Severe Myocarditis: Symptoms and Treatment Approaches

Severe myocarditis presents with more than just common symptoms such as palpitations, chest pain, and fatigue. It is often accompanied by elevated cardiac enzyme levels, which indicate damage to heart muscle cells. In more critical cases, patients may exhibit signs of severe heart failure, including fluid retention, shortness of breath, and extreme exhaustion.

Diagnostic Indicators of Severe Myocarditis

One of the key markers for heart failure is an increase in BNP (B-type natriuretic peptide), a hormone released by the heart in response to stress. Echocardiography typically reveals a reduced ejection fraction, reflecting impaired heart function. Additionally, dangerous arrhythmias may develop, especially during heart failure episodes. These can be detected on an electrocardiogram (ECG) and may include frequent ventricular premature contractions, ventricular bigeminy or trigeminy, or atrial fibrillation.

Potentially Life-Threatening Arrhythmias

In more severe cases, patients may experience malignant arrhythmias such as polymorphic ventricular premature beats, torsades de pointes, or paroxysmal ventricular tachycardia. These abnormal heart rhythms significantly increase the risk of sudden cardiac death and require immediate medical attention.

Treatment Strategies for Severe Myocarditis

The standard approach to treating severe myocarditis involves managing heart failure symptoms. This includes the use of medications aimed at improving heart function, reducing fluid buildup, and supporting myocardial health. Diuretics are commonly prescribed to address edema, while other drugs help improve blood flow and reduce ischemia in the heart muscle.

In cases where myocarditis leads to hypotension or cardiogenic shock, the prognosis becomes significantly worse. These severe complications often limit the effectiveness of treatment, and recovery may be unlikely without advanced interventions such as mechanical circulatory support or emergency heart transplantation.