Myocarditis: inflammation of the heart muscle after infection - diagnosis and treatment in Tashkent

Where does inflammation of the heart muscle come from?

In the vast majority of cases, the cause is viruses - the same ones that cause common respiratory and intestinal infections. The virus enters the heart muscle, and further damage develops in two ways: some of the cells suffer directly, and some suffer from their own immune response, which has already destroyed the pathogen, but continues to attack the tissue. Therefore, a characteristic feature of myocarditis is delay: cardiac symptoms do not appear at the height of the infection, but after one to three weeks, when the person already considers himself recovered.

• Respiratory and intestinal viral infections are the most common cause
• Bacterial infections, including severe sore throat and its complications
• Autoimmune diseases: systemic lupus erythematosus, sarcoidosis, vasculitis
• Reactions to certain drugs and vaccines are rare but have been described
• Toxic effects of alcohol, cocaine and other psychoactive substances
• Selected anticancer drugs and radiation therapy to the chest area
• In some cases, the cause cannot be determined, and this does not interfere with treatment

It is important to understand that not everyone who has contracted the virus gets sick, otherwise everyone would have myocarditis every winter. A combination of factors is important: the type of pathogen, the characteristics of the immune response and, what is most often missed, the load in the acute period. Physical work and training during infection increases muscle damage, and this is the only factor listed that a person can influence himself.

How to recognize: symptoms that are attributed to weakness after illness

The diagnostic difficulty of myocarditis is that it does not have a single unique symptom. Everything a person feels can easily be explained by a recent infection: weakness, shortness of breath, palpitations, aches. That is why it is not a separate complaint that is of decisive importance, but its connection with the recent virus and its dynamics - normally, after an infection, the state of health improves day by day, but with myocarditis it stops or begins to worsen.

• Shortness of breath during exertion that was previously easy: climbing stairs, walking uphill, ordinary cleaning
• Pain or heaviness in the chest - pressing, sometimes sharp, not always associated with movement
• Palpable palpitations, irregular heartbeats, pounding or sinking sensations in the chest
• Severe fatigue, disproportionate to the workload, lasting longer than two weeks after infection
• Increased resting heart rate that does not decrease with rest
• Swelling of the feet and legs in the evening, heaviness in the right hypochondrium
• Dizziness, lightheadedness, especially when standing up and exercising
• Some patients have only low-grade fever and general malaise without cardiac complaints

For young children the picture is completely different and easy to miss. The child becomes lethargic, refuses to eat, sweats during feeding, breathes quickly and shallowly, and the skin looks pale or grayish. There are no complaints of chest pain at this age, so they focus on behavior: unusual drowsiness and shortness of breath after an infection in a child is a reason to show him to the doctor on the same day, and not observe him at home.

Why you can’t return to training immediately after the virus

This is the most practically important section of the material. The inflamed heart muscle becomes electrically unstable: areas appear in it that can trigger dangerous rhythm disturbances. As long as the person is at rest, the risk is low. But physical activity sharply increases the heart's need for oxygen and the release of adrenaline - and it is at this moment that the unstable myocardium can break into ventricular fibrillation. This is how the vast majority of cases of sudden death of young athletes due to myocarditis occur: not in bed, but on the field, at a distance or in the gym.

• During any infection with fever, training stops completely and does not decrease in intensity
• The rule “above the neck - below the neck”: with a slight runny nose without fever, light activity is acceptable, with fever, aches, cough and weakness - no
• Return to exercise begins no earlier than a few days after complete normalization of temperature and well-being, and always gradually
• If you had chest pain, palpitations or shortness of breath during the infection, you need an examination before returning to sports, not an independent decision
• With confirmed myocarditis, loads are excluded for a period determined by the cardiologist, and it is measured in months, not days
• Competitions, intense interval training and lifting heavy weights are the last to return.
• Any chest pain, fainting, or unusual shortness of breath during exercise - stop immediately and get checked out

A separate and very common mistake is taking anti-inflammatory and antipyretic drugs to “bring down the temperature and go to training.” This tactic masks the symptoms, but does not eliminate the inflammation, and the person puts stress on the heart at the most vulnerable moment, without feeling the warning signals. The same applies to heavy physical work: the rule applies not only to athletes, but to everyone whose work involves heavy loads.

Examination: what troponin, ECG, EchoCG and MRI show

The diagnosis is made from a combination of complaints related to recent infection and examination data. No single method provides the answer alone: ​​ECG can be nonspecific, echocardiography at an early stage is normal, and troponin does not increase in everyone. Therefore, the survey is built sequentially, from the most accessible to the most accurate.

1. ЭКГ — первый шаг при любой боли в груди. Изменения при миокардите разнообразны и неспецифичны: нарушения реполяризации, экстрасистолы, блокады, синусовая тахикардия. Нормальная ЭКГ диагноз не исключает.
2. Тропонин — маркер повреждения сердечной мышцы. Его повышение говорит о том, что клетки миокарда пострадали, но не объясняет причину: тот же результат бывает при инфаркте, поэтому трактует его врач.
3. Общий анализ крови, СРБ и СОЭ — показатели воспалительной активности, полезные для оценки динамики.
4. ЭхоКГ — оценивает сократимость сердца, размеры камер, состояние клапанов и наличие жидкости в полости перикарда. Снижение фракции выброса — важный признак, определяющий тактику.
5. МРТ сердца — метод, наиболее точно подтверждающий воспаление: он показывает отёк миокарда и участки повреждения, невидимые другими способами. Именно МРТ во многих случаях позволяет отличить миокардит от инфаркта.
6. Суточное мониторирование ритма — выявляет нарушения, не попавшие на короткую запись ЭКГ, и используется при решении вопроса о возвращении к нагрузкам.
7. Коронарография при типичной картине боли у пациентов среднего и старшего возраста — чтобы исключить инфаркт, поскольку клинически эти состояния бывают неразличимы.

The distinction with a heart attack deserves special mention, because it determines all further tactics. A young person with chest pain, elevated troponin, and a recent viral infection is more likely to have myocarditis rather than a heart attack. But their clinical picture and laboratory parameters overlap so much that the decision is made only by a doctor and often after additional research. Making a diagnosis yourself based on the coincidence of symptoms with descriptions on the Internet is especially dangerous here.

Treatment: the main drug is rest.

In most cases, there is no specific medicine that kills the virus in the heart muscle, and treatment is structured differently. The goal is to remove the load from the inflamed myocardium, support its work and prevent complications while natural recovery is underway. That is why limiting physical activity is not a recommendation from the general list, but the main part of therapy.

• Limiting physical activity for the entire acute period and for several months after it - according to the decision of the cardiologist
• Drugs for the treatment of heart failure with decreased contractility: they reduce the load on the heart and improve long-term prognosis
• Diuretics for fluid retention and edema, with electrolyte control
• Antiarrhythmic therapy for significant rhythm disturbances
• Treatment of the underlying disease in the autoimmune nature of myocarditis - immunosuppressive therapy according to indications
• Hospitalization for severe cases: decreased ejection fraction, dangerous arrhythmias, signs of heart failure
• Avoiding alcohol and smoking for the entire recovery period, limiting salt for edema

Non-steroidal anti-inflammatory drugs require a separate discussion. In case of pericarditis, they form the basis of treatment, and in case of myocarditis with signs of heart failure, their use is limited: they can retain fluid and worsen the course. That is why the usual logic “if my chest hurts, I’ll take a painkiller” does not work here, and any drugs are prescribed after it is determined what exactly is inflamed - the heart muscle or the membrane surrounding it.

Prognosis and what to do after recovery

The outcome of myocarditis varies widely, and this is its second feature. In most patients, especially with a mild course and timely limitation of exercise, complete restoration of cardiac function occurs within several months. In some cases, a residual decrease in contractility remains, requiring constant monitoring and therapy. In a small proportion, the disease progresses to dilated cardiomyopathy, a condition in which the heart remains stretched and weakened. The difference between these scenarios is largely determined by how early the diagnosis is made and how strictly the regimen is followed.

1. Контрольная ЭхоКГ через несколько месяцев после острого периода — оценка того, восстановилась ли сократимость.
2. Повторное суточное мониторирование ритма перед возвращением к спорту и физической работе.
3. Постепенное расширение нагрузок под контролем самочувствия: сначала ходьба, затем лёгкая аэробная активность, и только потом силовые и интенсивные тренировки.
4. Продолжение назначенной терапии до решения врача о её отмене — даже при полном отсутствии жалоб.
5. Ежегодная вакцинация против гриппа и обсуждение с врачом других прививок: каждая новая тяжёлая инфекция — потенциальный фактор риска повторного эпизода.
6. Немедленное обращение при возобновлении одышки, перебоев или боли в груди — рецидивы возможны, и они требуют повторной оценки.

It’s worth being honest about recovery: it often takes longer than a person expects, and fatigue can persist for weeks after tests have returned to normal. This is not a sign of treatment failure, but the normal course of the process. A gradual, measured return to activity works better here than trying to suddenly “get into shape,” and the most reliable guide is not the calendar, but the results of a control examination.