Adding to the growing list of the multisystem effects of COVID-19 infection, a large number of cases of post-COVID-19 myocarditis were reported. 

Although a rare but the most under-diagnosed heart condition, myocarditis, has been linked to roughly 20% of sudden deaths in young adults. 

Through this article, let's try to recognize each of the many faces of the disease.

What is Myocarditis?

Myocarditis is the inflammation of the heart. This is a result of the body's immune response to certain infections (most commonly viral) and autoimmune conditions, which leads to weakening and swelling of the heart, which in turn reduces your heart's ability to pump blood and oxygen, causing rapid or abnormal heart rhythms (known as arrhythmia). 

In severe cases, myocarditis can lead to heart failure and sudden death. 

What Are The Symptoms of Myocarditis?

One of the greatest challenges to diagnosing and treating myocarditis is the lack of specific symptoms of myocarditis. 

In a majority of cases, individuals experience no symptoms at all and death due to myocarditis occurs with no warning. 

However, there are a few indications/red flags you should watch out for and these include:

  • Chest pain, heaviness, or burning sensation in the chest.

  • Shortness of breath, especially on exertion or lying down.

  • Flu-like symptoms such as palpitations, high temperature, and fatigue.

  • Unexplained fainting or loss of consciousness (also known as syncope).

  • Lightheadedness.

  • Swelling in the hands, legs, ankles, and feet.

Who is at a Risk of Developing Myocarditis?

Myocarditis can affect anyone from young adults to toddlers. However, people who are at the highest risk of developing this condition are those who have reached puberty through their early 30’s. 

It has been reported that the male population is more prone to this than their female counterparts.

To find out your risk of developing this heart condition, your doctor would need to run some tests and ask a few questions pertaining to your health, family members, or any risk factors for the same, such as:

  • History of cardiac arrest.

  • History of any of the symptoms mentioned above.

  • History of low blood pressure before or after exercise.

  • Family history of cardiac arrest, sudden deaths, or any underlying heart condition.

Tests may include ECG (electrocardiogram), 2D echo (echocardiogram), X-ray, and a routine blood test. 

Can Sudden Death Due to Myocarditis in Young People be Prevented?

Yes, sometimes with regular screening examinations and follow-up, death can be prevented, especially if you belong to the high-risk group. 

Depending on your underlying condition, your doctor may suggest some lifestyle modifications, restrictions in your physical activity, and medical or surgical treatments to reduce your risk of sudden death.

Should Young People at High-Risk Avoid Physical Activity?

Certainly, physical activity should be avoided if you are at risk of sudden cardiac death, or are just recovering from COVID-19 infection and post-vaccine myocarditis. 

Ideally, 3 to 6 months of rest is recommended for the latter situation. Talk to your doctor about restrictions on your physical activity.

Can Myocarditis be Treated?

The treatment of myocarditis depends on the extent and severity of the heart (myocardial) inflammation. In many cases, patients recover completely with minimal and supportive therapy. 

In acute cases with symptoms of heart failure, your doctor may start you on protocol-guided medical treatment which may include particular medications.

They may also recommend behavioural and lifestyle changes such as refraining from competitive sports for 3 to 6 months, fluid restriction, a low-sodium diet, and restrictions on alcohol and tobacco consumption.

Can Myocarditis Recur?

Yes, according to the Myocarditis Foundation, the chance of it recurring is approximately 10 to 15%. Most people with myocarditis recover and it does not have long-term adverse effects on their heart. 


References:

1. Circulation. 2021. Myocarditis and Sudden Cardiac Death in the Young. [online] Available at: <https://www.ahajournals.org/doi/full/10.1161/circulationaha.107.693085> [Accessed 8 November 2021].

2. Harikrishnan, S., Mohanan, P., Chopra, V., Ambuj, R., Sanjay, G., Bansal, M., Chakraborty, R., Chandra, S., Chattarjee, S., et al, M., 2020. Cardiological society of India position statement on COVID-19 and heart failure. Indian Heart Journal, 72(2), pp.75-81.


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