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Source: Guide To Myocarditis And COVID-19 By Thailand Medical News  Oct 09, 2020  2 years, 11 months, 3 weeks, 2 days, 19 hours, 49 minutes ago

GUIDE TO MYOCARDITIS-A Dangerous Heart Condition Affecting Up To 78 Percent Of COVID-19 Infected Symptomatic or Asymptomatic Individuals!

GUIDE TO MYOCARDITIS-A Dangerous Heart Condition Affecting Up To 78 Percent Of COVID-19 Infected Symptomatic or Asymptomatic Individuals!
Source: Guide To Myocarditis And COVID-19 By Thailand Medical News  Oct 09, 2020  2 years, 11 months, 3 weeks, 2 days, 19 hours, 49 minutes ago
Myocarditis-COVID-19: Of late many have been hearing reading about the devastating effects of the SARS-CoV-2 coronavirus on the hearts of those infected irrespective of conditions they endured ie mild, moderate or severe or even if they were asymptomatic or are recovered.
One of the most common but dangerous heart condition affecting most individuals who had come into contact with the SARS-CoV-2 coronavirus is a condition called myocarditis.
Myocarditis, also known as inflammatory cardiomyopathy, is inflammation of the heart muscle. It is a type of heart disease that usually causes no symptoms, but it can be life-threatening. Myocarditis gets its name because the middle layer of the heart muscle is called the myocardium. "Myo" means muscle "card" means heart "itis" means infection or inflammation, i.e., inflammation/infection of the muscle wall of the heart.
The incidence rate of myocarditis is of great concern to many medical researchers and doctors. In one study involving COVID-19 recovered healthcare staff, it was found that about 39 percent had myocarditis.
A German study published in the JAMA journal showed that up to 78 percent of recovered COVID-19 patients had developed myocarditis!
There are numerous studies showing varied incidence rates but it is now generally assumed that between 78 to 85 percent of all recovered COVID-19 patients could be having myocarditis and majority do not even know that they are having this dangerous condition that might heal by itself or maybe simply deteriorate further, putting them at a high risk of mortality!
Now considering that to date we have almost 37 million people infected with the SARS-CoV-2 globally according to official figures from John Hopkins as of the 9th of October. and millions more asymptomatic individuals who have never been tested walking around plus even more scary is that the WHO (World Health Organization)is now saying that up to 10 percent of the world’s population is most probably  already infected with the SARS-CoV-2 coronavirus or about  760 million individuals, we do not only have a COVID-19 pandemic at hand but a serious global heart disease crisis!
Even before the COVID-19 global pandemic made its debut from China, myocarditis was responsible for 45% of heart transplants in the United States each year!
Many ask is myocarditis a heart attack? No, but it can sometimes lead to one. Symptoms of myocarditis, when they do occur, are similar to those caused by a heart attack, such as experiencing chest pains and shortness of breath. The most significant long-term complication associated with myocarditis is chronic heart failure.
So What Really Is Myocarditis?
The Myocarditis Foundation says that “Myocarditis is a disease marked by inflammation and damage of the heart muscle.” It can affect both children (Pediatric myocarditis) and adults, including individuals who have no prior history of heart disease.
The purpose of the myocardium muscle contracts in order to pump blood through the body. Because myocarditis affects the heart’s cells and electrical system, it can cause irregular heartbeats (or changes in heart rhythms called arrhythmias) and decreased circulation.
Hence myocarditis can also cause blood flow to be reduced in certain parts of the body, may lead to blood clots developing in the heart, and can trigger a stroke or heart attack. This does not always happen, but it is possible when myocarditis becomes severe. Sometimes scar tissue (fibrosis) can develop in the myocardium, which increases the risk for long-term complications.
Myocarditis Symptoms And Signs
Myocarditis usually affects individuals who are otherwise healthy and it’s the cause of between 5 percent to 20 percent of all cases of sudden death in young adults.
Typically most individuals with myocarditis experience no noticeable symptoms or signs. How is a heart infection diagnosed? Someone might display certain symptoms, or they might only receive a diagnosis after an electrocardiogram (ECG) or blood test reveals signs of heart injury or inflammation.
However when symptoms of myocarditis do occur they can include:
-A shortness of breath, especially during exercise or periods of exertion.
-Difficulty breathing or rapid breathing might occur. Shortness of breath at night is also possible.
-General fatigue and weakness.
-Random heart palpitations (abnormal heart rhythms)
-Chest pains or pressure.
-Sudden swelling in the legs and arms due to fluid retention (called peripheral edema). Edema is usually the worst in the ankles and feet.
