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Inflammation of the Heart: Myocarditis, Pericarditis and Endocarditis

Heart inflammation, also known as carditis, is a condition that affects the heart muscle, which is the outer lining of the heart or the inner lining of the heart and its valves. 

Inflammation, in general, is a natural response your body’s immune system takes to fight against any infection or injury. It attempts to protect the body by ridding it of perceived foreign invaders. 

While it is usually a beneficial response, carditis can lead to serious complications if it prolongs for an extended period or occurs in healthy tissues. 

Here we explore the three types of heart inflammation: myocarditis, pericarditis and endocarditis. We will delve into their causes, symptoms, diagnosis and treatment while providing ways to reduce your risk. 

The structure of the heart

Your heart has three layers: the endocardium, the myocardium and the pericardium.

  • The endocardium is the innermost layer and is made up of endocardial cells. It is a layer of cells and connective tissues that coats the inner surfaces of the heart chambers and valves.
  • The myocardium is the middle layer or “muscle of the heart.” It is the thickest and most functional layer comprising myocardial or muscle cells. The myocardium does the main work: it relaxes to fill with blood and then squeezes to pump the blood to the body.
  • The outermost layer is called the epicardium, which is part of the pericardium (visceral layer). “The pericardium is a sac that surrounds the heart, protecting it from friction and easing its function,” said Beeletsega Yeneneh, MD, a cardiologist with Banner – University Medicine. “It is also where nerves and blood vessels supply and support the heart.”

The main difference between the three is the layer affected. “Endocarditis is inflammation of the innermost layer, myocarditis affects the middle layer, and pericarditis affects the outermost layer,” Dr. Yeneneh said.

Endocarditis

Endocarditis, sometimes called infective endocarditis, is most commonly caused by bacterial and fungal infections or other germs that spread through the body using the bloodstream. You may be at greater risk if you have damaged or artificial heart valves, congenital heart defects or a history of endocarditis.

Symptoms of endocarditis include the following:

  • Fever
  • Fatigue
  • Joint pain
  • Night sweats
  • Unexplained weight loss
  • Shortness of breath
  • Small red spots on the skin

Myocarditis

Myocarditis is often caused by viral infections, such as the common cold or flu and certain bacterial, fungal or parasitic infections. 

"You may be at greater risk for myocarditis if you have a weakened immune system, a recent viral illness or exposure to certain chemicals,” Dr. Yeneneh said.

Symptoms of myocarditis can vary, but they commonly include the following:

  • Fatigue
  • Chest pain
  • Shortness of breath
  • Rapid or irregular heartbeat
  • Swelling in the legs, ankles and feet

In severe cases, it can lead to heart failure or sudden cardiac arrest.

Pericarditis

Pericarditis is commonly caused by viral or bacterial infections but can also occur due to autoimmune disorders, heart attacks, cancer or radiation therapy. 

Symptoms of pericarditis may include the following:

  • Sharp chest pain that worsens with deep breathing or lying down
  • Fever
  • Cough
  • Fatigue
  • Shortness of breath

Some people may also experience heart palpitations (racing heart) or a sense of pressure in the chest.

How is carditis diagnosed? 

Because of their similarity in symptoms, it can sometimes be hard to diagnose each type of carditis. Your health care provider will usually perform a thorough medical history and physical exam and order additional tests to help diagnose.

Common tests ordered may include checking for inflammatory blood markers, blood cultures to check for infection and heart imaging tests such as EKG, transthoracic echocardiogram, transesophageal echocardiogram, cardiac CT or cardiac MRI.

“If there is pericarditis and fluid accumulation around the heart, a procedure called pericardiocentesis can be done to drain the fluid, and a sample can be sent for further laboratory analysis to help find out the cause of pericarditis,” Dr. Yeneneh noted. 

In some instances, more advanced procedures such as endomyocardial biopsy may be needed, where small pieces of the heart are taken to look for myocarditis and determine the cause of the inflammation.

How is inflammation of the heart treated?

Treatment of carditis is usually geared towards minimizing injury or damage to the heart from the inflammation and treating the cause that led to it. 

“Endocarditis is usually caused by microbial infections so treatments may include anti-microbial medicines like antibiotics, antiviral or antifungal medications,” Dr. Yeneneh said. “In rare cases of endocarditis related to autoimmune diseases, you may need blood thinners and immunomodulators, medicines that change your immune system, so it works more effectively.”

Myocarditis is usually treated with the help of immunomodulators to control the body’s immune and inflammatory response.

The treatment of pericarditis involves anti-inflammatory medications to help reduce inflammation and relieve pain. 

“First-line medications for pericarditis that are usually used are a combination of colchicine and aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen,” Dr. Yeneneh said. “In cases of recurrent pericarditis, steroids can be used.”

What is the outlook for those with heart inflammation?

The outlook for heart inflammation depends on the specific condition, its severity and how quickly it is diagnosed and treated. With timely treatment, many cases can be successfully managed, and the heart can fully recover.

However, the outlook may be more challenging in severe cases or when complications occur. In some cases, inflammation may be ongoing and may lead to chronic changes, which is most common in pericarditis.

“Some people may have chronic recurrent pericarditis that may lead to significant thickening and constriction of the pericardium,” Dr. Yeneneh said. “This can put a lot of strain on relaxation and filling of the heart.”

Overall, it’s very important to follow up with your provider regularly to check for any ongoing heart inflammation.

Ways you can reduce your risk for heart inflammation

To prevent heart inflammation, it is essential to maintain good overall health. Some general recommendations include:

  • Follow a healthy lifestyle, including regular exercise, a balanced diet, adequate sleep and stress management techniques.
  • Avoid risky behaviors, such as illicit drug use and unprotected sexual activity, which can increase your risk of certain infections.
  • Drink alcohol in moderation.
  • Take good care of your teeth and skin to prevent infections that may spread to the heart.
  • Practice good hygiene, such as washing hands regularly and avoiding close contact with people who are sick.
  • Manage chronic conditions, such as diabetes, high blood pressure or autoimmune disorders, as your provider advises.
  • , such as the flu shot.
  • Seek medical attention for respiratory infections or other illnesses that could potentially lead to heart inflammation. 

Takeaway

Heart inflammation, or carditis, encompassing conditions like myocarditis, pericarditis and endocarditis, can be a serious concern. Recognizing the symptoms, seeking medical attention and receiving timely treatment is crucial for a positive outcome.

Adopting preventive measures and leading a healthy lifestyle can help reduce your risk of heart inflammation and promote overall cardiovascular well-being. 

Remember to contact your health care provider with any concerns or questions regarding heart health or other medical conditions. To find a Banner Health specialist near you, visit bannerhealth.com.

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