Let's talk about a case of Myocarditis

These last few days I have shared diverse content, related in some way to medicine, and not only that, but to genetics, and to some particularities that could be considered superhuman. But today I want to share specific information about a case I recently saw with a cardiology specialist.

I only saw something strange in the electrocardiogram, but I had no idea what it was exactly, however, I knew it was something dangerous because the patient referred a pain in the chest, but no doubt there were no signs suggestive of acute myocardial infarction, but this organ was affected.

After investigating the symptoms a little more, the patient definitely had to be evaluated by a specialist, which was the best thing to do, since only a cardiologist could diagnose the patient, which was a Myocarditis. Had you read that word before, if not I invite you to continue reading, what I have to tell you will surely interest you.

Pixabay/ Author: gfkDSGN

The heart is the organ in charge of pumping oxygenated blood throughout the body, it is a vital, contractile organ that works permanently. Its structure is quite complex, with a set of valves that allow the passage of blood in only one direction, there are also small blood vessels that irrigate it, in addition to specialized cells that produce an electrical impulse that makes it contract.

It is divided into four chambers, two atria and two ventricles. It is located in the center of the chest, between the two lungs, to which it is connected by blood vessels Source. And it is composed of different types of tissues, such as:

  • Myocardium: is the muscular tissue of the heart and is responsible for the contraction and relaxation of the heart.

  • Endocardium: is the inner layer of the heart that lines the heart chambers and heart valves.

  • Pericardium: the outer layer of the heart that protects the heart and helps hold it in place within the chest.

  • Epicardium: is the outermost layer of the myocardium and is in contact with the pericardium.

  • Connective tissue: is the tissue that surrounds and connects the other tissues of the heart and helps maintain its shape and structure.

  • Nervous: the sympathetic and parasympathetic nervous systems innervate the heart and regulate its activity.

  • Vascular: the heart has a network of arteries and veins that carry blood to and from the heart.

The disease I want to talk about today affects precisely the myocardium, which alone occupies most of the heart's mass.

Pixabay/ Author: GDJ

Myocarditis is an inflammation of the heart muscle (myocardium) that can be caused by a variety of factors. As I mentioned earlier, the function of the heart is to contract to pump blood to the rest of the body 24 hours a day. If this muscle tissue is inflamed, that function is simply compromised.

To make it more visible and easier to understand, it is likely that most have experienced lower back pain due to inflammation of these muscles, or pain at the level of the calf (calf muscles), which are then unable to do virtually any activity, and simply go to rest.

That is the same thing that happens with the cardiac muscle, which becomes inflamed and painful, and it becomes very difficult to fulfill its function, however, it cannot stop working, just as we do. Therefore, it is something to be very careful about, and it must be attended to quickly, as almost everything that affects the heart.

There are many causes that can produce a myocarditis, to determine it is usually a bit complicated, even diagnose it usually has its difficulties, so it is best that a specialist who has what it takes to treat a patient is the one who intervenes.

Pixabay/ Author: Myriams-Fotos

The causes of myocarditis I will mention below, emphasizing that most of the time it is an infection:

  • Viral infections: many different viruses, such as coxsackie, adenovirus, parotitis (mumps) virus and measles virus, can cause it.

  • Autoimmune diseases: diseases such as systemic lupus erythematosus (SLE), central nervous system (CNS) disease and peripheral nervous system (PNS) disease can cause myocarditis.

  • Allergic: some medications, such as beta-blockers and non-steroidal anti-inflammatory drugs (NSAIDs), can cause allergic myocarditis.

  • Toxic: excessive alcohol consumption, illicit drug use and exposure to certain toxins can cause myocarditis.

  • Other: other causes include idiopathic myocarditis (no known cause) and myocarditis related to other heart diseases such as coronary artery disease.

Pixabay/ Author: Pexels

The symptomatology is why the emphasis should be on finding out, investigating well, and usually presents with the following:

  • Chest pain: may be felt as a tightness, burning or sharp pain in the chest, often extending to the arms, neck, shoulder and jaw. *Often mistaken for an acute myocardial infarction.

  • Fatigue: extreme tiredness and weakness may be felt. Because the heart is not pumping enough oxygenated blood, which is necessary for energy production.

  • Dyspnea: you may feel short of breath, especially during light exercise, including walking.

  • Palpitations: you may feel irregular or rapid heartbeat.

  • Swelling of the legs, feet or abdomen.

  • Fever: fever may be present in case of infection.

  • Syncope: there may be fainting due to arrhythmias.

  • Pain in the shoulder and neck: there may be pain in these areas due to inflammation of the heart muscle.

I would like to point out that, even if it seems strange, there are people who could have myocarditis and not have any symptoms, especially if it is mild.

Pixabay/ Author: stux

In this particular case, the patient in question reported oppressive pain in the chest, shoulder and neck, which merited an emergency electrocardiogram, in addition to fatigue. Of the multiple tests that can be done, the one that verified the diagnosis was the echocardiogram performed by the specialist, which showed a thickening of the cardiac walls.

As for the probable cause, an autoimmune disease is suspected, due to the fact that she does not refer any type of recent infection, and considering some direct hereditary factors, such as the death of the mother due to Systemic Lupus Erythematosus. The treatment and diagnosis is left to the specialist. But a biopsy will be performed to determine if the cause is autoimmune.

There is always a lot to learn when you are in clinical practice, you never leave a university knowing everything, and it is along the way with experience that knowledge is strengthened and deepened.

I hope this post has been useful for everyone, and I would appreciate that if you have something to add you can leave it in the comments so we can all benefit from it.

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