-Dizziness or lightheadedness
-Other symptoms due to infection (headaches, body aches, joint pain, fever, a sore throat or diarrhea).
-Sudden loss of consciousness.
-Increased risk for heart failure, blood clots, stroke or heart attack.
Symptoms in myocarditis typically develop about one or two weeks after someone has a viral infection or another illness. Symptoms are a sign that inflammation and damage has spread to the heart and is interfering with normal circulation. Your body treats myocarditis like an ongoing infection, causing your immune system to produce antibodies to fight the infection that wind up damaging your heart. This can cause scar tissue to form that stops the heart from pumping properly.
Symptoms Of Myocarditis In Children
When children develop myocarditis, they might have signs and symptoms including:
-Breathing difficulties
-Rapid breathing
-Rapid or abnormal heart rhythms (arrhythmias)
Long-Term Damage Of Myocarditis
Most of the time, myocarditis recovery time will depend on the severity of the condition and an individual’s overall health. It might take several months to feel completely better, or longer if any permanent damage developed.
It must be warned that myocarditis has been associated with permanent heart damage and in some cases can lead to sudden death, heart failure, heart attacks, stroke, and heart arrhythmias.
Myocarditis can cause swelling of the heart and heart failure. It can stop the heart muscle from properly being able to pump blood, which might cut off blood supply to the brain or other organs. Injury to the heart might also cause blood to pool in your heart and develop into clots. Clots can travel to your arteries causing a heart attack, or travel to your brain leading to a stroke.
Just as deadly, resulting arrhythmias might also cause your heart to stop beating (called sudden cardiac arrest).
Causes Of Myocarditis And Risk Factors
The heart has several layers, including the myocardium, endocardium and pericardial cavity. Myocarditis is caused by inflammation of the myocardium layer, which is the middle layer of the heart muscle.
They are many causes for the heart muscle (or myocardium) to swell and become damaged and there are many reasons that someone might become affected by myocarditis.
Medical experts believe that when the myocardium becomes inflamed or damaged it is usually infectious, but not contagious and not hereditary (not passed down from parents to their children). Two of the most common causes of myocarditis are:
-Viral or bacterial infections
-Autoimmune responses that affect the heart
It has been found that Infections that are associated with myocarditis include various types of upper respiratory tract infections including the current COVID-19 disease and a variety of other types.
Also myocarditis can be non-infectious, which is the case when it is due to causes like autoimmune reactions or medications. Autoimmune responses are self-directed responses from the immune system that cause damage to various tissues and organs. Examples of autoimmune diseases include polymyositis (causing systematic/general inflammation), lupus, rheumatoid arthritis or Lyme disease.
Interestingly another type of myocarditis is called giant-cell myocarditis. The cause of this type is unknown. Giant-cell myocarditis happens when macrophages fuse together to form giant cells in the heart, interfering with normal activities.
Typically the most common myocarditis causes include:
-Viral infections. This can include the common cold, respiratory infections, hepatitis C and B, parvovirus, measles, mumps, the flu, fifth disease, HIV, herpes simplex virus, echoviruses, rubella and mononucleosis (Epstein-Barr virus) and off course the SARS-CoV-02 coronavirus that causes the deadly COVID-19 disease.
-Infections caused by bacteria. This can include infections caused by staphylococcus, streptococcus, or tick-borne bacterium that cause Lyme disease.
-Autoimmune diseases, including lupus or Lyme disease.
-certain parasites, such as Trypanosoma cruzi (which causes Chagas disease) and toxoplasma.
-Fungus can also cause myocarditis in people with weakened immune systems. Examples of fungi that have been associated with myocarditis include certain types of mold, candida, yeast infections and histoplasma.
-Sudden or constants exposure to environmental toxins or metal poisoning. Even carbon monoxide can cause myocarditis.
-High levels of inflammation.
-Adverse reactions to drugs, medications or recreational drugs, including cocaine. Medications including certain antibiotics, sulfonamide drugs, anti-seizure medications and cancer medications have been associated with myocarditis. Adverse reactions to these drugs can cause hypersensitivity, which inflames the heart.
-certain types of cancer.
-certain snake or spider bites.
- Other diseases. These include disorders such as lupus, Wegener's granulomatosis, giant cell arteritis and Takayasu's arteritis.
Clinical Diagnosis
There are several ways that myocarditis is diagnosed.
-Laboratory blood tests might reveal that levels of troponin or creatine kinase cardiac isoenzymes are elevated hence indicating that the heart muscle are inflammed.
