Councilor Dr.  Jamal explains what myocarditis is and why the disease happens

Councilor Dr. Jamal explains what myocarditis is and why the disease happens

Heart disease is 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% 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 more common in children, pregnant women and patients with compromised immune systems, explains Jamal.

Causes

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

For the urologist and occupational physician, Dr. Jamal said that everyone is subject to myocarditis: “It can be caused by a number of viruses, medications [quimioterápicos são alguns exemplos] and by rheumatological and immunological diseases, such as lupus”.

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

Jamal also clarifies that the process of decreased pumping can additionally compromise blood flow to other organs, which causes 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 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 in pumping blood to the other organs, chest pain, tiredness, fever, shortness of breath, arrhythmias and palpitations, headache, swelling in the legs and sudden death.

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

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

Diagnosis

The diagnosis is made through the clinical analysis of the cardiologist and exams. 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, which measure damage to the heart muscle [troponina enzimas liberadas após alguma lesão no coração]electrocardiogram, which shows reduced heart strength, heart MRI, and sometimes a biopsy is 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-inflammatories, but in the case of more debilitated patients, as in the acute phase, there is restriction of physical exercises, to drive or perform any other activity that generates impact. Preferably, the person has to rest.

“Most cases are self-limiting and resolve with the use of medications that act against 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 or permanent artificial heart systems or even transplantation”, highlights the doctor.

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

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