Myocarditis is inflammation that occurs in the myocardium or heart muscle. This inflammation is generally caused by a bacterial or viral infection. However, in some cases, myocarditis can also occur due to exposure to hazardous substances or using drugs without a doctor's prescription.

The myocardium is the heart muscle whose role is to pump blood from the heart throughout the body. Inflammation of the heart muscle can cause a decrease in the heart's ability to pump blood and disturbances in heart rhythm. This condition can cause disturbing symptoms, such as chest pain and shortness of breath.

Mild myocarditis can heal more easily, either with or without treatment. However, if it is classified as severe and does not get proper treatment, myocarditis has the potential to cause blood clots which can trigger serious complications, such as strokes and heart attacks .

Causes of Myocarditis

Although the cause of myocarditis is often unknown, in most cases, myocarditis is caused by an infection, such as:

1. Virus

Viruses that can cause myocarditis are:

  • SARS-CoV-2 ( COVID-19 )
  • Adenovirus
  • Hepatitis B and C
  • Herpes simplex virus
  • Epstein-Barr virus (causes mononucleosis )
  • Echovirus (causes gastrointestinal infections)
  • Rubella
  • HIV

2. Bacteria

Types of bacteria that can cause myocarditis include:

  • Staphylococcus (the cause of impetigo, MRSA )
  • Streptococcus
  • Corynebacterium diphtheriae (causes diphtheria )
  • Clostridia
  • Meningococci
  • Mycobacteria

3. Parasites

Types of parasites that can cause myocarditis are trypasonoma and toxoplasma .

4. Mushrooms

Fungi that can cause myocarditis are candida , aspergillus, or histoplasma fungi which are commonly found in bird droppings. Myocarditis caused by fungal infections usually occurs in people with weak immune systems.

5. Drugs

Using drugs without a doctor's advice or misusing drugs can cause allergic reactions and poisoning which then trigger myocarditis.

Medications that can cause myocarditis include chemotherapy drugs, antibiotics (such as penicillin or sulfonamides ), and anti-seizure drugs. Meanwhile, the illegal drug that can cause myocarditis is cocaine .

6. Chemical substances or radiation

In some cases, a person can get myocarditis due to exposure to radiation or harmful substances, such as carbon monoxide .

7. Autoimmune disease

Myocarditis can also be triggered by other diseases, such as autoimmune diseases, such as rheumatoid arthritis and lupus .

Myocarditis symptoms

Mild myocarditis generally does not cause any complaints. Conversely, if it is considered severe, myocarditis can cause symptoms in the form of:

  • Chest pain
  • Shortness of breath, either on exertion or at rest
  • Heart pounding or beating irregularly
  • Swelling in the limbs
  • Weak

Other symptoms may also occur, depending on the cause of the myocarditis itself. If myocarditis is caused by an infection, other symptoms that can appear are fever, headache, and joint pain.

Meanwhile, myocarditis in children and infants does not have specific symptoms, so a direct examination by a doctor is needed. Signs and symptoms that commonly appear in children and infants with myocarditis are:

  • Weak
  • Loss of appetite
  • Chronic cough
  • Stomach ache
  • It's hard to breathe
  • Fever
  • Diarrhea
  • Stupid
  • Joint pain

When to see a doctor

Check with your doctor if you or your child experience the above symptoms, especially if you have chest pain and shortness of breath. If symptoms get worse or don't improve within a few minutes, don't delay going to the emergency room at the nearest hospital, so you can get medical treatment right away.

Diagnosis of myocarditis

First of all, the doctor will conduct a question and answer regarding the patient's symptoms and medical history, then proceed with carrying out a physical examination. Furthermore, to confirm the diagnosis, the doctor will carry out supporting examinations, such as:

  • Electrocardiography or EKG , to check the electrical activity of the heart
  • Chest X-ray, to check the size and shape of the heart, and to check for possible heart failure
  • Echocardiography or ultrasound of the heart, to check the pumping function of the heart, and detect blood clots in the heart, accumulation of fluid in the lining of the heart ( pericardial effusion ), disorders of the heart valves, and heart enlargement
  • Cardiac MRI, to see whether there is inflammation in the heart muscle
  • Cardiac catheterization accompanied by a heart muscle biopsy, to see the condition of the heart and to take samples from the heart muscle to be examined under a microscope

Other tests can also be done as a follow-up examination to find out the cause of myocarditis. For example, blood tests may be done to look for signs of infection or autoimmune disease.

Myocarditis Treatment

In most cases, people with myocarditis can make a full recovery. The treatment given will be adjusted to the causes and symptoms that occur. Generally, treatment can also be done independently at home.

In myocarditis caused by a bacterial infection, treatment can be done with antibiotics. If myocarditis causes inflammation, corticosteroids can be given to relieve it.

Myocarditis patients are also advised to get plenty of rest, avoid strenuous exercise for at least 3–6 months, and limit consumption of salt and water according to doctor's recommendations. This is so that the work of the heart is not excessive, so that it can speed up recovery.

In patients who have experienced complications, such as arrhythmias or heart failure, doctors will recommend hospitalization. The doctor will also prescribe a number of medicines to reduce the risk of blood clots forming in the heart.

Medicines that can be given by doctors include:

  • ACE inhibitors, such as enalapril, captopril, ramipril , and lisinopril
  • Angiotensin II receptor blockers (ARBs), eg losartan and valsartan
  • Beta blockers, for example metoprolol, bisoprolol , and carvedilol
  • Diuretics, such as furosemide

In myocarditis that is classified as severe, treatment can be carried out in the form of:

1. Infusion of drugs

Administering drugs through an infusion is done so that the function of the heart to pump blood can improve more quickly.

2. Ventricular assist devices (VAD)

Ventricular assist devices (VAD) are mechanical heart pumps, which function to pump blood from the heart chambers throughout the body. VAD is used in patients who suffer from weak heart or heart failure.

3. Intra-aortic balon pump

In this method, a special balloon is implanted in the main artery (aorta). The tool serves to increase blood flow and reduce the workload of the heart.

4. Extracorporeal membrane oxygenation (ECMO)

ECMO is a tool that functions to provide oxygen supply to the body, and remove carbon dioxide from the body. ECMO can be performed in myocarditis patients who have already had severe heart failure, or in patients awaiting a heart transplant.

5. Heart transplant

Heart transplantation is a procedure to replace a patient's badly damaged heart with a healthy heart from a donor. Although it can be used to treat severe myocarditis, this action is not yet available in Indonesia.

Myocarditis complications

If left untreated, myocarditis can cause permanent damage to the heart muscle. As a result, sufferers can get serious complications, such as:

  • Heart rhythm disturbances
  • Heart attacks and strokes
  • Heart failure
  • Sudden cardiac arrest

Although rare, myocarditis can also cause inflammation of the lining of the heart (pericarditis) and changes in the structure of the heart muscle ( cardiomyopathy ), which can result in permanent decreased heart function .

Prevention of myocarditis

Until now, it is not known how to prevent myocarditis. However, the risk of developing myocarditis can be reduced by taking steps to prevent infection, such as:

  • Always take care of personal hygiene, food, and shelter
  • Vaccinate according to doctor's advice
  • Avoid contact with someone who is sick
  • Have sex in a healthy way, namely by using a condom and not having multiple partners

In addition, avoid using illegal drugs and use drugs from a doctor with the recommended dosage and method of use.

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