Pericarditis
The pericardium is the thin sac around the heart. When it becomes inflamed, typically after a viral infection, it causes sharp chest pain that is worse lying flat and on breathing in, and better sitting forward. An ECG often shows characteristic changes and there may be a small collection of fluid around the heart on echocardiogram. Most cases settle within weeks with anti-inflammatory medication, usually ibuprofen or aspirin with colchicine to reduce the chance of recurrence. About one in five people have a second episode, and recurrent or persistent pericarditis needs specialist follow-up and sometimes longer treatment.
Myocarditis
Myocarditis is inflammation of the heart muscle itself. It can follow a viral illness, occasionally a vaccine, or an autoimmune condition, and typically causes chest pain, breathlessness, palpitations or unusual tiredness, with a raised troponin blood test. Because a raised troponin can also mean a heart attack, many people first present to an emergency department and have their coronary arteries checked. When the arteries are normal, cardiac MRI is the test that confirms myocarditis, shows how much muscle is inflamed and whether the pumping function is affected.
How we assess it
- A detailed history of the illness, symptoms and any exercise since
- ECG and bulk-billed echocardiogram to measure heart function and look for fluid
- Cardiac MRI, interpreted by A/Prof Verjans as a Level 3 certified CMR cardiologist, to confirm inflammation, quantify scar and, at follow-up, show that it has healed
- Holter monitoring if there are palpitations, since inflamed muscle can cause rhythm disturbances
- Blood tests for inflammation, troponin and, where relevant, autoimmune causes
Treatment and recovery
Mild myocarditis is managed with rest, avoidance of anti-inflammatories in some cases, and treatment of any reduced heart function with standard heart failure medication until it recovers. The most important advice concerns exercise: current guidelines recommend avoiding competitive sport and strenuous exercise for three to six months after myocarditis, because exercising an inflamed heart increases the risk of dangerous rhythms. Return to sport is guided by a repeat echocardiogram, Holter and, where the initial MRI showed scar, a follow-up cardiac MRI.
Who we see
Patients discharged from an emergency department or hospital with suspected myocarditis or pericarditis, people with recurrent pericarditis, athletes needing clearance to return to training, and anyone with chest pain after a viral illness whose GP wants a specialist opinion. Referrals marked urgent are seen promptly; GPs and ED doctors can send them to HealthLink EDI adelspec.