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[[File:Viral myocarditis (1).JPG|300px|thumb|right|Microscopic image of myocarditis, viral and bacterial endocarditis]] '''Myocarditis''' or inflammatory cardiomyopathy is an [[inflammation]] of the [[heart]] muscle.<ref name="Merriam-Webster">{{Cite web | title = Myocarditis|website=Merriam-Webster Dictionary|access-date=Nov 5, 2020|url=https://www.merriam-webster.com/dictionary/myocarditis}}</ref> Myocarditis can be caused by numerous toxic or infectious agents, including [[virus]]es, [[bacteria]], [[fungal infection]]s, or by [[autoimmune disease]] or a chest infection.<ref name="BHF">{{Cite web|url=https://www.bhf.org.uk/informationsupport/conditions/myocarditis | title = Myocarditis | last = British Heart Foundation | first = | authorlink = | date = |website=|archive-url=|archive-date=|url-status=|access-date=Nov 8, 2020}}</ref> [[Coxsackievirus B3]] has been found in 20-25% of patients with cardiomyopathy and myocarditis.<ref name="Tracy1990">Tracy S, Chapman NM, McManus BM, Pallansch MA, Beck MA, et al. (1990) A molecular and serologic evaluation of enteroviral involvement in human myocarditis. J Mol Cell Cardiol 22: 403–414.</ref><ref name="Bowles1986">Bowles NE, Richardson PJ, Olsen EG, Archard LC (1986) Detection of Coxsackie-B-virus-specific RNA sequences in myocardial biopsy samples from patients with myocarditis and dilated cardiomyopathy. Lancet 1: 1120–1123.</ref><ref name="Martin1994">Martin AB, Webber S, Fricker FJ, Jaffe R, Demmler G, et al. (1994) Acute myocarditis. Rapid diagnosis by PCR in children. Circulation 90: 330–339.</ref><ref name="Jin1990">Jin O, Sole MJ, Butany JW, Chia WK, McLaughlin PR, et al. (1990) Detection of enterovirus RNA in myocardial biopsies from patients with myocarditis and cardiomyopathy using gene amplification by polymerase chain reaction. Circulation 82: 8–16.</ref> In mouse models, [[Ampligen]] was found to be protective of Coxsackie B3-induced myocarditis.<ref name="Padalko2004">{{Cite journal | last = Padalko | first = E | date = Jan 2004 | title = The interferon inducer ampligen [poly(I)-poly(C12U)] markedly protects mice against coxsackie B3 virus-induced myocarditis|url=https://www.ncbi.nlm.nih.gov/pubmed/14693549|journal=Antimicrobial Agents and Chemotherapy|volume=48|pages=267-74|via=|issue=| doi = | pmc = | pmid = | quote = }}</ref> More recently, myocarditis has been found in people who have recovered from [[COVID-19]], including some people who were mildly ill or asymptomatic, including professional athletes.<ref name="Kim2020" /> Myocarditis treatment varies from monitoring to anti-inflammatories, antibiotics and more intensive treatments.<ref name="BHF" /> It is a significant cause of sudden cardiac death in professional athletes.<ref name="Rajpal" /> Expert consensus advice has been published for competitive athletes who have tested positive for COVID-19.<ref name="Rajpal" /> Several studies of a mouse model of Coxsackie B3 myocarditis have found that [[exercise]] increases the virulence of the [[infection]] and results in poorer outcomes.<ref name="Cabinian1990">Cabinian AE, Kiel RJ, Smith F, Ho KL, Khatib R, Reyes MR. Modification of exercise-aggravated coxsackie virus B3 murine myocarditis by T-lymphocyte suppression in an inbred model. J. Lab. Clin. Med. 1990; 115: 454– 62.</ref><ref name="Kiel1989">Kiel RJ, Smith FE, Chason J, Khatib R, Reyes MD. Coxsackie B3 myocarditis in C3H/HeJ mice: Description of an inbred model and the effect of exercise on the virulence. Eur. J. Epidemiol. 1989; 5: 248– 67.