Care During Chemotherapy and Beyond
What Is Myocarditis?
Myocarditis is a rare condition that may cause local or widespread inflammation
of the heart (myocardium). Myocarditis can cause irregular heartbeats, but
it may potentially lead to heart failure.
Causes of Myocarditis:
- Infection - from viruses (the most common form of myocarditis),
bacterium, parasites, or fungus
- Chemical - due to drugs or toxic substances that may damage and
cause inflammation to the heart muscle
- Certain diseases - Of the immune system, such as Systemic Lupus
Erythematosus (SLE, or Lupus)
Symptoms of Myocarditis:
- If your myocarditis is caused by infection, you may have fever or chills
- Some people may have no symptoms, or their symptoms may be very mild if caught early
- You may be overly tired, or very weak (fatigued). It may be hard for you to do any
kind of your normal activities.
- Myocarditis often follows a respiratory infection if caused by a virus
- You may have "coughing spells", or a long-term (chronic) cough, if your myocarditis
results in a certain type of heart failure (such as congestive heart failure).
- You may experience sudden or gradual shortness of breath, either at rest or while
performing any type of activity. This may include walking to the door, or climbing
- If you have gradual shortness of breath, you may have trouble lying flat in bed,
and you may have to sleep on 2 or more pillows. Your shortness of breath may cause
you to wake up in the middle of the night.
- Your legs may be swollen, especially in your feet and ankles. You may gain "water"
weight easily, or feel bloated.
- You may feel anxious, or "stressed out." You may feel your heart pounding in your
chest or throat, which may cause pain or mild discomfort. You may also feel your
heart "fluttering," and it may seem as if it is skipping a beat.
- Some people may have chest pain in addition to palpitations, sweating, or feelings
of impending doom. This may be a sign of heart muscle damage, or a heart attack.
The chest pain may range from excruciating, to a mild discomfort. The severity of
pain does not indicate how severe the damage to the heart muscle may be. If you
experience chest pain or palpitations, seek emergency help immediately.
- An EKG, Chest x-ray, and echocardiogram (ECHO) will be preformed. The EKG and ECHO
will often show heart abnormalities, such as an enlarged heart, or problems with
the heart muscle as it squeezes (contracts).
Things You Can Do for Myocarditis:
- Myocarditis may cause your heart muscle to work ineffectively (heart failure), and
may lead to serious problems. If you think you are having a heart attack, with symptoms
of chest pain, irregular heart beats, or palpitations, it is important to seek emergency
assistance immediately. Damage to the heart muscle can be decreased if you act quickly.
It is better to be safe.
- Not all forms of chest pain are life threatening, but it is important that you have
your chest pain evaluated by a healthcare provider. The goal of chest pain is to
relieve the cause.
- Severe shortness of breath needs to be evaluated by a healthcare provider. Do not
wait for it to improve, especially if you are having shortness of breath at rest.
- Make sure you tell your doctor, as well as all healthcare providers, about any other
medications you are taking (including over-the-counter, vitamins, or herbal remedies).
- Remind your doctor or healthcare provider if you have a history of diabetes, liver,
kidney, or heart disease.
- Notify your healthcare provider if you have a family history of heart disease, stroke,
high blood cholesterol, or high blood pressure, in a first or second-degree relative.
- If you experience heart failure as a result of myocarditis, you may be told to reduce
the amount of salt you are eating in a day. Many times, it may be restricted to
about 2 grams of sodium per day. You should discuss this with your healthcare provider
how you can specifically use your diet to control your symptoms of heart failure.
- You should try to exercise, as tolerated, to maintain your optimal level of functioning.
Discuss with your healthcare provider how you can create a specific exercise program
to suit your needs during your illness.
- You should restrict the amount of alcohol you take in, or avoid it all together.
Alcohol may adversely interact with many medications.
- If you are ordered a medication to treat this disorder, do not stop taking any medication
unless your healthcare provider tells you to. Take the medication exactly as directed.