- Electrocardiogram or ECG. Electrical activity of your heart is detected by electrodes taped to your skin. This activity is recorded as waves that represent the electrical forces in the different parts of the heart. This test can also reveal abnormal heart rhythms by detecting T-wave inversions and saddle-shaped ET inversions
Some physicians may also choose to do imaging studies to look for an enlarged heart:
-A Chest X-Ray. A chest X-ray produces an image on film that outlines your heart, lungs and other structures in your chest. From a chest X-ray, your physician learns information such as the size and shape of your heart.
-Less frequently, a cardiac magnetic resonance imaging (MRI) scan may be done to diagnose myocarditis. An MRI creates images using a magnetic field and radio waves.
Some physicians might call for other tests including:
-An Echocardiogram (abbreviated echo)
Sound waves (too high-pitched to be heard) are used to make an image of your heart or analyze blood flow. The sound waves are sent into your body from a transducer, a small plastic device. The sound waves are reflected back from internal structures, returning to the transducer and producing images of the heart and its structures.
Occasionally, a heart biopsy is required to confirm the diagnosis.
-others:  looking for signs of inflammation such as edema, increased lymphocytes and increased microphages.
Treatments For Myocarditis
Treatment for myocarditis will depend on the underlying cause of the condition and how severe the patient’s symptoms are.
Mild or moderate viral myocarditis can go away on its own, but a patient’s symptoms have to be monitored constantly least it deteriorates, which it often does, sometimes over a long period of time.
The most common way that moderate-to-severe myocarditis is treated is with steroids and medications that are used to treat heart damage and heart failure.
Pharmaceuticals and Drugs that can be prescribed for myocarditis include:
-Diuretics, to help control edema/fluid retention (furosemide or Lasix is often used)
-Digoxin, which helps to prevent heart failure. Digoxin helps to improve contractions of the heart muscle and to slow heartbeats, which might help control palpitations.
-Milrinone and ACE inhibitors (example lisinopril), which help to regulate heart rhythms.
-Aldosterone agonists, which can help to prevent scarring of the heart and remove excess fluid. (Examples are spironolactone and eplerenone)
-Corticosteroids to manage inflammation of the heart and prevent further damage.
-Antibiotics if an infection is the underlying cause.(be careful as certain antibiotics can actually aggravate heart conditions or arrhythmias.
-Use of oxygen to help ensure enough circulates through the body.
If it’s been detected that someone has abnormal heart rhythms that require intervention, then they might need to take certain medications and use a pacemaker. Arrhythmias will usually resolve once inflammation levels decrease.
Your doctor might also recommend resting, avoiding any strenuous activity including gyms, exercise or sports and eating a low-salt diet. Even sex is dissuaded!
After having myocarditis, one will need to recover for a period of time and ease back into physical activity slowly.
Preventions, Natural Recovery Etc
-Strengthen One’s Immune System with a Nutrient-Dense Diet
Diet plays a very important role in both preventing and treating myocarditis. Consume an anti-inflammatory diet. Include a variety of fresh vegetables and fruit in your diet, aiming to fill half your plate with fresh produce at every meal.
Among some of the best choices include leafy greens, berries, carrots, tomatoes, squash, cruciferous veggies like broccoli or cauliflower, asparagus, avocado, cranberries, blueberries, grapes and mushrooms. Other healthy food choices for heart health include flax and chia seeds, almonds and other nuts, olive oil, wild-caught fish, dark chocolate (if caffeine is OK), beans and legumes, fresh herbs and green tea.
Consuming soy products especially fermented soy products are a good way to reduce inflammation.
Cut down on salt intake. Sodium (salt) aggravates the symptoms of myocarditis and heart failure because it causes more fluids to be drawn into the bloodstream, demanding more work for your heart to pump blood through your system. The best way to reduce salt intake is to avoid eating processed foods, including fast food, frozen meals, canned foods, processed meats, cheeses, condiments, pre-made soups and packaged baked goods. Avoid foods that damage gut health and increase inflammation, such as those made with additives, refined grans and trans-fats.
Avoid sugars of any kind and also sweet foods etc.
Monitor how much potassium you’re getting. If you’re taking any medications to prevent heart failure, then speak with your doctor about whether or not this will affect your ability to balance potassium. You might need to get less or more potassium from your diet depending on your condition and any medications you take. Low potassium levels can worsen heart rhythm problems, so you might need to supplement with more if needed.
