Myocarditis, pericarditis and other pericardial diseases

Understanding Myocarditis, Pericarditis, and other Pericardial Diseases

When we think of damage to the heart, we often consider conditions such as cardiovascular disease and heart attacks.

Inflammation can also cause heart problems, however. These cases often occur because of a bacterial or viral infection and can occur in people of all ages, even if they seem in perfect health. 

When the heart muscles and the surrounding structures are affected they can become enlarged causing symptoms such as pain and fatigue. While these symptoms should subside when the infection has been treated, for some patients there is a long term impact.

What Is Myocarditis?

Myocarditis is inflammation of the muscular part of the heart that helps us pump blood around the body. It can mean the heart becomes enlarged and weakened and may, in certain cases, cause scarring of the tissue affected. 

For many patients, myocarditis improves on its own. It is, however, important to have the condition diagnosed quickly in case there are further complications. The most common approach is to monitor the individual and control the condition using heart medications, particularly if the person is having arrhythmias.

Causes of Myocarditis

An infection with a pathogen is often the trigger. In particular, viral infections that are harmless in themselves (such as a cold or diarrhoea) and are not entirely cured can lead to myocarditis. More rarely, bacteria such as streptococci or staphylococci trigger myocarditis. The pathogens are transported with the blood from their actual source of infection to the heart.Even certain parasites and fungi (such as yeast infections and mould) could mean someone develops myocarditis. 

The condition is not uncommon for patients who are taking medications, including those being treated for cancer. Myocarditis is also more common in people with a weakened immune system.

Signs and Symptoms of Myocarditis

Milder symptoms in the early stages of the disease include chest pain and an irregular heartbeat. The individual may have symptoms relating to the viral infection such as a high temperature, joint pain and a sore throat. 

They could also notice a fluid build up in the legs and feel more fatigued than usual.

Pericarditis shown on ultrasound

What Is Pericarditis?

The pericardium is a fluid-filled sac that surrounds the heart and is essentially a protective layer. Pericarditis usually comes on acutely with little or no warning and the first thing that patients typically notice is pain in the chest area. The inflammation causes the protective sac to become red and swollen. 

Compared to myocarditis, pericarditis can persist, with individuals suffering attacks for up to 3 months. In some cases, the conditions can last for several years – between 15 and 30% of patients develop a chronic condition that needs to be carefully managed.

Causes of Pericarditis

Pericarditis can occur in individuals at any age but many times the underlying cause is not identified. The most common, however, are:

  • A viral infection, particularly in the gut.
  • Bacterial infections, including tuberculosis. 
  • Fungal infections. 
  • Parasite infections. 

Individuals who suffer from autoimmune diseases such as rheumatoid arthritis, lupus and scleroderma are more likely to suffer from pericarditis. It can also be diagnosed in those who have had a heart attack or heart surgery, as these individuals are at a greater risk.

Signs and Symptoms of Pericarditis

The main symptom of pericarditis is a sharp, stabbing pain in the chest that can be quite alarming. This is caused by inflammation of the pericardium which then rubs against the chest wall. 

The pain may improve if someone sits up straight and leans forward slightly. It can also feel worse if they lie down or cough suddenly. Other symptoms include feeling fatigued and pain in the neck, left shoulder or back. 

As with myocarditis, there may also be swelling in the feet and other extremities which could mean the pericardium is constricting the heart. This is a serious development that requires immediate medical attention.

Initial treatment for pericarditis is to use anti-inflammatories and treat the infection if one is present. In more severe cases, other medications may be used such as colchicine and diuretics.

Other Pericardial Diseases

In some cases, excess fluid may gather in the pericardium sac, causing a condition called pericardial effusion. This can then lead to cardiac tamponade (where the blood pressure drops dramatically) which can be life-threatening and requires immediate medical attention.

Chronic constrictive pericarditis occurs over the long term and can be a very serious condition if not controlled properly. Half of the cases tend to be caused by a virus, while 37% occur following cardiothoracic surgery. 

For very severe conditions where less intrusive treatments fail to work and there is an immediate threat to life, the typical solution is to surgically remove the pericardium.

The Miskawaan Way - Integrative Care

A weakened immune system can cause infections caused by pathogens that do not heal completely-permanently. 

Our curative approach to healthcare is to get to the root cause of the illness or disease you are suffering from and treat it beyond the symptoms. We also try to calm and strengthen your immune system so that your body can protect and heal itself. We look at healthcare from a holistic perspective and treat you as a person, not a diagnosis.