. Thursday, October 2, 2008
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You’d think that a virus that causes colds and flu would be satisfied with making millions of people miserable every winter. You’d think that two common bacteria would be happy inflicting countless infections and sore throats. You’d think that, but you’d be wrong. Coxsackie virus and strep and staph bacteria will sometimes go the extra mile and infect your heart. The result can be a potentially life-threatening infection that goes by the name myocarditis or endocarditis.

Fortunately, these infections are not something most people have to worry about. They’re as rare as the nasty little microbes are common. Less than 28,000 cases of myocarditis and endocarditis are reported each year, and of these, an estimated 1,000 are fatal––small numbers in a nation of a quarter-billion people. But for those who have them, the infections and their repercussions can be serious.


Myocarditis is an inflammation of the heart muscle itself. Inflammation––the –it is––is a by-product of the immune system reacting to a foreign substance or even to the body itself. The Coxsackie virus is the most common known cause, says Herman Price, M.D., associate director of the Cardiology Section and medical director of the heart transplant service, the coronary care unit and the cardiac intermediate care unit at Ochsner Medical Institute in New Orleans. “But most of the time we don’t know for sure what causes myocarditis,” he says. “And it’s very difficult to diagnose. Probably there are many who get it without being diagnosed.”

There are no specific people prone to myocarditis, outside of people with weak immune systems, Dr. Price says. “Young people, old people, middle-aged people––all are susceptible,” he says. “There are no preventive measures you can take.”

From Flu to Heart Failure

A doctor will suspect you have myocarditis if you have viral-like illness, followed shortly by congestive heart failure. “If a 25-year-old healthy male had a respiratory illness three weeks ago,” Dr. Price says, “and now comes in with symptoms of heart failure––he is short of breath, fatigued, he has a rapid pulse and an enlarged heart, and his cardiovascular tests are abnormal––he may have myocarditis, even if we can’t identify a virus or bacteria.” Usually there’s no heart pain with myocarditis alone, but the infection is often accompanied by pericarditis, a painful inflammation of the membrane surrounding the heart.

“The primary treatment is directed at controlling heart failure, unless the specific cause is known,” says Dr. Price. That usually means bed rest and drugs to reduce fluid buildup, inflammation and pain and to maintain blood pressure and proper heart rhythm.

“If the myocarditis is mild or moderate, you may fully recover with no damage to your heart,” Dr. Price says. “You can do whatever you want. Your limitations are determined by how you feel. The more physically fit you were before the infection the better off you’ll be after you recover.”


“Endocarditis is a different kettle of fish,” Dr. Price says. “It usually attacks the heart valves instead of the muscle or membrane––and it usually can be prevented.”

Strep and staph bacteria are the most common causes of the endocarditis, and they may be found anywhere. “But most people are not at risk for endocarditis,” dr. Price says. “The people who are at risk are those who already have a valve abnormality, whether it’s congenital or the result of heart damage from another cause. At even higher risk are people who have artificial valves.” Fever is usually the first symptom of the disease.

“Endocarditis is always dangerous, because there are so many complications that can occur,” Dr. Price says. “Clots that form on a valve can break off and go any place the circulation takes them, such as the brain. There they can block a blood vessel and causes a stroke. In the leg they can block blood flow, which, if not corrected, can eventually cause less of the leg.”

Sometimes endocarditis is caused by slower-growing microbes, and the damage can develop over several months. But a fast-acting form of endocarditis can destroy the valve in a matter of days, Dr. Price says, causing life-threatening heart and organ failure and fluid buildup in the lungs. Surgery to replace the valve is often required, he says.

Reducing Your Risk

If you have a valve problem, or if you have an artificial valve, dental work that causes bleeding––cleaning, fillings or extractions––is the most common situation that puts you at risk, says Dr. Price. Bacteria can evade even the most stringent standards of cleanliness and sterilization. Other medical procedures that cause bleeding, like colonoscopy or biopsy, are also risky. Your doctor will most likely order a course of antibiotics before any dental or medical procedure that causes bleeding.

If it’s too late for prevention––don’t despair. With good treatment, your chances of complete recovery are high, Dr. Price says. Treatment usually is limited to antibiotics, but if they don’t work, doctors can surgically replace the infected valve. If the infection didn’t spread to the heart muscle itself, Dr Price says, “A new valve can mean a whole new person.”


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