What is myocarditis?


What is myocarditis?

Myocarditis is inflammation of the myocardium (middle muscular layer of the heart). Often it is due to viral infection, though it is not a common condition. Inflammation can be so mild as to be hardly noticeable or very severe (fulminant myocarditis) so that the pumping function of the heart is deranged and the individual requires mechanical support for blood circulation. In between there are cases of varying severity. Myocarditis can occur secondary to other major diseases like dengue virus infection or human immunodeficiency virus (HIV) infection.

What are the symptoms of myocarditis?

Mild forms of myocarditis may be asymptomatic and symptoms may be just due to an underlying disease like dengue. Viral myocarditis usually has preceding prodromal symptoms like a general feeling of being unwell, fever, fatigue or headache. Symptoms actually due to the involvement of the heart could be breathlessness, fatigue, giddiness, palpitation (undue awareness of one’s own heartbeat) or chest discomfort. In severe cases, features of heart failure like severe breathlessness, swelling of feet due to fluid collection beneath the skin (edema) or fall in blood pressure (hypotension) may occur. Such a situation needs treatment in an intensive care setting.


Symptoms of heart disease


What are the important symptoms of heart disease?

Symptoms depend on the type of heart disease. Sometimes there could even be silent heart disease without any symptoms. Many of the birth defects of the heart remain asymptomatic for long periods. Some become symptomatic during another illness or a major stressful event. Occasionally the very first manifestation of a silent underlying heart disease is sudden death. Apart from these two extremes, most significant heart diseases have some symptom or other though there may be a lot of variation between individuals. The severity of symptoms may not correlate with the severity of heart disease in some cases.

Important symptom of heart disease which every one is familiar with is the severe chest pain of a heart attack. As the name implies, it often occurs out of the blue and is quite disabling. A crushing feeling may be felt instead of chest pain, and it may spread to the arms or jaw. It may be associated with profuse sweating or sometimes breathlessness and dizziness. Some even feel an impending doom.

Classical symptom of reduced blood supply to the heart is chest pain brought on by exertion and relieved by rest (effort angina). This indicates gradually increasing blockage of coronary arteries which supply oxygenated blood to the heart. This pain may also spread to the jaw, neck or the arms. Occasionally pain may be felt in the upper part of the stomach. Rarely jaw pain or pain in the wrist occurs without chest pain.

Breathlessness brought on by exertion and relieved by rest is another important symptom of heart disease, though it can be due to lung disease or even reduced amount of hemoglobin in the blood (anemia). Sudden breathlessness during sleep and breathlessness which gets worse on lying down are also important symptoms of some forms of heart disease.

Palpitation or undue awareness of one’s heart beats is another important symptom of heart disease, though it may occur with anxiety and undue exertion as well. Palpitation can be fast, slow, regular or irregular, depending on the abnormality in the heart rhythm.

Some forms of heart disease, especially birth defects of the heart, produce a bluish discoloration of the skin and lips (cyanosis). This is due to reduced content of oxygen in circulating blood. Spitting out blood can also be a symptom of heart disease, though it is more often a symptom of lung disease.

Prolonged fever can occur with infections of the heart valve. Joint pain and swelling can occur in infections of the heart valves as well as in rheumatic fever, which can affect the heart valves.

Stroke or sudden weakness of one part of the body can be an indirect symptom of heart disease. Atrial fibrillation, an abnormal rhythm of the upper chambers of the heart, can cause clots to form in the heart. These clots can move out of the heart and block a blood vessel in the brain causing stroke. Similar clots can form in diseases of heart valves, where there is obstruction to blood flow.



What is palpitation?

Normally our heart is beating regularly at a rate between 60-100 per minute. But we are not aware of it. In certain circumstances, we become aware of our own heart beat. This is known as palpitation. Very often palpitation is just a manifestation of anxiety. When you are stressed or with exercise, the heart races and we become aware of our heart beating fast. Though most often palpitation is harmless, in some situations it could be a manifestation of a dangerous disease. For example, abnormal heart rhythms can cause palpitation. Very fast rhythms can be regular or irregular. Sometimes it may not be continuous palpitation, but feeling of an occasional flutter in the chest. This is due to transient irregularity in the heart rhythm, which is often of not much significance.

Serious forms of palpitation occurs in those with severe heart disease – either electrical or structural. Structural abnormalities of the heart which damage the heart muscle or heart valves can cause paliptation due to extra load which it gives the heart. Electrical disorders of the heart often produce either very fast rhythms or very slow rhythms, both of which can be life threatening if severe.

One of the simple tests to analyse the heart rhythm in case of palpitation is an ECG. Structural damage to the heart can be assessed by ultrasound imaging of the heart known as echocardiography. Both these tests are commonly done for evaluation of heart disease. Other more advanced tests are needed only in selected cases. If the palpitation is only occasional, it can be recorded by long term ECG monitoring known as Holter monitoring (typically 24-48 hours) or event monitoring (one week to three months). If still longer recording is needed, we have implantable loop recorders – small devices which can be implanted under the skin under local anaesthesia, which can record electrical abnormalities of the heart for up to 3 years. These devices have wireless options which can relay the signals to a device at home which in turn can transmit it to a central server by mobile networks. The central server could be even located in another continent!

Rhuematic heart disease

Rheumatic Heart Disease

What is rheumatic heart disease?
Rheumatic heart disease is heart disease secondary to one or more attacks of rheumatic fever. Rheumatic fever involves mainly the heart valves and produces long lasting damage. In the initial stages the valve becomes leaky (regurgitation). Later on the valve becomes distorted and thickened, narrowing the orifice (stenosis). The valves on the left side of the heart (mitral valve and aortic valve) are more frequently involved than that on the right side (tricuspid valve and pulmonary valve).

What are the symptoms of rheumatic heart disease?

Symptoms of rheumatic heart disease depends on the valves which are involved and the type of involvement (leak or obstruction). Leaky valves cause a volume overload on the related heart chambers leading to increased awareness of heartbeat (palpitation) and sometimes breathlessness. Obstruction to valves produces breathlessness and sometimes dizziness when sufficient amount of blood cannot be pumped out into the circulation. Both these symptoms are more likely to occur during exertion as the oxygen requirement of the body goes up and requirement for blood is more. In advanced cases, fluid may collect in the lungs, body cavities and under the skin. Fluid collection in the skin usually is more in the dependent regions (legs and ankles). Face may become puffy with severe heart failure.

Can heart rhythm be upset by rheumatic heart disease?

Enlargement of upper chambers of the heart (right atrium and left atrium) can upset the rhythm of the heart so that an irregular rhythm known as atrial fibrillation occurs. This can lead to a fast irregular rhythm and exacerbate heart failure. When there is atrial fibrillation, the upper chambers cannot contract effectively and blood pooling in them can produce clots. These clots can move to other parts of the body, causing obstruction to blood vessels (embolism). Obstruction of blood vessels of the brain can cause weakness of one or more limbs (stroke).

Can rheumatic heart disease be treated?

In early stages medications are useful to prevent the manifestations and complications of rheumatic heart disease. A severely damaged valve can be surgically replaced by an artificial valve (valve replacement). An obstructed valve can be opened even without surgery using balloons attached tubes known as balloon catheters, introduced through the skin into blood vessels. This procedure is known as balloon valvotomy or balloon valvuloplasty. This can be done under local anaesthesia in a special suite known as cardiac catheterization laboratory equipped with cine X-ray equipment.