Heart Inflammation (Carditis)

Carditis (heart inflammation) is a condition that happens when your heart is hurt or infected. This can happen to your heart’s muscle, the sac around your heart or the lining of your heart’s chambers.

For some people, inflammation of the heart happens without warning. For others, it takes longer. Some people have severe symptoms, while others barely have any symptoms. The degree of inflammation can also vary from person to person, depending on individual factors and causes.

Types of this condition

Carditis affects three different areas of your heart. All three types of heart inflammation are rare:

• Endocarditis: Bacteria infect the lining of the heart chambers your blood goes through and the valves that control blood flow between those chambers. It can go to other parts of your body and infect those areas, too.
• Myocarditis: This harms the muscle that makes your heart pump. Inflamed heart muscle has a harder time pumping blood.
• Pericarditis: This affects the sac (pericardium) around the outside of your heart. When inflamed, your pericardium’s two layers get thicker. They also brush against each other and your heart muscle.

Symptoms of carditis

Common symptoms for all three types of heart inflammation include chest pain, shortness of breath and fever.

Other signs of carditis are more specific to the type you have, like:

• Pain in your belly, blood in your pee or night sweats (with endocarditis)
• Swelling in your legs or feet, heart palpitations or extreme tiredness (with myocarditis)
• A fast heartbeat and chest pain that gets better when you sit up and lean forward (with pericarditis)

When a virus causes heart inflammation, you can have symptoms from the virus first.

Carditis causes

Infections — usually from viruses or bacteria — cause most cases of heart inflammation. These can range from HIV or COVID-19 to herpes and others. Lyme disease bacteria can lead to Lyme carditis. Rheumatic fever can cause rheumatic carditis.

Other causes of an inflamed heart include:

• Autoimmune diseases like rheumatoid arthritis or lupus
• Chest injury or trauma
• Harmful things in your environment, like lead
• Medicines for depression, seizures, certain heart issues or cancer
• Medical problems like a heart attack, cancer or uremia

Risk factors

People in any age group can get heart inflammation, but it’s more common in males. Certain medical issues or treatments put you at a higher risk of an inflamed heart. These include:

• Diabetes
• HIV/AIDS
• Eating disorders
• Procedures that require a catheter in your vein
• Radiation therapy for cancer
• Heart devices like pacemakers or replacement valves
• Open-heart surgery

How to lower your risk

You can’t change your age or the medical conditions you have that put you at risk for heart inflammation. But there are a few things you can control, including:

• Limiting how many beverages with alcohol you drink
• Not using recreational IV drugs.
• Taking good care of your teeth
• Keeping your skin clean to prevent infections

If you’re at high risk for endocarditis, your healthcare provider can prescribe antibiotics. You take these before going to the dentist or having surgery. You’re at high risk if you’ve had endocarditis before, had a valve replaced or have had a specific heart issue since birth.

You can get carditis more than once, so be on the lookout for symptoms.

Complications of this condition

A mild case of pericarditis or myocarditis can go away on its own. But some complications of heart inflammation are serious and can be life-limiting. Without treatment, heart inflammation can cause:

• Blood clots
• Coronary heart disease
• Heart muscle disease (cardiomyopathy)
• Heart failure
• Abnormal heart rhythms
• Fainting
• Worse infections that can spread throughout your body (from endocarditis)
• Lung problems (from myocarditis)
• Too much fluid building up around your heart (from pericarditis)

How doctors diagnose carditis

To detect carditis, your healthcare provider will perform a physical exam and collect your medical history. They’ll do blood tests and other tests to help them rule out a heart attack and find the infection’s source. Your provider will also check for fluid around your heart. They’ll look at how well your heart is functioning and see if it’s working normally.

Tests include:

• Cardiac computed tomography (CT)
• Chest X-ray
• Electrocardiogram (EKG)
• Echocardiography
• Heart MRI
• Positron emission tomography (PET) scan

How is it treated?

Treatment for carditis varies. Medications can help you fight infections and keep your immune system and heart from working too hard. If you have more serious complications, you may need procedures or medical devices.

Medicines

Medicines for heart inflammation may vary depending on which part of your heart is inflamed. Medications you take may include:

• Corticosteroids
• Antibiotics
• Antifungal drugs
• Anti-inflammatory drugs
• Heart failure medicines
• Blood thinners
• IV immunoglobulin

Procedures

For some cases of carditis, you may need a procedure or surgery to:

1. Drain extra fluid (pericardial effusion) from your pericardium or remove part of the sac
2. Remove an infected device or tissue
3. Put in a pacemaker, ICD or left ventricular assist device (LVAD)
4. Perform a heart transplant

When should I see my healthcare provider?

Contact your healthcare provider if you get any new symptoms while you’re recovering. Since chest pain is a common symptom of carditis and a heart attack, you may not know which one is happening. To be safe, call 911 (or your local emergency service number) if you’re having chest pain.

When you visit your provider, you may want to ask:

• Which type of heart inflammation do I have?
• Do you know what caused it?
• Which treatment is best for me?

What can I expect if I have heart inflammation?

It can take several weeks or years to recover from some types of heart inflammation. Once you see your healthcare provider, be sure to follow their instructions for taking medicines they prescribed. You’ll also need follow-up appointments throughout your recovery. These may include repeat blood tests or imaging.

Follow-up visits are important because carditis can come back months or years later.

Carditis can be mild, life-threatening or somewhere in between. The prognosis (outlook) is generally good when you get treatment quickly. You might not even need treatment for a mild case. After treatment, you might not have issues, or you might still need medicine. You may need a heart transplant at some point.