Inflammatory heart diseases

Overview

Pericarditis, myocarditis, and endocarditis are all examples of inflammatory heart disease (IHD). Although males tend to be more afflicted than females, IHD can affect people of any age. While the sickness may be self-limiting and lead to complete recovery, afflicted individuals may acquire chronic disease, implying that identifying key triggers is crucial for successful therapy. Adding to the complication is the fact that IHD can be caused by a range of viral and non-infectious causes, as well as sequel events following main injuries.

Myocarditis, or inflammation of the myocardium, can be caused by a variety of pathogens, including bacterial, rickettsial, mycotic, protozoan, and viral agents. The disease's clinical presentation is exceedingly diverse, ranging from nonspecific flu-like symptoms to arrhythmias, palpitations, disorientation, and syncope, as well as left ventricular failure. 

What is Heart Inflammation?

The body's response to infection or damage is inflammation. It can impact various parts of the body and is linked to a variety of significant illnesses, including cancer, ischemic heart disease, and autoimmune disorders.

When irritants such as bacteria, chemicals, or viruses enter your heart muscle, you may have heart inflammation or infection. An infection of this type can harm or inflame the heart's lining, valves, outer membrane, or the heart muscle itself.

Heart inflammation can occur abruptly or gradually, with severe symptoms or absolutely no symptoms. Depending on the kind and severity of the heart inflammation, you may experience a variety of symptoms. The therapy your doctor advises may differ depending on whether you have inflammation of your heart's lining or valves, the heart muscle itself, or the tissue around the heart. You might be treated with medication, treatments, or even surgery.

Heart Inflammation Symptoms

Depending on the kind of heart infection, you may have the following symptoms:

• Shortness of breath, especially after exercise or when lying down
• Chest pain or pressure
• Unusual fatigue
• Heart palpitations
• Lightheadedness or fainting
• Swelling in the hands, legs, ankles and feet
• Red spots under the fingernails
• Purple or red spots on the skin
• Sudden loss of consciousness

Pericarditis

Pericarditis is an inflammation of the pericardium, a sac-like structure with two thin layers of tissue that surrounds and supports the heart. A little quantity of fluid separates the layers, causing less friction while the heart beats.

Pericarditis is generally caused by an unknown cause, while viral infections are a prevalent culprit. Pericarditis can develop as a result of a respiratory or intestinal illness.

Autoimmune diseases such as lupus, scleroderma, and rheumatoid arthritis can cause chronic and recurrent pericarditis. These are conditions in which the body's immune system produces antibodies that wrongly assault tissues or cells.

Other possible causes of pericarditis are:

• Heart attack and heart surgery
• Kidney failure, HIV/AIDS, cancer, tuberculosis and other health problems
• Injuries from accidents or radiation therapy
• Certain medicines, such as phenytoin (an anti-seizure medicine), warfarin and heparin (both blood-thinning medicines), and procainamide (a medicine to treat irregular heartbeats)

• Diagnosis and Further evaluation of Pericarditis

At least two of the following criteria must be met for a diagnosis: distinctive acute, pleuritic chest pain; pericardial friction rub; suggestive alterations on electrocardiography; and a new or worsening pericardial effusion. Evaluation includes chest radiography and laboratory studies to support the diagnosis, such as a complete blood count, basic metabolic panel, troponin-I and creatine kinase levels, erythrocyte sedimentation rate, and serum C-reactive protein [CRP] level, in addition to a history, physical examination, and electrocardiography.

Chest radiography can rule out lung and mediastinum abnormalities, including pericardial effusion. In the absence of documented heart illness, cardiomegaly suggests a pericardial effusion of at least 250 mL. White blood cell count, erythrocyte sedimentation rate, and serum CRP level are often high.

• Pericarditis Treatment

Many pericarditis patients can be effectively treated in the outpatient environment. Management choices are influenced by the clinical appearance, assumed cause, medical history, and response to previous therapies. Patients who are at greater risk should be treated in a hospital.

• NSAIDS

Despite the lack of randomized controlled studies, pericarditis is typically treated empirically with nonsteroidal anti-inflammatory medications (NSAIDs). Patients with suspected viral or idiopathic pericarditis should begin taking NSAIDs and continue taking them until symptoms resolve, which generally takes two weeks. Although there are several NSAIDs available, there is no evidence that one is preferable to another for treating acute pericarditis. However, aspirin at 650 to 1,000 mg four times per day, tapered over four weeks, is the best treatment for treating acute pericarditis caused by MI.

