Can Myocarditis Come Back (Prognosis)

Myocarditis, an inflammation of the myocardium (heart muscle), is quite rare. The outcome (prognosis) varies, depending on several factors especially such as your overall health and the cause of the disease. And after treatment, you may wonder whether the disease will come back?!

Risks to concern

Sometimes left untreated inflammation of myocardium can become severe enough to interfere with the heart function. It may cause the heart work harder to pump blood around the body. When your heart doesn’t work in the way it should, you may experience difficulty breathing, fluid retention (edema), abnormal /rapid heart rhythms (arrhythmias), or other symptoms of heart failure.

Myocarditis could be potential to significantly decrease the quality of your life – this particularly true if the disease persists and left untreated.

A weakened heart cannot supply enough blood and oxygen to the kidneys, brain, and other organs. This may drive more fluid to easily build up in the heart and lungs, making you even more difficult to breathe!

In rare cases, the disease turns into serious and might cause emergency conditions such as:

  1. Cardiomyopathy, abnormal or weakened heart muscle.
  2. Pericarditis, inflammation of pericardium (the sac covering the heart).
  3. Heart failure. If myocarditis worsens and left untreated, the myocardium might fail to work – so does the heart.
  4. Stroke or heart attack. If the heart can’t pump blood normally, you’re at high risk of developing blood clots. Stroke can occur if a clot forms in the blood vessel that carries blood to the brain. The blood may also pool in the heart and form a clot in one of the heart arteries, resulting in a heart attack.
  5. Over time, arrhythmias-related to myocarditis may turn into serious and stop the heart from beating. If left untreated, this can cause a sudden cardiac death.

Depending on the severity of the disease, the heart may continue to weaken with or without treatment. The heart function may not go back to normal after the disease. As a result, the patient may require a heart transplantation and long-term medical therapy. In fact, myocarditis is one of the leading causes for heart transplants.

Can myocarditis come back?

Treatment options are dependent on the cause and symptoms. If the disease is caused by infection (viral, bacterial, or fungal infection), treating this underlying infection is important to promote quick recovery. If it’s linked to chronic inflammatory disease (rheumatoid arthritis or lupus for example), treatment is focused at this underlying disease.

Since there is a chance for the disease to turn into serious, it’s important to avoid activities that can make your heart work harder (such as competitive sports) even though if your myocarditis is mild. Take adequate rest, and if necessary ask your doctor for any medicine to help ease the symptoms.

Your doctor may prescribe some of the following medications to help decrease the workload of your heart until you gain a complete recovery (especially if your heart is weak);

  1. Medications to help relax the arteries such as ARBs (angiotensin II receptor blockers) and angiotensin-converting enzyme (ACE) inhibitors.
  2. Beta blockers to treat arrhythmias and prevent heart failure.
  3. Diuretics to relieve fluid retention.

More aggressive treatments may be required for severe myocarditis. These include;

  1. Intravenous (IV) medications to provide a quick relief for the heart-pumping function.
  2. If necessary, doctors may need to use particular devices to help support the heart function such as ventricular assist device, intra-aortic balloon pump, or ECMO (extracorporeal membrane oxygenation).
  3. And a heart transplantation, typically for most severe cases.

The good news, myocarditis is usually mild and doesn’t cause serious problems. Many patients can have a complete recovery without long-term negative health effects. Even in some cases, it may improve on its own and you may never even know you had it.

It is often treated successfully, leading to a complete healing. But this doesn’t mean we can underestimate myocarditis, because there is a chance for the disease to get worse and lead to some serious complications as mentioned above.

Another challenging question, will the disease come back?

The disease might come back months or years later. However in general, the rate of myocarditis recurrence is low (probably around 10-15 percent). We can say that the disease doesn’t return in most cases.

The chance for the disease to return might depend on several factors.

  1. The underlying cause of the disease can play a role for the outcome (prognosis). For example, myocarditis could occur more than once (chronic) if it’s linked to particular chronic condition such as rheumatoid arthritis, particularly if this underlying condition is poorly controlled.
  2. The severity of the disease. When the disease has become advanced or has caused some complications, it’s more difficult to treat and you’re less likely to have a complete recovery.
  3. Overall health of patients.

Since myocarditis is not common (rare), it’s not fully understood yet. Information is also limited regarding its effective treatments and preventions. But though there is no specific information to prevent the disease (including its recurrence), the following steps might help: