Fight with myocarditis

There is no cure for myocarditis, although the heart muscle inflammation usually goes away on its own in time.

The goal of treatment is to support heart function and treat the underlying cause of the myocarditis. Most children with this condition are admitted to a hospital. Activity can strain the heart and therefore is often limited.

Treatment may include:

• Antibiotics to fight infection
• Anti-inflammatory medicines called steroids to control inflammation
• Intravenous immunoglobulin (IVIG), a medicine made of substances that the body produces to fight infection, to control the inflammatory process
• Medicines called diuretics to remove excess water from the body
• Medicines to treat heart failure and abnormal heart rhythms

Approximately 50% of the time, myocarditis is classified as idiopathic, although the aforementioned report by Klugman et al found that 82% of the pediatric cases studied were considered idiopathic.The investigators also determined that 3% of cases in the study had a known bacterial or viral etiology, and that 6% of cases were related to other diseases.

In idiopathic cases, a viral etiology is often suspected but unproved, even with sophisticated immunohistochemical and genomic studies. Studies on patients with idiopathic dilated cardiomyopathy found evidence of viral particles in endomyocardial biopsy specimens in up to two thirds of the patients. 

• Viral - Enterovirus coxsackie B, adenovirus, influenza, cytomegalovirus, poliomyelitis, Epstein-Barr virus, HIV-1, viral hepatitis, mumps, rubeola, varicella, variola/vaccinia, arbovirus, respiratory syncytial virus, herpes simplex virus, yellow fever virus, rabies, parvovirus
• Rickettsial - Scrub typhus, Rocky Mountain spotted fever, Q fever
• Bacterial - Diphtheria, tuberculosis, streptococci, meningococci, brucellosis, clostridia, staphylococci, melioidosis, Mycoplasma pneumoniae, psittacosis
• Spirochetal - Syphilis, leptospirosis/Weil disease, relapsing fever/Borrelia, Lyme disease
• Fungal - Candidiasis, aspergillosis, cryptococcosis, histoplasmosis, actinomycosis, blastomycosis, coccidioidomycosis, mucormycosis
• Protozoal - Chagas disease, toxoplasmosis, trypanosomiasis, malaria, leishmaniasis, balantidiasis, sarcosporidiosis
• Helminthic - Trichinosis, echinococcosis, schistosomiasis, heterophyiasis, cysticercosis, visceral larva migrans, filariasis
• Bites/stings - Scorpion venom, snake venom, black widow spider venom, wasp venom, tick paralysis
• Drugs (usually causing hypersensitivity myocarditis)
  • Chemotherapeutic drugs - Doxorubicin and anthracyclines, streptomycin, cyclophosphamide, interleukin-2, anti-HER-2 receptor antibody/Herceptin
  • Antibiotics - Penicillin, chloramphenicol, sulfonamides
  • Antihypertensive drugs - Methyldopa, spironolactone
  • Antiseizure drugs - Phenytoin, carbamazepine
  • Amphetamines, cocaine, catecholamines
• Chemicals - Hydrocarbons, carbon monoxide, arsenic, lead, phosphorus, mercury, cobalt
• Physical agents (radiation, heatstroke, hypothermia)
• Acute rheumatic fever
• Systemic inflammatory disease - Giant cell myocarditis, sarcoidosis, Kawasaki disease, Crohn disease, systemic lupus erythematosus, ulcerative colitis, Wegener granulomatosis, thyrotoxicosis, scleroderma, rheumatoid arthritis
• Peripartum cardiomyopathy
• Posttransplant cellular rejection