Myocarditis

Definition/Overview

Myocarditis, inflammation of the heart muscle (myocardium), impairs the heart’s blood-pumping ability, causing chest pain, shortness of breath, and arrhythmias. Often resulting from viral infections, drug reactions, or inflammatory conditions, myocarditis can weaken the heart, disrupt blood flow, and increase the risk of strokes and heart attacks. It’s a significant health issue, particularly affecting healthy young adults and is a leading cause of sudden death in this demographic, representing 5 to 20 percent of all cases. Recovery varies, potentially lasting months, especially with permanent heart damage. Complications include heart failure, attacks, stroke, and severe arrhythmias, due to reduced blood supply and clot formation. Treatments depend on severity and causes, ranging from medications to surgeries.

Globally, myocarditis incidents are around 1.8 million annually, with a 62.19% increase in cases from 780,410 in 1990 to 1,265,770 in 2019. Moreover, related deaths rose from 19,618 to 324,490 over the same period. More recently, according to research published by the American Heart Association, “SARS-CoV-2 increased the incidence of myocarditis/pericarditis at least 15× over pre-COVID levels”. Additionally, children with COVID-19 had an almost 40 times higher risk of developing myocarditis.

Causes/Risk Factors

• Viruses: Adenovirus (common cold), COVID-19, hepatitis B and C, parvovirus (fifth disease), herpes simplex virus, Echoviruses (gastrointestinal infections), Epstein-Barr virus (mononucleosis), rubella (German measles), and HIV (AIDS).
• Bacteria: Staphylococcus, streptococcus, diphtheria-causing bacteria, Lyme disease bacteria.
• Parasites: Trypanosoma cruzi (causes Chagas disease, more common in Central and South America), toxoplasma.
• Fungi: Yeast infections (candida), molds (aspergillus), histoplasma (found in bird droppings), particularly in people with weakened immune systems.
• Medications or Illegal Drugs: Cancer treatment drugs, antibiotics (penicillin, sulfonamide drugs), anti-seizure medications, cocaine (drug-induced myocarditis).
• Chemicals or Radiation: Exposure to carbon monoxide, radiation causing heart muscle inflammation.
• Other Inflammatory Diseases: Lupus, Wegener’s granulomatosis, giant cell arteritis, Takayasu’s arteritis
• No Clear Cause: In 50-80% of Myocarditis cases, there is no clear cause.

Signs and Symptoms

• Asymptomatic Presentation: It is important to note that many people with myocarditis do not experience notable symptoms.
• Respiratory Symptoms: Shortness of breath during exercise or exertion, difficulty breathing or rapid breathing, shortness of breath at night
• Fatigue and weakness
• Heart palpitations (abnormal heart rhythms)
• Chest pains or pressure
• Swelling in the legs and arms due to fluid retention (peripheral edema), often most severe in the ankles and feet
• Lightheadedness or feeling like you might faint
• Flu-like symptoms such as headaches, body aches, joint pain, fever or sore throat
• Diarrhea
• Sudden loss of consciousness
• Increased risk for heart failure, blood clots, stroke, or heart attack

Diet and Lifestyle Considerations for Myocarditis

• Stress Reduction
• Anti-Inflammatory Diet
• Herbs and Supplements
• Avoid Risky Drugs or Medications
• Exercise with Caution
• Protect Against Viruses and Infections

Integrative Treatments Overview

In managing myocarditis, a multi-faceted approach is key, encompassing various aspects of health and lifestyle. Nutritional strategies play a critical role, advocating for a diet rich in whole foods, antioxidants, fiber, and probiotics, coupled with adequate hydration to support heart health. Environmental strategies also contribute significantly, emphasizing the importance of stress management, maintaining a healthy living environment, preventing and remediating water damaged buildings, and ensuring good air quality. Supplemental support, including the use of omega-3 fatty acids and antioxidants like vitamins C and E, complements these efforts, although consultation with healthcare professionals is advised. Furthermore, lifestyle modifications such as regular, moderate exercise, prioritizing quality sleep, and minimizing caffeine and alcohol intake are essential. This comprehensive approach aims to holistically support the management of myocarditis, enhancing heart health and overall well-being.

Nutritional & Environmental Medicine Overview

Consider approaching the treatment of Myocarditis in a way that combines nutritional, supplemental and herbal, environmental and lifestyle modifications and conventional treatments when needed.

It is recommended that a patient consult a certified practitioner to assess their symptoms and case history and explore their individual needs.

Nutritional Approaches

• Anti-Inflammatory Diet: integrate fresh vegetables, fruits, nuts, olive oil, fish, dark chocolate, beans, legumes, herbs, and green tea into your diet to help strengthen your immune system and fight inflammation
• Limit salt intake, avoid processed foods
• Manage potassium levels as per medical advice
• Reduce caffeine and alcohol intake

Supplemental and Herbal Support

• Supplements: Preventing nutrient deficiencies is key to managing Myocarditis. Consider supplementing with antioxidants, omega-3 fatty acids, coenzyme Q10, and vitamin D.
• Herbs: Astragalus Root, Hawthorn Berry, Green Tea, Reishi Mushrooms

Environmental and Lifestyle Modifications

• Protect Against Viruses and Infections: Treat bacterial infections early. Avoid contact with infected individuals. Practice safe sex and good hygiene. Avoid sharing needles. Prevent tick bites.  Prevent mold by preventing and remediating water damage and promoting good air flow and sun exposure.
• Exercise with Caution: Clear exercise with a doctor if you have a heart condition. Focus on light activities like walking, swimming, cycling, stretching.
• Avoid Risky Drugs or Medications: Take caution with new supplements and over-the-counter medications. Stop using tobacco and nicotine.Stress Reduction: In order to reduce Autoimmune flare-ups, consider implementing stress-relieving techniques like exercise, meditation, and yoga. Getting enough quality sleep is also vital.
• Precautions: Seek immediate medical attention for symptoms of myocarditis (shortness of breath, edema, chest pains). Be vigilant post-surgery, post-infection, or during autoimmune flare-ups.

Conventional Treatments

• Diuretics, to help control edema/fluid retention
• Digoxin, which helps to prevent heart failure. Digoxin helps to improve contractions of the heart muscle and to slow heartbeats, which might help control palpitations.
• Milrinone and ACE inhibitors, which help to regulate heart rhythms.
• Aldosterone agonists, which can help to prevent scarring of the heart and remove excess fluid.
• Corticosteroids to manage inflammation of the heart and prevent further damage.
• Antibiotics if an infection is the underlying cause.
• Use of oxygen to help ensure enough circulates through the body.
• If abnormal heart rhythms that require intervention are detected, then they might need to take certain medications and use a pacemaker. Arrhythmias will usually resolve once inflammation levels decrease.