How is myocarditis diagnosed?

Written by Zhou Yan
Geriatrics
Updated on March 13, 2025
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Myocarditis is an inflammatory disease of the myocardium, which can be confirmed by the following tests:

Chest X-rays can show an enlarged cardiac silhouette. Electrocardiograms can reveal changes in the ST-T segments, and various arrhythmias may also occur, especially ventricular arrhythmias and atrioventricular conduction blocks. Echocardiography might be normal, or it might show enlargement of the left ventricle and weakened wall motion.

Cardiac MRI is of significant importance for the diagnosis of myocarditis, showing patchy enhancement of the myocardium. Biochemical blood tests can show elevated non-specific inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein, and elevated levels of myocardial enzymes and troponin. Serological testing for viruses can suggest a cause but is not definitive for diagnosis.

Finally, endomyocardial biopsy, besides diagnosing, can also aid in assessing the condition and prognosis. However, it is invasive, so it is generally used only in urgent and severe cases, cases with poor treatment response, or in patients with undiagnosed causes. It is not commonly performed in patients with mild conditions.

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Difference between myocarditis and myocardial injury

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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How is myocarditis treated?

Let's talk about how myocarditis is treated. Myocarditis is actually considered a self-limiting disease with no specific cure. However, treatment generally revolves around symptomatic treatment, combining conventional care and symptom management. For general treatment, bed rest is highly recommended for patients suffering from acute viral myocarditis to reduce the strain on the heart. Patients suffering from severe arrhythmias or heart failure are advised to rest in bed for at least one month and are not allowed to participate in strenuous physical labor for six months. For those without cardiac morphological or functional changes, rest for half a month is recommended, followed by avoiding heavy physical activity for three months. Additional antiviral treatments, such as interferon-alpha and Astragalus membranaceus, may be used; protective cardiac therapies or immunotherapies may also be administered. Symptomatic treatment mainly targets patients with severe heart failure or severe arrhythmias, following conventional treatment protocols for these conditions. For patients with complete atrioventricular block, temporary pacemakers may be used, and permanent pacemakers can be installed depending on the situation if the block cannot be resolved. Depending on the type of arrhythmia, antiarrhythmic medications like beta-blockers, amiodarone, and others may also be used. As each patient's cause of illness, severity, and physical constitution vary, it is essential to undergo personalized treatment under the guidance of a doctor.

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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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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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Is myocarditis nauseating?

For patients with myocarditis, they may experience palpitations, chest tightness, difficulty breathing, various arrhythmias, and edema, and even fainting or sudden death. If the diagnosis of myocarditis includes these conditions, one to three weeks prior to the onset, the patient might have symptoms of viral infections, such as nausea, vomiting, and other gastrointestinal symptoms, or may have fever, general fatigue, muscle soreness, and other discomforts. However, not all cases of myocarditis will have symptoms of nausea, and nausea is not necessarily indicative of myocarditis, therefore there is no inevitable link between the two.