An observational research using aspirin (800 mg orally every six to eight hours for seven to ten days, followed by a two- to three-week taper) and gastroprotection revealed an 87 percent resolution rate after 38 months of follow-up. Ibuprofen, which may be preferable because to its low risk of side effects, can be taken at doses ranging from 300 to 800 mg every six to eight hours, reduced to 800 mg weekly over three to four weeks.

Indomethacin (Indocin) should be taken at a dose of 75 to 150 mg daily. Tapering reduces the likelihood of recurrence and should be guided by symptoms and inflammatory indicators (e.g., erythrocyte sedimentation rate, CRP level). Patients should avoid intense activities until they are no longer in discomfort and their biomarkers have returned to normal. Gastroprotection should be utilized in people who need it while taking NSAIDs.

• Colchicine

Colchicine is used to treat recurrent pericarditis or pericarditis that does not respond to standard therapy. European guidelines also recommend colchicine as an initial therapeutic option for acute pericarditis. 7 Patients with acute pericarditis were randomly assigned to either conventional therapy + colchicine or conventional treatment alone in one prospective, randomized, open-label research. At 18 months, those who got colchicine had a considerably decreased recurrence rate. 

Myocarditis

Myocarditis is an uncommon form of cardiovascular illness that is characterized by sudden death, chest discomfort, or heart failure. Shortness of breath, weariness, and ankle edema are all indications of heart failure caused by myocarditis. The cause is an inflammation of the heart muscle, which usually occurs after a viral infection. Myocarditis accounts for between 0.5 and 3.5 percent of heart failure admissions.

The majority of myocarditis instances are seen in young adults, with males being afflicted more frequently than females. Any young adult with unexplained cardiac reasons of shortness of breath or loss of consciousness should be evaluated for this diagnosis. Many authorities advocate a cardiac biopsy to make the diagnosis, however magnetic resonance imaging is becoming more popular as a diagnostic tool. Myocarditis causes differ by area, necessitating region-specific diagnostic and therapeutic techniques.

Myocarditis is most commonly found in younger persons aged 20 to 40 years. Children appear to present in a more severe manner than adults, with a higher proportion requiring temporary mechanical circulatory support. Men are more likely to be impacted than women, probably due to the effects of testosterone on the immunological response to infection. The prevalence of more prevalent age-related cardiovascular disorders, such as coronary artery disease, may result in underdiagnosis among the elderly. Certain types of myocarditis, such as cardiac sarcoidosis, are more frequent in black people than in white people in the United States. However, there is no known racial predilection to most kinds of myocarditis.

• Myocarditis Causes

The majority of myocarditis patients have an unknown etiology (idiopathic). When a cause is discovered, it is almost often the consequence of an infection. Viral infections are the most prevalent causes of myocarditis in North America and Western Europe. Other significant causes in certain global locations include myocarditis caused by streptococcal bacterial infection and HIV-related illnesses. Bacteria such as diphtheria, rubella, and even scorpion sting have been observed among distinct Eurasian tribes.

The cardiac damage might be caused by a toxic impact, such as a poison or a virus. Myocarditis is more usually caused by the body's immunological response to the original heart injury. Most immune reactions are beneficial and serve to eliminate infections, but scar tissue caused by inflammation can contribute to long-term loss in heart function or persistent irregularities in heart rhythm. When the immune system fails to eliminate an infection, it might result in persistent viral myocarditis. Myocarditis can also be associated with systemic inflammatory illnesses like lupus or Kawasaki disease.

Myocarditis does not run in families. There are no known genes that are linked to human myocarditis. When numerous family members are afflicted, the cause is likely a similar sickness or exposure to the environment. Experimental investigations, for example, reveal that low blood selenium levels and high mercury levels may aggravate viral myocarditis.

• Myocarditis Symptoms

Myocarditis symptoms are not unique to the disease and are comparable to those of other prevalent cardiac conditions. A tightening or squeezing sensation in the chest that occurs both at rest and during effort is frequent. When the inflammation affects the outside lining of the heart, or pericardium, as well as the heart muscle, chest discomfort typically improves with leaning forward and worsens with reclining back. A sluggish heart rhythm may produce weariness or lightheadedness if the cardiac pacing or conduction tissues become irritated.

Inflammation can also generate additional beats in the chest, which feel like a flutter. Sustained runs of additional beats in rapid succession might cause dizziness or even loss of consciousness. A myocarditis-related arrhythmia-related sudden death is a leading cause of mortality in children and young athletes.