As far as possible reduce caffeine and alcohol intake. Caffeinated drinks, such as coffee or tea, can cause your heart to beat faster, which can be dangerous when you have myocarditis. Alcohol can interfere with normal heartbeats and potentially worsen heart arrhythmia or interfere with medications you’re taking. When myocarditis is severe no alcohol or caffeine should be consumed until a doctor says otherwise because both can weaken the heart muscle.
-Protect Against Viruses and Infections
Always treat bacterial infections in their early stages to prevent complications. Visit a doctor if you suspect you have any type of serious infection, especially if its affects your respiratory system or ability to breathe. Following surgery, an incision, cut or wound to your skin, keep a close eye on your symptoms in order to spot signs of a developing infection.
As far as possible, avoid close contact with anyone who has a viral or bacterial infection, such as the flu. Protect other people by staying home from work or school if you yourself are infected.
Try to always practice safe sex and limit the number of partners you have.
Always practice good hygiene habits by washing your hands regularly, keeping your home clean, washing your clothes and showering daily. Some of the most common places that infections are spread are hospitals or doctors offices, nursing homes, daycares, schools, universities and gyms.
Never ever share needles if you are ever getting a tattoo, piercing, medical procedure or using illegal drugs.
Try to prevent tick bites by covering exposed skin when outdoors in high-risk areas, checking your clothing and skin afterwards, washing your clothes and controlling pests around your home. Get help from your doctor right away if you suspect you’ve been bitten by a tick or another infectious insect.
 In the COVID-19 scenario, wear a mask, wash hands, practice social distancing of always more than 6 metres, try isolating wherever possible.
-Reduce Autoimmune Flare-Ups
Besides eating an anti-inflammatory diet, you can also reduce your risk for autoimmune flare-ups by controlling stress, preventing nutrient deficiencies and getting enough sleep.
Often high levels of stress can lead to many health problems, including those that affect your immune and cardiovascular systems. Uncontrolled stress is associated with higher risk of heart disease, high blood pressure and susceptibility to viral or bacterial illnesses.
Make a plan for how you can adopt stress-relieving techniques to handle some of the biggest worries and obstacles in your life. Meditation helps.
Try acupuncture, meditating or practicing mindfulness, praying, reading, writing, joining a social group, doing light yoga and breathing exercises, or anything else soothing.
-Avoid Risky Drugs, Supplements or Medications
Always be cautious about using new supplements or even herbs and taking over-the-counter medications when you have myocarditis because some of these can add stress to your already weakened heart. Certain medications might contain caffeine or cause your heart rate to speed up, such as headache medications or drugs used to treat colds/flu.
Immediately stop using tobacco and nicotine products as soon as possible since chemicals in these products can increase inflammation, worsen arrhythmias and cause damage to arteries.
Try taking supplements that can help reduce inflammation. Remember that you should always ask your doctor before taking any supplements. Some that might be helpful for protecting your heart, which you can discuss with your doctor include: Antioxidants like vitamin C and vitamin E, omega-3 fatty acids, coenzyme Q10, vitamin D and herbs like curcumin, garlic, gingko, ginseng and hawthorn.
-Effectively Manage Edema (Fluid Retention) and Swelling
Try to monitor edema by weighing yourself each morning, looking for sudden increases that point to fluid build-up. Weight gain of about three or more pounds that either appears suddenly or keeps creeping up over several days can mean that congestion and edema is building in your lungs, legs or abdomen. This can indicate that heart failure may be getting worse. If you notice this happening, especially along with other symptoms like shortness of breath or chest pain, then visit your doctor right away.(note that sometimes edema though present might not be apparent)
Try to limit the amount of fluids you drink in order to prevent edema from worsening. You can ask your doctor how much he or she recommends. Temporarily, you may need to limit the amount of water you drink. So if you feel thirsty, try rinsing your mouth with water, taking very small sips, sucking on frozen grapes or ice chips, chewing gum or your brushing your teeth.
-Exercise with Caution (only if you have yet to get myocarditis)
Typically exercise is a great way to prevent inflammation and boost immunity, but if you already have a heart condition, such as a heart arrhythmia, you need to clear exercise with your doctor first. Use caution when beginning exercise again during recovery and don’t do more than your doctor advises. If you notice shortness of breath, pains or fatigue, then you’re likely doing too much and should rest before gradually reintroducing exercise. Take breaks throughout the day to rest and relax. Avoid very strenuous activity that makes it hard to breathe, instead focusing on soothing activities like walking, swimming, light cycling and stretching.

Always head to either the emergency room of your hospital or doctor right away if you experience any signs or symptoms of myocarditis, especially shortness of breath, edema or chest pains.
