Contents
Symptoms are not obvious and disease development is unpredictable. Until the coronavirus pandemic, myocarditis was not a major science issue. Recently, however, research into the condition has gained momentum. Scientists are slowly solving the mysteries of myocarditis.
- It is estimated that there are 1,5 million cases of myocarditis worldwide every year
- The disease began to receive more attention in the era of the coronavirus. This is a common complication following COVID-19 infection
- However, there are many causes of inflammation
- Myocarditis most often affects young men
- More current information can be found on the Onet homepage.
Author Paul Klammer, welt.de
Every year, 20 thousand Germans develop myocarditis. Most, however, are not aware of it. Symptoms such as fatigue, shortness of breath with exertion and palpitations are also present in many other diseases and are therefore often overlooked as warning signs of myocarditis. Moreover, these symptoms are often mild, so those affected never see a doctor. At least so far it has been. However, for several months now, heart disease has suddenly taken the spotlight. Not only because it is sometimes the result of a coronavirus infection. Myocarditis also appears as a very rare but potentially dangerous side effect of mRNA vaccines, significantly worsening the reputation of these preparations.
Now, this challenge also presents an unexpected chance for medical advances. “COVID-19 has given a boost to myocarditis research,” says Carsten Tschöpe, professor of cardiology at Berlin’s Charité hospital. It is also urgently needed. Because probably no other heart disease is such a mystery to him and his colleagues.
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Until now, for example, they did not understand why the disease is only dangerous for some patients. And who belongs to the risk group. Moreover, the diagnosis is very complex, which also contributes to the fact that the disease is not diagnosed in many patients. As a result, medicine doesn’t even know exactly how large the annual death toll is. The hope is that this could change now thanks to the pandemic. There are mainly five areas of progress.
New triggers found
Medicine has known since the 50s that viruses can attack the heart. Michael Böhm from the German Society of Cardiology assumes that up to 10 percent. all viral infections result in myocarditis. Inflammation can be caused by influenza and cold pathogens. The same is true for viruses that remain in the body for life, such as the Epstein-Barr virus (EBV). Bacteria and fungi can also be dangerous to the heart muscle.
What is new, however, is the realization that drugs can also cause inflammation of the heart muscle. I am talking about the potential side effects of the so-called immune checkpoint inhibitors. These anti-cancer drugs release the brakes on the immune system, which can lead to autoimmune reactions against the cells of the heart, among other things. “Virus disease was very common in the 90s and 2000s, and things are getting better now,” says cardiologist Dirk Westermann of the University Hospital Hamburg-Eppendorf.
Not all cases of myocarditis are the same
Whether the disease is severe or mild depends on the factor that caused it. The last few months have shown this clearly. “Myocarditis after the COVID-19 vaccine almost always has a good prognosis and can be treated without consequences,” says cardiologist Tschöpe. A completely different situation occurs when the heart muscle is attacked by the coronavirus. Coronavirus infection leads to hospitalization for myocarditis four to seven times more often than vaccination, according to studies from Israel and the UK.
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Age also affects symptoms. “In children, the picture of myocarditis is different from that in adults,” explains Dr. Franziska Seidel from the German Heart Center Berlin (Deutschen Herzzentrum Berlin). Together with Daniel Messroghli from Deutschen Herzzentrum Berlin and Stephan Schubert from Herz- und Diabeteszentrum NRW, he oversees the world’s largest and constantly expanding registry of children and adolescents with suspected myocarditis.
“In sick adolescents, the heart rate looks good, while young children with myocarditis are often seriously ill,” he says. In many cases, a weakened muscle must be relieved temporarily with a small pump. Some even need a heart transplant.
The new role of the immune system
Cold viruses attack the heart muscle cells to destroy them. However, not all pathogens act the same way. Chronic Epstein-Barr virus infection can confuse the immune system so much that it attacks the heart. And almost every German will be infected with this pathogen in their lifetime.
The coronavirus appears to trigger similar autoimmune responses. Heavy COVID-19 courses are often accompanied by the so-called a cytokine storm. Case reports and tissue samples show that such an overreaction of the immune system can lead to organ failure. But the pathogen itself also directly infects the cells responsible for the functioning of the heart.
