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Health Guide / Heart health

Myocarditis: symptoms and causes

raagini yedidisteve silvestrogina-allegretti

Reviewed by Raagini Yedidi, MD and Steve Silvestro, MD, written by Gina Allegretti, MD

Last updated: Mar 07, 2022
6 min read

table of contents

  1. What is myocarditis? 
  2. Myocarditis symptoms
  3. Diagnosing myocarditis
  4. Causes of myocarditis
  5. Does myocarditis go away on its own? 
  6. Myocarditis treatment
  7. Is there a myocarditis vaccine? 

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Having a virus isn’t often cause for concern—a few days of congestion, cough, body aches, and fever and you’re back to normal after some rest and lots of fluids. 

But if you start to notice new symptoms like chest pain, a racing heartbeat, and difficulty breathing, one possible reason could be a complication called myocarditis or inflammation of the heart. 

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What is myocarditis? 

Myocarditis is inflammation of the heart muscle or myocardium. This condition is somewhat uncommon, affecting roughly 1.5 million people worldwide each year (Kang, 2022). 

Myocarditis can happen on its own or alongside a condition called pericarditis, which is inflammation of the heart lining. Myocarditis is usually caused by a viral infection, but there are other risk factors we’ll discuss below. 

Myocarditis symptoms

Myocarditis can be mild without any noticeable symptoms. Other times it’s severe and affects your heart’s ability to pump blood. Symptoms of myocarditis include (Ammirati, 2018): 

  • Chest pain
  • Fever
  • Passing out (syncope)
  • Dizziness
  • Fatigue
  • Shortness of breath or difficulty breathing
  • Racing heartbeat (palpitations) 
  • Body aches or joint pain
  • Cough, stuffy nose, and sore throat (symptoms of a recent virus)

Diagnosing myocarditis

Myocarditis is diagnosed mostly based on your symptoms. Other tests a healthcare provider may use to diagnose the condition include (Marholdt, 2004; Cooper, 2007): 

  • Blood tests: A troponin blood test measures the levels of troponin (proteins found in the muscle tissue of the heart) to see whether the heart muscle is injured. 
  • Electrocardiogram: An ECG or EKG records electrical signals in your heart to determine if there’s an abnormal heart rhythm. 
  • X-ray or MRI: Chest X-rays help visualize structures in the chest like the heart and lungs. Another type of imaging is an MRI (magnetic resonance imaging), which might help identify injured heart muscle. 
  • Sonogram: A heart sonogram (also called an echocardiogram) looks directly at the heart, its size, and how it moves. 
  • Biopsy: This is when a sample of heart muscle tissue is taken and examined under a microscope. Biopsies aren’t done often but may help diagnose myocarditis if other test results aren’t clear. 

Causes of myocarditis

Viruses are the most common causes of myocarditis. Many viruses cause inflammation that damages the myocardium including coxsackievirus (causes hand, foot, and mouth disease), Epstein-Barr virus (causes mononucleosis), cytomegalovirus, influenza, hepatitis C, HIV, parvovirus, and coronavirus. 

Viruses aren’t the only way to get myocarditis. Other possible causes include (Cooper, 2009; Caforio, 2013): 

  • Chemicals: Exposure to chemicals and toxins can injure the myocardium. These include recreational substances like alcohol and cocaine, prescription medications, chemotherapy drugs, and mood stabilizers like lithium. Metals like iron, copper, and lead can also cause damage. 
  • Bacterial infections: Bacteria can lead to inflammation of the myocardium. Some common culprits include Staphylococcus aureus (which causes staph infections), Haemophilus influenzae, mycoplasma, and Streptococcus pneumoniae. Other bacterial infections that cause myocarditis include Lyme disease and sexually transmitted infections like syphilis and chlamydia. 
  • Medical conditions: People with autoimmune diseases or health conditions that affect the immune system can develop myocarditis. Some examples include lupus, scleroderma, and sarcoidosis.

Other things that may factor into the development of myocarditis include pregnancy, radiation therapy, yeast or fungal infections, parasite infections, spider bites, and scorpion stings.

Does myocarditis go away on its own? 

Mild myocarditis may go away without causing long-term complications. 

More severe cases of myocarditis usually need treatment to avoid severe complications including: 

  • Abnormal heart rhythms (arrhythmias)
  • Dilated cardiomyopathy (a stretched, enlarged heart that can’t pump)
  • Heart failure
  • Sudden death (rare but possible)

Myocarditis treatment

Myocarditis affects the heart’s ability to pump, so medications that relieve strain on the heart can be recommended––if treatment is necessary. Drugs used to treat myocarditis include beta-blockers, ACE inhibitors, and diuretics. Your healthcare provider may also suggest resting and limiting physical activity for a while until your heart has recovered (Caforio, 2013). 

If first-choice medications don’t work, some drugs can be prescribed off-label including steroids, antibodies, and immunosuppressive drugs (medications that affect the immune system) (Caforio, 2013). 

