The public generally has a misunderstanding of heart disease and how it develops. Many believe heart disease is when the arteries slowly narrow over the course of many years. The way inflammation attacks the heart is much different. It can occur over the course of a few days and is commonly seen after a simple viral illness. Often times it attacks patients who are relatively young, active and have no preexisting health conditions. Dr. Maria Tehrani, a cardiac surgeon, practices at the Ronald Reagan UCLA Medical Center in Westwood, California. Tehrani also sees patients throughout the city of Los Angeles. Many of these patients suffer from chest pain and are told by health care professionals it is caused by acid reflux, a muscle strain or the flu. An important aspect of Dr. Tehrani’s practice is trying to educate her patients about the different cardiac conditions such as myocarditis and pericarditis. This is because both conditions can be treated if they are managed properly.

Two Conditions with Three Layers

When a part of the heart becomes inflamed, the other parts can become inflamed as well.

When the membrane that surrounds the heart (pericardium) becomes inflamed, it is called pericarditis. The layers of this membrane can also become fluid-filled. This membrane also helps the heart to move.

When the muscle of the heart (myocardium) becomes inflamed, it is called myocarditis. Unlike pericarditis, this condition can affect the heart’s ability to pump blood and cause irregular heartbeats.

Causes of Heart Inflammation

Many cases of heart inflammation are triggered by viral infections. An inflamed heart can occur as a complication of an infection with a viruses including the flu or COVID-19, or with common cold viruses. Heart inflammation is possible in the weeks and even months after the symptoms of the initial viral infection resolve.

Inflammation of the pericardium can occur as a result of rheumatoid arthritis or lupus. Other causes of inflammation of the heart muscle and pericardium include some cancer treatments, recreational drugs, and heart surgery.

Inflammation of the heart muscle (myocarditis) can also occur following COVID-19 vaccination. This has primarily occurred in young men within a few days of vaccination. Most cases of post COVID-19 vaccine myocarditis have been mild. Each individual should consider the benefits of COVID-19 vaccination based on their personal situation and consult their doctor with any questions.

Pain and other Symptoms

People experiencing inflammation of the pericardium may experience sharp, stabbing pain in the chest that is made worse by taking deep breaths or coughing. The pain is made better by leaning forward. The pain of pericarditis can also occur in the neck and shoulders. Fever is also common with pericarditis.

Myocarditis can be hard to diagnose because it’s often mistaken for a case of the flu or COVID. Patients may experience less classic symptoms like: chest pain that resembles a heart attack, swelling in legs, palpitations, a fast and irregular heart rate, shortness of breath especially when lying down, fatigue and muscle weakness. Sometimes, patients may not experience symptoms at all. Myocarditis can also be fatal. It can lead to heart failure and life threatening arrhythmias.

The complicating factor is that patients may experience myocarditis symptoms a few weeks after experiencing flu or COVID-19 symptoms. At that point, patients may still feel weak and experience symptoms of a lingering infection.

How the Diagnosis Is Made

An ECG is typically the first test to be done and can help confirm the diagnosis if there are abnormalities. A troponin test may also be ordered to check for any injury to the heart muscle. If there is excessive fluid buildup around the heart, an ECHO can help identify that and confirm heart muscle dysfunction.

Treatment

Myocarditis can be more difficult to treat compared to Pericarditis. Sometimes, corticosteroids may be prescribed. On their own, corticosteroids can provide little to no benefit, but, combined with colchicine, they can prevent a relapse. Like with pericarditis, treatment and management should be done by a specialist if conditions persist or symptoms come back.

Treatment is based on the case severity. Mild cases require rest, and may need to be monitored and treated for any heart failure or arrhythmias. Worsening cases require treatment for heart failure and arrhythmias and may need more continuous support and monitoring. Rarely, myocarditis may need surgical intervention. Surgical intervention may be required to alleviate the compression and tension on the heart from fluid and inflammation by the pericardium.

Recovery of mild cases of myocarditis is usually full and complete. It is important to do follow-up tests and assessments to evaluate recovery.

Rest From Exercise

This is the recommendation that is usually disputed the most. The heart is still healing and inflamed from myocarditis, therefore, it is at risk for more arrhythmias. Myocarditis can also be a cause of sudden death, especially during exercise, in young adults.

It is usually recommended that after diagnosis, training and competition be avoided for many months. Before full training and competition may be resumed, many assessments including, exams, ECGs, and stress tests may also be required. Pericarditis usually has a shorter restriction.

It is likely that many of your from Santa Monica and Westside may feel that restriction is too long. However, it is better to be safe than sorry.

When to See a Physician

Chest pain that causes fainting, very rapid/irregular heart rates, or in which you feel your heart racing, or experience shortness of breath or sudden squeezing/pressure in your chest is a medical emergency regardless of your age or physical conditioning.

You should be seen by a doctor as soon as possible if you have: Sharp chest pain that worsens with deep breathing or when lying down; Shortness of breath that is not relieved by resting, and/or palpitations; Fatigue or inability to exercise that lasts more than a few weeks after an illness; New swelling in your legs; and/or Chest pain that worsens with deep breathing or when lying down (and) is not better with 3-4 days of taking over the counter medications. Also, you should be evaluated by a doctor if your pericarditis symptoms return rather than attempt to treat your symptoms on your own.

Dr. Tehrani is a trusted physician, located in the Greater Los Angeles area, who provides an in depth evaluation, and if needed, surgical care for patients suffering from inflammation of the pericardium, and constrictive and recurrent pericarditis, as well as large pericardial effusions. The best way to manage this condition is to have it diagnosed in its early stages.

Maria Tehrani, MD Cardiac Surgeon | Ronald Reagan UCLA Medical Center

Phone: 818-350-9899

Email: welcome@mariatehranimd.com

Address: 757 Westwood Plaza, Los Angeles, CA 90095 Hours: Monday–Friday, 9AM–5PM

Serving patients throughout Westwood, Brentwood, Beverly Hills, Santa Monica, Century City, Bel Air, Pacific Palisades, Marina del Rey, and Culver City.