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According to studies, every 19 patient with COVID-XNUMX experiences symptoms of myocarditis. It is already known that various inflammatory cells are involved in various viral infections, stresses cardiologist Tschöpe from Berlin. Thanks to this knowledge, we expect the development of new diagnostic and therapeutic options in the coming years, he says.
So far, doctors have only been able to fight a heart muscle infection in a few cases. Bacteria are combated with antibiotics. However, viruses can only be slowed down to a very limited extent with the right drugs. In severe cases, drugs such as cortisone should to some extent suppress the excessive immune response.
Essentially, the treatment of myocarditis is still about protecting the heart. Let him rest until the inflammation subsides. Doctors still advise athletes to take a six-month break before starting training again. “We haven’t achieved a breakthrough in therapy so far,” says Dirk Westermann.
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Alternatives to the biopsy
However, initial progress has been made in diagnostics. This is difficult because the most common acute symptoms, such as shortness of breath, chest pain, and arrhythmia, can also arise from other heart conditions. They also vary depending on the part of the muscle affected. In addition, in many cases, inflammation develops slowly and is initially only signaled by a fever or digestive problems. So, symptoms that do not clearly indicate heart disease.
If myocarditis is suspected, the most reliable method of diagnosis is to take a tissue sample from the heart. Doctors usually perform a biopsy through a catheter. However, due to the risks involved, only less than one in 10 patients with suspected inflammation is sampled.
- Read also: Myocarditis after COVID-19 vaccination. Scientists showed new data
Therefore, doctors diagnose most affected people with ECG and ultrasound, provided that the appropriate symptoms are present. If patients need to go to the hospital for their symptoms, special magnetic resonance imaging, that is, cardiac magnetic resonance imaging, is sometimes added. The contrast agent that builds up in the area of inflammation then tells doctors where the heart is infected. For now, however, devices are available only in specialized clinics.
Franziska Seidel’s team is working on a testing scheme that will allow a reliable diagnosis in children based on different blood values and imaging test results. – This is one of our goals. So far, however, a heart muscle biopsy has been the gold standard, he says.
However, diagnosis based on blood tests is still a dream. But here too, new discoveries emerge. For example, last summer, Spanish researchers showed that blood samples can be used to distinguish patients who have acute myocarditis from those who have had a heart attack. Scientists have found tiny bits of genetic material that produces immune cells that are especially active in inflammation of the heart muscle.
Immunological markers for early detection
In fact, immune markers may play an important role in diagnostics in the future, according to cardiologist Tschöpe. “But there probably won’t be just one marker, but a lot,” he says. The problem is that depending on the trigger, different immune cells are activated during the disease.
A test is also needed to help predict the course of the disease. Most myocarditis is healed and it becomes fully functional again. Arrhythmias also disappear. However, some cases of the disease leave behind scars that permanently impair muscle conduction and the pumping ability of the blood.
– How to recognize those from 10 to 15 percent patients whose disease is not going well? – asks Tschöpe. They are at risk of developing heart failure. In the meantime, it has become clear that the greatest danger is not the infection itself, but the sometimes excessive immune response. – That is why for the prognosis we need markers that provide information about the balance of the immune response – he explains.
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The most important benefit, however, is the increased public attention. Remember that the danger increases if you do not give your heart enough time to heal. Scars from inflammation of the heart muscle cause one in ten sudden cardiac death in people under the age of 35.
Myocarditis mainly affects young men
Many of the inflammations of the heart muscle are overlooked as they are often mild. Moreover, the diagnosis is very complex. Therefore, no one knew exactly how many people developed myocarditis at all. The American medical journal “JAMA” recently presented one of the most reliable estimates.
- Read also: Why does COVID-19 destroy the heart?
It shows that young men aged 16 to 29 are particularly at risk. In all other age groups and in women, the disease is much less common. In the study, researchers calculated the risk of developing myocarditis in the first week after vaccination against COVID-19, which was not caused by the vaccine itself.
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