who will develop these conditions.

What Are the Signs and Symptoms of Myocarditis and Pericarditis?

Because both conditions can seriously affect the heart's function, they may lead to signs and symptoms of heart failure. Patients with myocarditis may experience fever, rapid heartbeat, extreme tiredness, difficulty breathing, and chest pain that can range from mild to severe, sometimes with heart attack-like intensity. In serious cases, congestive heart failure ^* , fainting, and, sometimes, sudden death can occur.

Pericarditis often is accompanied by sharp chest pains, trouble breathing, and pain when taking a deep breath. These conditions usually improve when the patient is sitting or standing rather than lying down. Other symptoms may include dry cough, extreme tiredness, fever, rapid heartbeat, and chills.

How Are Myocarditis and Pericarditis Diagnosed?

A doctor will suspect myocarditis based on symptoms and a physical exam. For instance, a rapid heartbeat, fluid in the lungs, and swollen ankles and feet may point to heart failure, which can occur with myocarditis. The history of the patient's illness is another important clue, as the patient often has had symptoms of a viral infection within the previous 2 weeks to 6 months.

To assess the heart's condition, the doctor may order any of a variety of tests. Although a chest X ray often appears normal in the early stages of the illness, it may show an enlarged heart or fluid-filled lungs. An electrocardiogram ^* (EKG) may show evidence of heart inflammation and can help identify a heart attack as the possible cause of the symptoms. An echocardiogram ^* may show the decreased heart function seen in myocarditis. Blood tests that reveal inflammation of the heart muscle are often abnormal in people with myocarditis and can help in making the diagnosis. A biopsy ^* of a piece of heart muscle can provide a definitive diagnosis. Other tests may be done to identify a specific virus or other infectious organism, but in many cases the exact cause of the inflammation is never found.

To diagnose pericarditis, doctors look for signs of fluid around the heart. During a physical exam, physicians also listen for a rubbing sound that can be heard when the pericardial sac is inflamed. If enough fluid is present, the heart may appear enlarged on a chest X ray. The fluid itself can be seen on an echocardiogram, a computerized tomography ^* (CT) scan, or a magnetic resonance imaging ^* (MRI) scan. An EKG can be helpful in making the diagnosis as well.

How Are Myocarditis and Pericarditis Treated?

Myocarditis and pericarditis may be difficult or impossible to prevent, but prompt recognition and treatment of these conditions will improve the chances of recovery. With both myocarditis and pericarditis, doctors strive to identify and treat the underlying cause, reduce the inflammation, and improve the heart's function. These are serious conditions that usually require hospitalization once the patient has developed detectable symptoms.

Anti-inflammatory medicines such as aspirin, nonsteroidal anti-inflammatory medications, or corticosteroids ^* may be prescribed to reduce inflammation. Patients also may receive medicine to ease pain and diuretics ^* to remove excess fluid from the body. Depending on the cause and the complications of the inflammation, other treatments may be necessary as well, including antibiotics and medications that control heart rhythm problems and improve heart function.

Some cases of pericarditis may require pericardiocentesis (per-ih-KAR-dee-o-sen-tee-sis), or the removal of fluid from the pericardial sac with a needle. This relieves pressure on the heart and collects fluid for tests. In chronic or recurrent cases, the doctor may recommend surgery to cut or remove part of the pericardium. During recovery, the patient's activity usually is restricted, and doctors typically recommend diet changes such as eating less salt. Cases of myocarditis and pericarditis may last from 2 weeks to 3 months, although some people never fully recover their prior heart function.

What Are Some Complications of Myocarditis and Pericarditis?

Complications of these conditions can be very serious. The heart muscle may become damaged and unable to pump effectively. Heart failure, irregular heartbeat, and death may occur. In some cases, if the heart muscle has been severely and permanently damaged, a heart transplant may be considered.