Understand what myocarditis is and why heart disease happens

Understand what myocarditis is and why heart disease happens

Heart diseases are among the leading causes of death in the world, according to the WHO (World Health Organization). Taking care of the heart and keeping routine exams up to date are essential attitudes for all people.

Cardiovascular diseases can increase by 30% in colder periods during the year, mainly in temperatures below 14°C. People aged between 75 and 84 are those who have the most heart complications and are considered vulnerable.

Strokes (stroke) also occur 20% more often in winter, and there is a 5% increase in cases of aortic dissection – deterioration of the wall of the artery that branches off the heart and ends up rupturing or dislocating.

According to SIH/SUS (Hospital Information System of the Unified Health System) there was a 36.8% increase in the total number of hospitalized patients in the year 2021 during the months of June to September.

Among the problems is myocarditis, a disease most common in children, pregnant women and patients with compromised immune systems.

Myocarditis is characterized by inflammation of the heart muscle, known as the myocardium, which is responsible for pumping oxygenated blood throughout the body.

Causes

The disease can be caused by a number of aggressive factors, but the most common are viral infections.

For the cardiologist and professor of Cardiovascular Surgery at Unifesp (Federal University of São Paulo), Diego Gaia, everyone is subject to having myocarditis: “It can be caused by a series of viruses, by [quimioterápicos, são alguns exemplos] and by rheumatological and immunological diseases, such as lupus.”

Gaia also explains the action of the virus in the heart. “The virus triggers an immune reaction in the heart, inflaming its cells responsible for muscle contraction or its electrical system. The affected heart can have its strength reduced with impaired blood pumping. Arrhythmias can also occur and are often serious.”

He clarifies that the process of decreased pumping can additionally compromise blood flow to other organs causing kidney and liver failure.

Some viruses are identified as possible causes, including:

• Coxsackie B
SARS-CoV-2

• HIV
• Influenza
• Human herpes 6
• Parvovirus

In the United States and other developed countries, myocarditis is most closely linked to parvovirus B19 and the human herpes virus. In developing countries, such as Brazil, the disease is more often associated with rheumatic myocarditis, Chagas disease or AIDS, as described in the MSD Manual. Excessive consumption of alcohol also triggers the disease.

Symptoms

Patients can present from no symptoms to the most serious consequences, depending on the evolution and situation of the condition.

The signs are variable and the most common are: acute failure, irregular development of the heart pumping blood to the other organs, chest pain, tiredness, fever, shortness of breath, arrhythmias and palpitations, headache, swelling in the legs and death. sudden.

Myocarditis can be acute, subacute, or chronic, according to the MDS Manual.

• Acute – lasting only a few days;
• Subacute – with extends to weeks or months;
• Chronic – when the treatment does not resolve.

Diagnosis

The diagnosis is made through the clinical analysis of the cardiologist, in addition to tests that can be done to prove myocarditis. The duration of the disease and the general state of health depends on each patient.

The specialist advises that there are different ways to diagnose the disease. “Electrocardiogram, blood tests that measure inflammation [PCR e VHS]blood tests that measure damage to the heart muscle [troponina – enzimas liberadas após alguma lesão no coração]electrocardiogram showing reduced heart strength and heart resonance and sometimes a biopsy indicated for these cases.”

Treatment

Treatment depends on the patient’s clinical condition, evaluated after the results of the tests. It can be done with anti-inflammatory drugs, but in the most debilitated cases, such as the acute phase, there are restrictions on physical exercises, driving or any other activity with more impact, and, preferably, the person has to rest.

“Most cases are self-limiting and resolve with the use of medications that counteract inflammation. So the support measures are usually temporary and the patient returns to a normal life”.

If the treatment or use of anti-inflammatory drugs does not show the expected results, surgery is possible. But operations are rare. “Some cases may require temporary, permanent or even transplant artificial heart systems”, highlights the doctor.

He also warns: “After treatment, some people may remain with compromised heart strength, but the vast majority recover fully.”

*Intern under the supervision of Carla Canteras.

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