The majority of myocarditis episodes are preceded by a flu-like sickness that lasts a few days to weeks. In immunocompromised people, such as those infected with HIV, specific viruses and even several viral infections may occur. In rare cases, myocarditis can be caused by an unfavorable medication response. In this case, a temporal relationship between a new medicine and myocarditis symptoms might point to the reason.

The majority of myocarditis cases are minor and respond to regular medical therapy aimed at increasing heart function or correcting aberrant cardiac rhythms. In a small percentage of instances, the symptoms may not improve or return. Referral to a medical center with experience in myocarditis care is helpful in these cases. The diagnosis and treatment of chronic or recurring myocarditis are not standardized.

• Related Disorders

Myocarditis is a very uncommon cause of a wide range of clinical symptoms. Chest discomfort and shortness of breath with exertion, for example, can be caused by a variety of heart diseases as well as non-cardiac factors. Because cardiac inflammatory diagnostic methods, such as magnetic resonance imaging or heart biopsy, are not generally available, the diagnosis is frequently ignored. Myocarditis in persons with autoimmune illnesses may be caused by an autoimmune reaction against heart tissues rather than a viral infection. In this context, myocarditis is part of a larger process that may necessitate immunosuppressive pharmaceutical therapy. Myocarditis can further aggravate the cardiac damage caused by other uncommon heart illnesses like amyloidosis.

• Myocarditis Diagnosis

Myocarditis should be considered in persons who have recently developed cardiac symptoms such as chest pains or difficulty breathing and no signs of more common illnesses such as coronary artery disease, heart valve damage, or severe hypertension. Characteristic characteristics on cardiac magnetic resonance imaging (MRI) significantly corroborate the diagnosis in mild instances, and a heart sample is typically not necessary. A cardiac biopsy may be required to confirm the diagnosis and guide therapy in more severe instances or if patients do not respond to normal medical care.

There are no particular blood tests to prove myocarditis; however, an otherwise unexplained increase in troponin (a blood test that shows heart muscle damage) and/or electrocardiographic characteristics of cardiac injury are helpful. Similarly, new heart wall motion abnormalities or fluid around the heart found on echocardiogram are not specific but help to confirm the diagnosis once other, more prevalent illnesses have been ruled out.

In moderate instances of myocarditis, particularly when there is normal heart pump function and indications of pericardial inflammation, cardiac MRI is an useful confirmatory test. The MRI findings of acute myocarditis are frequently transitory, evolving from a localized to a more widespread pattern of damage. These diagnostic findings may resolve with time.

A cardiac biopsy should be conducted in more severe instances of myocarditis when the findings would have a distinct influence on prognosis or guide treatment. To reduce the risk of procedure-related problems, heart biopsies should be performed in locations with experience in the technique. Heart biopsy centers should have access to cardiac pathologists who can analyze the heart tissue. In general, the diagnostic method for confirming myocarditis should weigh the likelihood of clinical impact against safety.

Myocarditis patients may require follow-up medical visits and cardiac tests to confirm that the condition is responding to therapy. The specific tests, as well as the intervals and duration of follow-up, are determined by the original illness's appearance and severity.

• Myocarditis Treatment

Myocarditis with symptoms of heart failure and impaired heart pump performance should be treated in accordance with the current national society recommendations for "systolic" heart failure. Immunosuppressive medications are typically not recommended for the treatment of the most common cases of myocarditis in adults. However, drugs that modulate the immune response should be evaluated in some types of myocarditis, such as giant cell myocarditis, cardiac sarcoidosis, or eosinophilic myocarditis.

A cardiac biopsy is used to diagnose certain types of myocarditis. Participating in sports while suffering from severe viral myocarditis might result in abrupt death. High amounts of physical activity should thus be avoided for at least 3 to 6 months after a diagnosis of myocarditis. Because of the potential of increased inflammation, nonsteroidal anti-inflammatory medicines such as ibuprofen should be avoided.

Despite receiving the best medical care, some individuals with severe myocarditis suffer low blood pressure. To survive the initial damage, these individuals may require a temporary heart pump (a type of mechanical circulatory support equipment). Some of these myocarditis patients can be bridged to recovery and have the pump withdrawn. Adult patients with myocarditis have similar survival rates following heart transplantation as individuals with other forms of cardiac failure. Patients with severe myocarditis should consult cardiologists who specialize in heart failure and cardiac rhythm disorders.

