Difference between myocarditis and myocardial injury

Written by Tao Kun
Geriatrics
Updated on September 05, 2024
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Myocarditis is inflammation of the myocardial cells caused by a virus that has not been timely cleared following a respiratory or gastrointestinal viral infection. It is a term used for disease diagnosis.

Myocardial injury, on the other hand, refers to the necrosis of myocardial cells due to various factors, including viral myocarditis and myocardial ischemia caused by the narrowing of coronary arteries. Therefore, myocardial injury is a state diagnosis, not a term used for disease diagnosis. Myocardial injury usually leads to elevated levels of troponin.

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Written by Zhou Yan
Geriatrics
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Criteria for Diagnosing Myocarditis

The diagnosis of myocarditis is primarily clinical, based on typical precursor symptoms, corresponding clinical manifestations, and physical signs. The precursor symptoms usually occur one to three weeks before the onset, including symptoms of a viral infection such as fever, general fatigue, and muscle soreness, or gastrointestinal symptoms like nausea and vomiting. Subsequently, symptoms such as chest tightness, palpitations, difficulty breathing, and even fainting and sudden death may occur. The physical signs generally include arrhythmias, commonly premature atrial contractions, premature ventricular contractions, or conduction blocks. There may be an increased heart rate which does not correspond to the body temperature, and there could be the presence of second or third heart sounds or gallop rhythm. A minority of patients may show signs of heart failure. Tests can include electrocardiograms, enzymatic studies, or echocardiograms, and magnetic resonance imaging may show symptoms of myocardial injury. To confirm the diagnosis, an endomyocardial biopsy must be performed.

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Cardiology
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Is myocarditis serious?

Is myocarditis serious? In fact, myocarditis is an inflammatory disease of the myocardium. Patients with myocarditis may experience symptoms such as fatigue, palpitations, shortness of breath, discomfort or pain in the precordial area, nausea, vomiting, abdominal pain, diarrhea, etc. During examinations, we often see slight enlargement of the heart, arrhythmias, gallop rhythm, and other manifestations of heart dysfunction. In severe cases, myocarditis can lead to fulminant myocarditis, such as severe heart failure or cardiogenic shock, often accompanied by arrhythmias. Even with timely and standard treatment, death may occur due to the severity of the condition. Even if patients with myocarditis recover, they may still have some sequelae on the electrocardiogram, such as atrioventricular block, bundle branch block, premature beats, or junctional rhythm.

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The dangers of myocarditis

Myocarditis is an inflammatory disease of the myocardium. Most cases of myocarditis are self-limiting, but if not treated promptly, it can progress to dilated cardiomyopathy. Dilated cardiomyopathy often begins insidiously. Once symptoms appear and the patient enters the stage of heart failure, the condition becomes very serious. Additionally, a minority of patients experience a fulminant onset, leading to acute decompensation or sudden death. Fulminant myocarditis and severe myocarditis progress quickly and have a high mortality rate, thus highlighting the dangers of myocarditis.

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post-myocarditis syndrome

Patients with myocarditis generally have a self-limiting condition; it can heal completely without any treatment. However, sometimes, some myocarditis cases are fulminant, leading to acute heart failure or sudden death. For self-limiting diseases, since the condition is relatively mild, not receiving timely treatment can leave sequelae, such as some dilated cardiomyopathies, which are often due to the transformation from myocarditis. Therefore, for patients with myocarditis, we should follow up and conduct regular reviews to avoid the occurrence of dilated cardiomyopathy.

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Does myocarditis cause a fever?

Myocarditis is an inflammatory heart disease, commonly caused by viral infections, with the Coxsackievirus being the most common. Other infections, such as bacterial, fungal, and Rickettsia, can also cause myocarditis. These infectious myocarditis cases generally show preliminary symptoms of infection, such as fever, in the 1 to 3 weeks before the onset of the disease. Fever indicates a high body temperature, which means the same as having a fever. However, there are also non-infectious forms of myocarditis, such as those caused by drugs, radiation, or connective tissue diseases, and these non-infectious types of myocarditis do not always involve a fever.