Diagnosis

Early diagnosis of myocarditis is important to preventing long-term heart damage. After a physical examination, your doctor might order one or more tests to confirm that you have myocarditis and determine its severity. Tests to diagnose myocarditis might include:

  • Electrocardiogram (ECG or EKG). This quick and painless test shows your heart's electrical patterns and can detect abnormal heartbeats.
  • Chest X-ray. An X-ray image shows the size and shape of your heart, as well as whether you have fluid in or around the heart that might be related to heart failure.
  • Heart MRI (Cardiac MRI). A cardiac MRI shows your heart's size, shape and structure. This test can show signs of inflammation of the heart muscle.
  • Echocardiogram. Sound waves create moving images of the beating heart. An echocardiogram can show your heart size and how well your heart is pumping. The test can also reveal valve problems, a clot within the heart or fluid around your heart.
  • Blood tests. Blood tests used to diagnose or confirm myocarditis include a complete blood count and a test to check the levels of certain proteins (enzymes) that signal heart muscle damage. Other blood tests can be done to determine if you have antibodies against viruses and other organisms that might cause a myocarditis-related infection.
  • Cardiac catheterization and heart muscle biopsy. A small tube (catheter) is inserted into a vein in your leg or neck and threaded into your heart. In some cases, doctors use a special instrument to remove a tiny sample of heart muscle tissue (biopsy) for analysis in the lab to check for inflammation or infection.

Treatment

In many people, myocarditis improves on its own or with treatment, leading to a complete recovery. Myocarditis treatment focuses on the cause and the symptoms, such as heart failure.

Medications

People with mild myocarditis may only need rest and medication.

  • Corticosteroids. Certain rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis, may improve with corticosteroids or other medications to suppress your immune system.
  • Heart medications. If myocarditis is causing heart failure or arrhythmias, you may need to stay in the hospital. Your doctor will prescribe drugs or other treatments, depending on your signs and symptoms. For example, if you have certain abnormal heart rhythms or severe heart failure, you may be given medications to reduce the risk of blood clots forming in your heart.

    If your heart is weak, your doctor might prescribe blood pressure medications to reduce the strain on your heart or help your body remove excess fluid. These medications may include diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).

  • Medications to treat chronic conditions. If myocarditis is caused by a chronic illnesses, such as lupus, treatment is directed at the underlying disease.

Surgeries and procedures

If you have severe myocarditis, you will need aggressive treatment, which might include:

  • IV medications. Medications given through a vein are used to quickly improve your heart's ability to pump.
  • Ventricular assist devices (VAD). A VAD is a device that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. VADs are used in people who have weakened hearts or heart failure. This treatment may be used to allow your heart to recover or while you're waiting for other treatments, such as a heart transplant.
  • Intra-aortic balloon pump. The doctor inserts a thin tube (catheter) into a blood vessel in your leg and guides it to your heart using X-ray imaging. A balloon attached to the end of the catheter inflates and deflates in the main artery leading out to the body from the heart (aorta). An intra-aortic pump helps increase blood flow and decrease the strain on your heart.
  • Extracorporeal membrane oxygenation (ECMO). An ECHO machine mimics the function of the lungs. It removes carbon dioxide and adds oxygen to the blood. If you have severe heart failure, this device can provide oxygen to your body. During ECMO, blood is removed from the body, passed through the ECMO machine and then returned to the body.

    The ECMO machine takes over the work of your heart. This treatment may be used to allow the heart to recover or while waiting for other treatments, such as a heart transplant.

  • Heart transplant. If you have very severe myocarditis, your doctor might recommend urgent heart transplantation.

Some people with myocarditis might have chronic and irreversible damage to the heart muscle requiring lifelong medications, while other people need medications for just a few months and then recover completely. Either way, your doctor is likely to recommend regular follow-up appointments, including tests to evaluate your condition.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Rest and reducing the workload on your heart is an important part of recovery. Your doctor will likely tell you what type of physical activity you can do during the months your heart is healing and when you can resume normal activities.

If you have myocarditis, you should avoid competitive sports for at least 3 to 6 months.

If you have lingering heart damage, it's important to:

  • Limit salt
  • Restrict the amount of fluids you drink (your doctor will tell you what your fluid intake should be)
  • Avoid or drink only a minimum amount of alcohol
  • Avoid smoking.

Preparing for your appointment

You're likely to start by seeing your primary care doctor. If you have severe symptoms, you might see an emergency room doctor. You'll likely be referred to a doctor trained in heart conditions (cardiologist) and possibly a doctor trained in infectious disease.

What you can do

Here's some information to help you get ready for your appointment. Write down the following details:

  • Your symptoms, including any that might seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including recent illnesses and their symptoms, recent travel locations, and your and your family's medical history
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

For myocarditis, basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What are other possible causes?
  • What tests do I need?
  • How is myocarditis treated?
  • What side effects can I expect from treatment?
  • Are there alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage these conditions together?
  • Do I need to restrict my activities?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions. Take a family member or friend along to your appointment, if possible, to help you remember the information you'll receive.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • Have you recently been sick or have you recovered from another illness?
  • Have you traveled out of the country recently?
  • Does anything seem to improve your symptoms?
  • What, if anything, makes your symptoms worse?

Myocarditis care at Mayo Clinic

Aug. 06, 2021
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