Endocarditis

Infective endocarditis, also known as bacterial endocarditis, is caused by bacteria entering the circulation and settling in the heart lining, a heart valve, or a blood artery. Although IE is uncommon, those with certain cardiac diseases are at a higher risk of acquiring IE. Infective endocarditis is an infection of the heart walls that also affects the valves. It frequently affects the cardiac muscles.

There are two forms of infective endocarditis, also known as IE:

1. Acute IE — develops suddenly and may become life threatening within days
2. Subacute or chronic IE (or subacute bacterial endocarditis) — develops slowly over a period of weeks to several months.

• What are the symptoms of infective endocarditis?

1. Acute IE symptoms often include fever (102°-104°), chills, rapid heart rate, exhaustion, night sweats, painful joints and muscles, a persistent cough, or edema in the feet, legs, or belly.
2. Fatigue, mild fever (99°-101°), a fairly quick heart rate, weight loss, sweating, and a low red blood cell count are all indications of chronic IE.

Antibiotics are frequently administered intravenously. The antibiotic used and the length of treatment are determined by the kind of infection causing the endocarditis. For individuals at risk, prevention mainly entails being aware of the hazards and taking prophylactic antibiotics before to specific surgical, dental, and medical procedures.

Heart inflammation and COVID-19

COVID-19 has been linked to cardiovascular issues in certain people, including myocarditis. According to CDC study, people with COVID-19 had roughly a 16-fold increased risk of myocarditis compared to those without COVID-19.

COVID-19-related myocarditis is more frequent in young males and adolescent boys. The great majority of these episodes of myocarditis are asymptomatic or mild, and individuals heal on their own.

According to research published in the New England Journal of Medicine, myocarditis caused by the COVID-19 vaccination is an exceedingly rare adverse effect, with an incidence of around 2 per 100,000 patients. Vaccination has far outweighed the danger of heart inflammation.

Inflammatory Heart Diseases in Children

Rheumatic fever, Kawasaki illness, and myocarditis are examples of inflammatory heart disorders. All of these disorders are the result of an inflammatory process that can result in considerable heart morbidity and death. These individuals frequently appear to the emergency department, and quick identification and treatment of these illnesses is critical. The Jones criteria are used to diagnose rheumatic fever, which is caused by group A streptococcal (GAS) infections.

Mitral and/or aortic valve failure can result from rheumatic fever. Kawasaki illness is a vasculitis that affects the medium-sized arteries throughout the body. Fever, conjunctivitis, mucositis, extremities abnormalities, rash, and lymphadenopathy are all diagnostic criteria. Patients with myocarditis may present with shock and aneurysms in the coronary arteries, which can lead to ischemic heart disease.

Immunomodulators and anticoagulants are used in treatment. Myocarditis can be caused by a variety of factors, although it is most usually caused by a viral infection. Although the clinical presentation varies greatly, individuals may appear promptly in cardiogenic shock. Immunomodulators and heart failure medicines are used in treatment.

Preventing Heart Inflammation

Certain lifestyle decisions can help you avoid inflammatory heart disease and the risks of heart damage that come with it:

• Follow good hygiene
• Stay current on vaccines
• Treat chest infections such as pneumonia promptly
• Get evaluated by a doctor for autoimmune conditions

Conclusion 

Inflammatory heart illnesses include inflammation of the heart muscles (myocarditis), the membrane sac that surrounds the heart (pericarditis), and the inner lining of the heart (myocardium), heart muscle (endocarditis). Heart inflammation is caused by recognized infectious agents, viruses, bacteria, fungi, or parasites, as well as hazardous chemicals from the environment, such as water, food, air, poisonous gases, smoke, and pollution, or by an unknown source.

Myocarditis is caused by viral infection of the heart muscle, such as sarcoidosis, and immunological disorders. Chest discomfort, angina, pain in the heart muscle, shortness of breath, edema, swelling of the feet or ankles, and exhaustion are all symptoms. The ECG, X-ray, and MRI can be used to detect the condition; blood tests and an increase in enzyme levels indicate an imbalance in cardiac function. Antibiotics and medicines are used in the treatment of heart muscle inflammation. The ultrasound imaging shows that the cardiac muscle has been damaged further.

In extreme cases of infection, heart failure might result, necessitating the use of long-term anti-inflammatory drugs. For inflammatory heart disorders, numerous biomarkers have been reported.