myocarditis?

Posted By  CCF Cardio MD-SGM on February 04, 1998 at 23:41:26:

In Reply to: myocarditis? posted by Jeffree Hickman on January 29, 1998 at 18:08:52:

:      Hello! I was diagnosed with myocarditis in mid-Nov. of last year,
  when my EF was 18% and I was really sick. After hospitalization, my Doc
  placed me on lisinopril, lanoxin, and lasix. He is an excellent Doc and
  I like him. As of 1/29/98, my EF has climbed to 29%. My Doc, however,
  has never heard of COQ10 until I told him about it last month, and he has
  been consitantly vague about:
  (1) physical therapy,  
  (2) full recovery (if any),
  (3) the relationship between myocarditis and CHF, i.e., do I have
      CHF now? Am I at risk due to my low EF of contracting CHF in
      the future? and,
  (4) the conditions which existed in instances where full recovery
      has been found.
       I understand that myocarditis is a uncommon ailment, but I haven't
  been able to find ANYTHING definitive on it. Can someone shed light on
  my questions listed above?                      Thank You Sooo Much,
                                                       Jeffree
  my questions listed above?

[CCF Cardio MD-SGM]

Dear Jeffree,
Myocarditis describes a condition of inflammation of the heart.  This can occur in response to numerous viruses as well as a host of other infectious agents.  The initial infection with a virus, for example, results in an inappropriate immunologic reaction that adversely affects the heart muscle, resulting in decreased muscle function (synonymous with low EF).  Myocarditis can assume one of several courses:  Some patients never know they have this problem, and it is identified in hindsight when heart dysfunction of unknown cause is discovered at a later time.  Some of these patients fall into the category of idiopathic--"unknown cause" cardiomyopathy.   Other patients with myocarditis present with severe, fulminant symptoms of heart failure, chest pain, and evidence of recent heart muscle damage on blood testing.  Some of these patients don't survive the initial event.   Others fall somewhere in between these two extremes.  I believe you fit into this last category.
The treatment of myocarditis-induced left ventricular dysfunction is exactly what your doctor has prescribed.  Many other therapies have been proposed, but don't seem to be helpful (some actually worsen the prognosis).  These include immunosuppressive drugs like steroids, cyclosporine, and others.  CoQ10 is discussed in answer to a question posted on this forum on 1/15/98.  Please refer to this for further information.  CoQ10 has not been tested in randomized clinical studies, and its use is thus highly speculative.  There is no evidence to show, even to suggest, that there is any role for this agent in the treatment of myocarditis.  
Traditionally, the recommendation regarding physical activity is to convalesce, or minimize any activity, for six months.  Then, once heart function shows a good return toowards normal, the patient can resume activities... even an exercise program supervised by his cardiologist.  Physical therapy is not indicated until heart function improves.  Many patients achieve full recovery with time (six months to one year after the initial event).  Some see moderate improvement without full recovery.  Finally, some patients suffer a downhill course that doesn't recover.  The fact that your EF has gone from 18% to 29% is highly encouraging, and suggests that you can expect further recovery, and possibly full recovery.  I think this is a very positive sign.   There are no specific conditions that are associated with recovery... this is very much an "watch and see" situation.  Again, the improvement that you've shown is the most positive sign you could have.
Finally, "CHF" or congestive heart failure, is a clinical syndrome that describes symptoms and signs such as shortness of breath, swelling of the legs and ankles, fluid in the lungs on stethoscopic exam, and other findings.  You may indeed have had CHF when you presented with the myocarditis, but I doubt that you have this now given the improvement that you've mentioned.  There is no reason that you would develop CHF in the future unless the heart's pumping function took a downhill course.   This would be detected, however, by serial echocardiograms, and could be treated more aggressively by your physician.  Best of luck.
Information provided in the Heart Forum is for general medical purposes only.  Specific diagnoses and therapies can only be provided by your physician.