Viral Myocarditis

[Patricia Prime]

My father was diagnosed with viral myocarditis 3 weeks ago. He has lost 40-45% of his EF, so they believe that he has had this for approximately 2 years.  He is 68 years old and has been active and healthy all of his life.  His symptoms have been few, no edema, no fainting, only a shortness of breath when active.  His doctor's treatment has been supportive in nature, basically treating his symptoms; digoxin, lasix, etc. From what I have read the course of treatment should be identification of the virus and then the use of anti-viral and anti-inflammatory drugs.  The doctor said that there is no reason to identify the virus as there are no drugs to fight virus infections.  Also, the biopsy of the heart would cause too much stress on the heart.  I've read that some of the viruses can be titred from blood and/or stool samples and nasal fluids.  My questions are:
1.  Are there viruses that can be identified this way?  
2.  Are there specific anti-viral drugs that can reduce the titre?
3.  Should we be persuing this more aggressively, treating the source and not just treating the symptoms?
4.  My Dad couldn't take the beta-blocker because it lowered his blood pressure too much, are there other drugs that can shrink the heart?

His next appointment is not until January, I'm wondering if we should be doing something to treat this more aggressively.
Thank you for your time.

[Cleveland Clinic, MD]

Dear Patricia,
Viral myocarditis is more of a "hit-and-run" illness rather than a chronic condition.  You are correct that there are viral titers that can be run and there are actually a few medications that can be used to treat viruses but these all must be done at the time of the viral illness.  Once the initial illness is over (usually in a week or so) the damage has been done and all that is left to do is take care of the damage.  (The only exception to the above discussion is HIV which can cause a myocarditis and can be treated with antiviral drugs though the damage to the heart is not usually reversible)

I think the important thing to be done in your father's case is to exclude treatable causes of heart failure such as coronary artery blockages.  Stress tests can be wrong so I tend to recommend going directly to cath for someone at high risk for coronary artery disease and new onset heart failure.  After this has been excluded then medical treatment (e.g. beta-blockers, ACE inhibitors, aldactone and diuretics) are the best option.  Low blood pressure by itself is not a reason to discontinue medications unless it is accompanied by symptoms such as dizziness or lightheadedness.  Diet and exercise also play an important role in the treatment of heart failure.  If you would like your father to be seen in Cleveland we have a clinic with specialists in the area of heart failure.  You can make an appointment at the "heart failure clinic" by calling the number below.

[Pat]

Thank you for your timely reply.  My Dad did have a catherization and physical abnormalities were excluded; no plaque in the arteries, no valve problems, etc.  The beta-blocker did cause dizziness, which led us to have his blood pressure checked.  I will certainly urge him to seek specialists in this field.  Thanks again for your input.

[C. A.]

Hi there, I have had the same problem. Mine started back in August of 1999, probably before then. Symptoms didn't get real bad until then. I had episodes of feeling very weak, near passing out, low blood pressure, and real slow heart rate (below 50 per minute). I was taken to hospital, checked and admitted. They couldn't find anything physically wrong with my heart there except for the slow rate. I was then set up to see a Cardiologist that came in from out of town. He was there during my stress test, stated that everything was ok and had my Dr. send me home. Before I left hospital, my Dr. put me on what is called an event monitor. It is what saved my life. I went back home, and kept having episodes. It lasted approx. 1-2 months, in and out of the hospital ER during that time. The end of Sept. my Cardiologist started me on a beta-blocker after doing a Cardiac Cath. Stated there was nothing wrong with my heart and that the EF was within normal limits. On October the 14th, 1999, I had a pulse rate below 20 per minute. I was transfered to the nearest major regional center from my Dr's office. I barely made it. I was at home by myself at the time that it happened. It was then that they stated that it was caused by a viral infection which settled in the S-A Node (pacemaker)of the heart. It basically destroyed it and had to have a pacemaker inserted on the 15th of October 1999. I continue to have trouble with Congestive heart failure, episodes of tachycardia, and being tired all the time. I am continuing to be followed monthly by my primary Dr. and the Cardiologist with the pacemaker. I understand what he is going through, I have been there also.
                                                    C.A.