Do not share your pills with anyone. If you miss a dose of your medication, discuss
with your healthcare provider what you should do.
- If you experience symptoms or side effects, especially if severe, be sure to discuss
them with your health care team. They can prescribe medications and/or offer
other suggestions that are effective in managing such problems.
- Keep all your appointments for your treatments.
Drugs That May Be Prescribed by Your Doctor:
Depending on your overall health status and your overall condition, many drugs may be used to treat myocarditis. These include:
- Antibiotics - If your doctor or healthcare provider suspects that
a bacterial infection has caused your myocarditis (not a viral), he or she may order
antibiotics, usually intravenous (IV). If you are prescribed antibiotics, you may
need to be admitted to the hospital unit for evaluation.
- ACE inhibitors - These drugs work by opening, or dilating, your
arteries. They will lower your blood pressure, and improve blood flow to your kidneys,
and through out your body. Your healthcare provider may also prescribe these medications
if you have diabetes or protein in your urine, to protect your kidneys. You may
also receive these drugs if your heart is not working well, as a result of the myocarditis.
Some examples of this medication may include: enalapril maleate (Vasotec®), lisinopril (Zestril®),
and fosinopril sodium (Monopril®)
- Antianxiety medications - If you have symptoms of anxiety,
your healthcare provider may prescribe an anti-anxiety medication, called an anxiolytic. These
medications will help you to relax. These may include lorazepam (Ativan®), or alprazolam (Xanax®).
It is important to take these medications only when you are feeling anxious. Do
not operate heavy machinery, or drive an automobile while taking these. If these
medications do not control your symptoms, discuss this with your doctor.
- Anticoagulants - These medications prevent your blood from clotting.
You may be ordered these medications if your heart is beating irregularly as a result
of your myocarditis. Each of them works in a variety of ways. Depending on your
overall health status, the kind of chemotherapy you are receiving, and the risk
for a blood clot, your healthcare provider may suggest warfarin sodium (Coumadin®), or enaxoparin (Lovenox®).
- Aspirin - depending on your overall health status, and the type
and severity of your irregular heart beat from the myocarditis (arrhythmia), your
healthcare provider may prescribe aspirin as a "blood thinner." Aspirin works by
preventing platelets in your blood from forming blood clots (anti-platelet).
- Beta-blockers - can be used to slow down your heart rate, and improve
blood flow through your body. You may take this drug if you have been diagnosed
with irregular heartbeats, palpitations, thyroid problems, heart failure or high
blood pressure. Some examples of this medication may include: metoprolol (Lopressor®), propanolol (Inderal®),
and atenolol (Tenormin®).
- Calcium Channel Blockers - These medications may be given to treat
chest pain, high blood pressure, or irregular heart beats. A few common drugs include
verapamil HCL (Calan®), and diltiazem (Dilacor
- Diuretics - may be known as "water pills" as they work to prevent
heart failure by making you urinate out extra fluid. Some examples of this medication
may include furosemide (Lasix®), and hydrochlorthiazide.
You may receive this medication alone or in combination with other medications,
if your myocarditis has resulted in heart failure.
- Digoxin - Also called digitalis, this medication works by slowing
down the heart rate, and making it beat more effectively. This will pump blood through
out the body better. It is also called Lanoxin®.
- Vasodilators -are drugs that work by opening up or "dilating" the
vessels. These may include isosorbide dinitrate, or Isordil®.
- Do not stop any of these medications abruptly, as serious side effects may occur.
When to Contact Your Doctor or Health Care Provider:
- Fever of 100.5° F (38° C), chills, sore throat (possible signs of infection).
- Sudden or gradual shortness of breath, chest pain or discomfort; swelling of your
lips or throat should be evaluated immediately
- If you feel your heart beat rapidly (palpitations), and have not noticed this before
- Any new rashes on your skin, especially if you have recently changed medications
- Any unusual swelling in your feet and legs, or weight gain of greater than 3 to
5 pounds in 1 week.
- Any new rashes on your skin
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org