Early diagnosis is key 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 might include:
- Electrocardiogram (ECG). This noninvasive test shows your heart's electrical patterns and can detect abnormal rhythms.
- 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 indicate heart failure.
- MRI. Cardiac MRI will show 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 might detect enlargement of your heart, poor pumping function, valve problems, a clot within the heart or fluid around your heart.
- Blood tests. These measure white and red blood cell counts, as well as levels of certain enzymes that indicate damage to your heart muscle. Blood tests can also detect antibodies against viruses and other organisms that might indicate a myocarditis-related infection.
- Cardiac catheterization and endomyocardial 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.
In many cases, 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.
In mild cases, persons should avoid competitive sports for at least three to six months. Rest and medication to help your body fight off the infection causing myocarditis might be all you need. Although antiviral medications are available, they haven't proved effective in the treatment of most cases of myocarditis.
Certain rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis, respond to corticosteroids or other medications to suppress your immune system. In some cases caused by chronic illnesses, such as lupus, treatment is directed at the underlying disease.
Drugs to help your heart
If myocarditis is causing heart failure or arrhythmias, your doctor might hospitalize you and prescribe drugs or other treatments. For 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 medications to reduce your heart's workload or help you eliminate excess fluid, including:
- Angiotensin-converting enzyme (ACE) inhibitors. These medications, such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil) and ramipril (Altace), relax the blood vessels in your heart and help blood flow more easily.
- Angiotensin II receptor blockers (ARBs). These medications, such as losartan (Cozaar) and valsartan (Diovan), relax the blood vessels in your heart and help blood flow more easily.
- Beta blockers. Beta blockers, such as metoprolol (Lopressor, Toprol-XL), bisoprolol and carvedilol (Coreg), work in multiple ways to treat heart failure and help control arrhythmias.
- Diuretics. These medications, such as furosemide (Lasix), relieve sodium and fluid retention.
Treating severe cases
In some severe cases of myocarditis, aggressive treatment might include:
- Intravenous (IV) medications. These might improve the heart-pumping function more quickly.
- Ventricular assist devices. Ventricular assist devices (VADs) are mechanical pumps that help 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 the heart to recover or while waiting for other treatments, such as a heart transplant.
- Intra-aortic balloon pump. Doctors insert a thin tube (catheter) in a blood vessel in your leg and guide it to your heart using X-ray imaging. Doctors place a balloon attached to the end of the catheter in the main artery leading out to the body from the heart (aorta). As the balloon inflates and deflates, it helps to increase blood flow and decrease the workload on the heart.
- Extracorporeal membrane oxygenation (ECMO). With severe heart failure, this device can provide oxygen to the body. When blood is removed from the body, it passes through a special membrane in the ECMO machine that removes carbon dioxide and adds oxygen to the blood. The newly oxygenated blood is then returned to the body.
The ECMO machine takes over the work of the heart. This treatment may be used to allow the heart to recover or while waiting for other treatments, such as a heart transplant.
In the most severe cases, doctors might consider urgent heart transplantation.
Some people 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.
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 lingering heart damage, it's important to keep salt to a minimum, restrict the amount of fluids you drink, drink a minimum amount of alcohol, if any, and avoid smoking. Your doctor will let you know what your fluid intake should be, as well as the amount of salt that's OK for you to include in your diet.
Preparing for your appointment
You're likely to start by seeing your primary care doctor, or in the case of severe symptoms, an emergency room doctor. You might then be referred to a doctor trained in heart conditions (cardiologist) and possibly a doctor trained in infectious disease.
Here's some information to help you get ready for your appointment.
What you can do
Make a list of:
- 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
Take a family member or friend along, if possible, to help you remember the information you'll receive.
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.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- Have you recently gotten over another illness?
- Have you traveled out of the country recently?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?