How to Diagnose Myocarditis

Myocarditis can be a challenging condition to diagnose, as its symptoms often overlap with other heart-related issues. While the gold standard for diagnosis is endomyocardial biopsy, it is rarely used in clinical practice due to its invasive nature. Instead, doctors typically rely on a combination of patient symptoms and diagnostic tests to make an accurate assessment.

Recognizing Common Symptoms

Patients with myocarditis may experience a range of symptoms, including chest pain, palpitations, and signs of heart failure. These heart failure symptoms often include shortness of breath during physical activity, difficulty lying flat while sleeping, swelling in the lower extremities, and increasing fatigue. When these signs appear, especially following a recent viral infection, myocarditis should be considered.

Key Diagnostic Tests

1. Electrocardiogram (ECG)

An ECG is often one of the first tests performed. It can reveal abnormal heart rhythms such as premature beats or atrial fibrillation, which are common in myocarditis. These irregularities can suggest inflammation or damage to the heart muscle.

2. Blood Tests

Blood work is crucial in evaluating myocardial damage. Elevated levels of cardiac enzymes, such as creatine kinase-MB (CK-MB) and cardiac troponins, indicate injury to heart muscle cells. These biomarkers are key indicators used by clinicians to assess the likelihood of myocarditis.

3. Echocardiogram

An echocardiogram provides a visual assessment of the heart's structure and function. It can detect changes in heart function, such as reduced ejection fraction or abnormal wall motion, which may point to myocardial inflammation.

4. Cardiac MRI

Cardiac magnetic resonance imaging (MRI) is a powerful tool for diagnosing myocarditis. It can provide detailed images of the heart muscle and detect characteristic changes such as edema, fibrosis, or scarring. This imaging method is particularly useful in confirming the diagnosis and ruling out other conditions with similar symptoms.