If the myocarditis is severe and doesn’t respond to medication, a machine called ECMO (extracorporeal membrane oxygenation) or a device called a VAD (ventricular assist device) can be used to support the heart. The last option if all else fails is a heart transplant (Chen, 2005; Topkara, 2006). 

Is there a myocarditis vaccine? 

Unfortunately, there isn’t a vaccine specifcally for myocarditis. That said, several vaccines prevent infections that lead to the condition including:

  • The flu shot (for influenza virus)
  • Pneumococcal vaccine
  • Hib vaccine (for Haemophilus influenzae type b)
  • COVID-19 vaccines 
  • Hepatitis B vaccine
  • Polio vaccine
  • MMR vaccine (for measles, mumps, and rubella viruses)

Myocarditis is most commonly caused by viral infections, but it may occur from medication, a bacterial infection, or even pregnancy. It’s important to follow up with a healthcare provider if you experience any signs of myocarditis. 

References

  1. Ammirati, E., Cipriani, M., Moro, C., Raineri, C., Pini, D., Sormani, P., et al. (2018). Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry. Circulation, 138(11), 1088–1099. doi:10.1161/CIRCULATIONAHA.118.035319. Retrieved from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.035319?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed 
  2. Ammirati, E., Frigerio, M., Adler, E. D., Basso, C., Birnie, D. H., Brambatti, M., et al. (2020). Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circulation. Heart Failure, 13(11), e007405. doi:10.1161/CIRCHEARTFAILURE.120.007405. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673642/ 
  3. Caforio, A. L., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S. B., et al. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart Journal, 34(33), 2636–2648d. doi:10.1093/eurheartj/eht210. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23824828/ 
  4. Chen, Y. S., Yu, H. Y., Huang, S. C., Chiu, K. M., Lin, T. Y., Lai, L. P., et al. (2005). Experience and result of extracorporeal membrane oxygenation in treating fulminant myocarditis with shock: what mechanical support should be considered first? The Journal of Heart and Lung Transplantation, 24(1), 81–87. doi:10.1016/j.healun.2003.09.038. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15653384/ 
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  7. Harmon, K. G., Drezner, J. A., Maleszewski, J. J., Lopez-Anderson, M., Owens, D., Prutkin, J. M., et al. (2014). Pathogeneses of sudden cardiac death in national collegiate athletic association athletes. Circulation. Arrhythmia and Electrophysiology, 7(2), 198–204. doi:10.1161/CIRCEP.113.001376. Retrieved from https://www.ahajournals.org/doi/10.1161/circep.113.001376 
  8. Kang, M. & An, J. (2022). Viral Myocarditis. [Updated Jan 5, 2022]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459259/#:~:text=The%20incidence%20of%20myocarditis%20is,is%20unknown%20and%20probably%20underdiagnosed. 
  9. Mahrholdt, H., Goedecke, C., Wagner, A., Meinhardt, G., Athanasiadis, A., Vogelsberg, H., et al. (2004). Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation, 109(10), 1250–1258. doi:10.1161/01.CIR.0000118493.13323.81. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14993139/ 
  10. Mason, J. W., O’Connell, J. B., Herskowitz, A., Rose, N. R., McManus, B. M., Billingham, M. E., et al. (1995). A clinical trial of immunosuppressive therapy for myocarditis. The New England Journal of Medicine, 333(5), 269–275. doi:10.1056/NEJM199508033330501. Retrieved from https://www.nejm.org/doi/10.1056/NEJM199508033330501?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov 
  11. Frustaci, A., Russo, M. A., & Chimenti, C. (2009). Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. European Heart Journal, 30(16), 1995–2002. doi:10.1093/eurheartj/ehp249. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19556262/ 
  12. Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., et al. (2020). Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology, 76(25), 2982–3021. doi:10.1016/j.jacc.2020.11.010. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755038/ 
  13. Topkara, V. K., Dang, N. C., Barili, F., Martens, T. P., George, I., Cheema, F. H., et al. (2006). Ventricular assist device use for the treatment of acute viral myocarditis. The Journal of Thoracic and Cardiovascular Surgery, 131(5), 1190–1191. doi:10.1016/j.jtcvs.2005.08.073. Retrieved from https://www.jtcvs.org/article/S0022-5223(06)00130-9/fulltext#secd5413354e438 
  14. Tschöpe, C., Ammirati, E., Bozkurt, B., Caforio, A., Cooper, L. T., Felix, S. B., et al. (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nature Reviews Cardiology, 18(3), 169–193. doi:10.1038/s41569-020-00435-x. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548534/ 
  15. Yajima, T. & Knowlton, K. U. (2009). Viral myocarditis: from the perspective of the virus. Circulation, 119(19), 2615–2624. doi:10.1161/CIRCULATIONAHA.108.766022. Retrieved from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.108.766022?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

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