Following surgery, a virus or bacterial infection, or a flare-up in autoimmune disease, be extra careful to look for any signs of myocarditis. Symptoms can progress quickly and be deadly, so always go to the emergency room is you suspect there’s a problem with your heart.
Key Notes:
-Myocarditis is a disease marked by inflammation and damage of the heart muscle.
-Symptoms don’t always occur, but can include those similar to a heart attack such as chest pains, trouble breathing and heart palpitations.
-Myocarditis can increase the risk for scar tissue developing on the heart, a heart attack, heart failure or stroke.
-The most common causes of myocarditis are viral infections, autoimmune diseases, bacterial infections, drug or medication use, or, rarely, tick/insect bites. (in this scenario the COVID-19 disease)
Post Myocarditis
Typically after treatment and recovery, many patients live long, full lives free from the effects of myocarditis. For others, however, ongoing cardiovascular medication or even a heart transplant may be needed. Overall, myocarditis which can cause dilated cardiomyopathy, are thought to account for up to 45 percent of heart transplants in the U.S. today.
Healthy lifestyle changes can also support proper heart function. Your doctor may recommend that you reduce sodium in your diet, avoid alcohol, limit fluid intake and quit smoking. It’s also generally advised that you avoid competitive sports and other rigorous exercise for a period after diagnosis, to be determined by the cardiologist. And while it’s possible for the disease to come back, more-so in giant cell myocarditis, it is extremely rare.
Can Myocarditis Recur?

Unfortunately yes, myocarditis can recur, and in some cases can lead to a chronically enlarged heart (called dilated cardiomyopathy). There is no known way to prevent recurrence of myocarditis. However, the risk of recurrence is low (probably about 12 to 18 percent).
Herbs For Myocarditis
Research has shown that certain herbs have therapeutic efficacy to help with myocarditis healing.
While certain herbs can help with myocarditis recovery, we strongly advise to stay away from using any TCM or Traditional Chinese medicine as most preparations contain ephedra which is known to actually aggravate existing myocarditis and also actually cause eosinophilic myocarditis. (Hence this is why many TCM formulations are banned by the U.S. FDA. And Europe)
The most commonly tested single herbs include Astragalus membranaceusSalviae miltiorrhizae, ginseng, and Sophorae flavescentis;,Shuanghuanglian%20in%20the%20clinical%20trials.
Astragalus (Astragalus membranaceus), a Chinese root best known for its ability to increase the production of immune cells in the bone, is also traditionally used to treat heart problems such as a heart arrhythmia or viral myocarditis. Physicians in China use it as their primary treatment when certain viruses infect the heart and cause an irregular heartbeat.
Another Chinese herb, reishi mushroom (Ganoderma lucidum), and two popular Western heart herbs, hawthorn (Crataegus spp.) and motherwort (Leonurus cardiaca), help regulate the heart and are regarded as heart tonics.
Another good herb is a special type of ginseng known as Tienchi ginseng (Panax notoginseng). It not only normalizes heartbeat and improves circulation but helps relieve fatigue and stress.
Antioxidant herbs such as ginkgo (Ginkgo biloba) also help strengthen the entire cardiovascular system
Yet another herb Salvia miltiorrhiza appears to have a protective action on ischemic myocardium, enhancing the recovery of contractile force. reoxygenation. More recently, S miltiorrhiza has been shown to protect myocardial mitochondrial membranes from ischemia-reperfusion injury and lipid peroxidation because of its free radical–scavenging effects. Qualitatively and quantitatively, a decoction of S miltiorrhiza was as efficacious as the more expensive isolated tanshinones.
Modern pharmacological studies confirmed that Salvia miltiorrhiza  (Danshen) can increase plasma CGRP, reduce plasma endothelin levels, reduce the plasma and myocardial local Ang II, and promote myocardial repair.
Hawthorn (Crataegus) contains a variety of phytochemicals that have shown to help with various heart issues including viral myocarditis.
Thailand Medical News has created a variety of therapeutic teas with patented blends of various herbs that have supporting studies to show these herbs efficacy against the SARS-CoV-2 virus or to help with certain symptoms or conditions of the COVID-19 disease. We have also created a new blend to help with chronic fatigue in recovered patients.
All our teas have been tested in observational studies and are in the process of going through actual randomized clinical trials shortly.
We are developing a special blend of herbs and phytochemicals involving over 27 herbs and 14 phytochemical extracts to help with viral myocarditis. We need your help with donations to help us further our research and developments.
For more Myocarditis-COVID-19, keep on logging to Thailand Medical News.

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(Note that this guide by Thailand Medical News is constantly being upgraded with more details added on a frequent basis)


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