</ref><ref name="Ilback1988">{{Cite journal | last = Ilbäck | first = NG | date = Jun 1989 | title = Exercise in coxsackie B3 myocarditis: Effects on heart lymphocyte subpopulations and the inflammatory reaction | url =https://www.ncbi.nlm.nih.gov/pubmed/2543197|journal=American Heart Journal|volume=117|pages=1298-302|via=|issue=| doi = | pmc = | pmid = | quote = }}</ref><ref name="Gatmaitan1970">{{Cite journal | last = Gatmaitan | first = Bienvenido | date = June 1, 1970 | title = Augmentation of the Virulence of Murine Coxsackie Virus B-3 Myocardiopathy by Exercise|url=http://jem.rupress.org/content/131/6/1121|journal=Journal of Experimental Medicine|volume=131|pages=1121|via=}}</ref><ref name="Reyes1976">{{Cite journal | last = Reyes | first = MP | date = Feb 1976 | title = Interferon and neutralizing antibody in sera of exercised mice with coxsackievirus B-3 myocarditis|url=https://www.ncbi.nlm.nih.gov/pubmed/1250870|journal=Proceedings of the Society for Experimental Biology and Medicine|volume=151|pages=333-8|via=|issue=| doi = | pmc = | pmid = | quote = }}</ref> ==Signs and symptoms== Common myocarditis symptoms include: *[[dyspnea|shortness of breath]], particularly during gentle [[exercise]] or walking *stabbing pain or tightness in the chest, which may spread across the body *[[flu-like symptoms]] including a [[fever|high temperature]], tiredness and [[fatigue]] *[[heart palpitation]]s or an abnormal heart rhythm.<ref name="BHF" /> Many of these symptoms are also found in people with [[ME/CFS]] who do not have myocarditis.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens| title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref> ==Notable studies== *Oct 26, 2020, Coronavirus Disease 2019 and the Athletic Heart. Emerging Perspectives on Pathology, Risks, and Return to Play<ref name="Kim2020">{{Cite journal | last = Kim | first = Jonathan H. | last2 = Levine | first2 = Benjamin D. | last3 = Phelan | first3 = Dermot | last4 = Emery | first4 = Michael S. | last5 = Martinez | first5 = Mathew W. | last6 = Chung | first6 = Eugene H. | last7 = Thompson | first7 = Paul D. | last8 = Baggish | first8 = Aaron L. | date = 2020-10-26 | title = Coronavirus Disease 2019 and the Athletic Heart|url=https://jamanetwork.com/journals/jamacardiology/fullarticle/2772399|journal=JAMA Cardiology|language=en|doi=10.1001/jamacardio.2020.5890|issn=2380-6583}}</ref> - [https://jamanetwork.com/journals/jamacardiology/fullarticle/2772399 (Full text)] ==News articles, letters and blogs== *Aug 2020, [https://www.scientificamerican.com/article/covid-19-can-wreck-your-heart-even-if-you-havent-had-any-symptoms/ COVID-19 Can Wreck Your Heart, Even if You Haven’t Had Any Symptoms] - Scientific American *Sep 11, 2020, [https://www.heart.org/en/news/2020/09/11/a-closer-look-at-covid-19-and-heart-complications-among-athletes A closer look at COVID-19 and heart complications among athletes] - Genaro C. Armas, American Heart Association News *Sep 11, 2020, [https://jamanetwork.com/journals/jamacardiology/fullarticle/2770645 Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection]<ref name="Rajpal">https://jamanetwork.com/journals/jamacardiology/fullarticle/2770645</ref> - Saurabh Rajpal, Matthew S. Tong, James Borchers, Karolina M. Zareba, Timothy P. Obarski, Orlando P. Simonetti, Curt J. Daniels. JAMA Cardiology. == Learn more == *[https://www.bhf.org.uk/informationsupport/conditions/myocarditis Myocarditis - British Heart Foundation] ==See also == *[[Post-COVID-19 illness]] *[[COVID-19]] *[[Long COVID]] *[[Heart]] * [[Roger Cicero]] == References == {{Reflist}} [[Category:Potential comorbidities]] [[Category:Cardiology]] [[Category:Diagnoses]]
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