Achey Brakey Heart

 Achey Brakey Heart

By Peter Galvin, MD

Acute myocarditis is inflammation of the heart muscle, also known as the myocardium. It may cause chest pain, shortness of breath, heart pounding (palpitations), and, rarely, fainting. Patients commonly report flu-like symptoms (such as fever, fatigue, cough, nausea, vomiting, or abdominal pain) before the onset of acute myocarditis. That is because the most common cause of acute myocarditis is a viral infection (such as coronaviruses, influenza, and parvovirus B19). Acute myocarditis has been in the medical literature more frequently of late because it has been shown to be a not-uncommon side effect of the mRNA vaccines for Covid-19, especially in younger people. You may have noticed, however, a conspicuous absence of any mention of a link between acute myocarditis and the Covid vaccines in the public media because most media outlets unfortunately have an agenda these days, and anything that questions the value of these vaccines doesn’t fit their agenda.

Acute myocarditis can also be caused by autoimmune diseases (such as lupus), certain drugs (such as immune system modulators used to treat certain types of cancer), and some vaccines (such as the aforementioned mRNA Covid-19 vaccine and smallpox vaccine). It should be noted that the risk of acute myocarditis is higher from a Covid-19 infection itself than it is from the mRNA vaccines, plus the risk of it from Covid infection is reduced by vaccination. Acute myocarditis affects four to 14 per 100,000 individuals and is more common in males than females. It usually occurs between the ages of 30 to 45 years, although children, teens, and older individuals can be affected. In most people, it does not cause serious health issues, however about 25% of patients have decreased cardiac strength, rhythm disturbances, or acute heart failure. Between 3% and 9% develop cardiogenic shock, a life-threatening condition in which the heart is unable to adequately pump blood to the vital organs, and about 1% to 7% of patients will die from it.

Those with acute myocarditis will have elevated levels of troponin, a protein normally found only in heart muscle, plus elevated levels of blood markers of inflammation (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]). The EKG may show abnormal electrical heart activity, and echocardiography may show decreased heart function. The diagnosis may be confirmed either by cardiac MRI or heart muscle biopsy. Treatment depends on the cause and severity. If it is due to autoimmune disease, treatment typically consists of steroids (i.e., prednisone) and other immunosuppressants. If it is deemed to be caused by a medication, then obviously that medication should be stopped. Chest pain can be treated with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. Heart rhythm disturbances may require external electrical shock (cardioversion or defibrillation) and/or a pacemaker plus anti-arrhythmic medication. Rarely, external cardiac support devices (such as intra-aortic balloon pump or extra-corporeal membrane oxygenation) are required, and even more rarely, heart transplant may be required.

Following an episode of acute myocarditis, it is usually recommended to avoid intense physical activity for three to six months, and follow-up cardiac testing is usually recommended before resumption of normal activities.

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