Myopericarditis

What is myopericarditis?

Myopericarditis is a heart condition that affects your heart muscle and the protective sac around your heart.

Your heart muscle is your myocardium. An inflamed myocardium is called myocarditis. Your heart’s protective sac, or pericardium, can get inflamed, too. That’s pericarditis.

When both of these happen, but it affects your pericardium more than your heart muscle, it’s myopericarditis. It can be mild to severe. When you have both conditions, but the issue is mostly with your heart muscle, it’s called perimyocarditis.

Myopericarditis vs. pericarditis

People with these conditions have similar symptoms, such as:

• Chest pain.
• Shortness of breath.
• Fatigue.
• Fever.

However, people with myopericarditis more often have abnormal heart rhythms and heart muscle dysfunction. People with pericarditis more often have pericardial effusion.

What are the symptoms of myopericarditis?

Myopericarditis symptoms include:

• Shortness of breath.
• Fever.
• Tiredness.
• Heart palpitations.
• Chest pain that can be sharp and get worse when you breathe in or cough. Chest pain may keep going without a break or get better when you lean forward.

What causes myopericarditis?

Most of the time, healthcare providers can’t find a definite cause of myopericarditis. However, myopericarditis causes include:

• Viruses, including COVID-19.
• Bacteria, including tuberculosis.
• Parasites.
• Fungi.
• Smallpox or COVID-19 vaccines. (Myopericarditis from a COVID-19 vaccine is rare and usually not serious.)
• Hypothyroidism.
• Kidney failure.
• A tumor in your heart.
• Inflammatory diseases (such as lupus, inflammatory bowel disease or rheumatoid arthritis).
• Cancer that has spread to other parts of your body (such as melanoma, breast cancer or lung cancer).
• Radiation to your chest.

What are the risk factors for myopericarditis?

Because providers believe viruses are the most common cause of myopericarditis, having a virus is a risk factor. Viruses that can put you at risk for myopericarditis include herpes, influenza (flu), COVID-19, coxsackie virus, human immunodeficiency virus (HIV) and hepatitis C.

People with myopericarditis are more likely to be men or assigned male at birth (AMAB) and younger than age 40.

What are the complications of myopericarditis?

Possible complications of myopericarditis include:

• Constrictive pericarditis. The risk of this is less than 1% for people with myopericarditis from a viral cause and 20% to 30% for people with myopericarditis from bacterial causes.
• Heart failure.
• A left ventricle (heart chamber) that isn’t working right.
• Abnormal heart rhythms.

How is myopericarditis diagnosed?

A healthcare provider will do a physical exam and order tests. They may make a myopericarditis diagnosis if you have:

• Pericarditis-like symptoms, such as chest pain.
• Pericardial effusion.
• Signs of inflammation in blood test results.
• An abnormal electrocardiogram (EKG).
• Imaging results that show your heart chambers are working right. (If they aren’t, it’s perimyocarditis.)

What tests will be done to diagnose myopericarditis?

Tests to diagnose myopericarditis include:

• Blood tests.
• Electrocardiogram (EKG).
• Echocardiogram.
• Heart MRI (magnetic resonance imaging).
• Chest X-ray.
• Computed tomography (CT).

How is myopericarditis treated?

Depending on your situation, you may need medicines and/or a procedure for myopericarditis management. Also, a healthcare provider may admit you to the hospital.

Specific medicines/procedures used

Myopericarditis treatments may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin® or Advil®). The dose will depend on whether most of your symptoms are in your heart muscle or pericardium.
• Other anti-inflammatory medicines including prednisone and colchicine.
• Heart failure/blood pressure medicines, such as beta-blockers, angiotensin-converting enzyme (ACE) inhibitors or diuretics.
• Pericardiocentesis (draining fluid from your pericardium).

Complications/side effects of the treatment

Possible side effects of the medicines used to treat myopericarditis include:

• Upset stomach.
• Dizziness.
• Loss of appetite.
• Fatigue.
• Dry cough.
• Headache.

Complications from pericardiocentesis may include:

• Infection.
• Injury to your heart, lungs, stomach or liver.
• Injury to the major blood vessels near your heart.

What can I expect if I have myopericarditis?

Your heart will need time to recover from myopericarditis. If you play sports or your condition affected your heart muscle, your provider may ask you to limit your physical activity for up to six months. You should limit your alcohol intake to a maximum of one drink per day.

How long myopericarditis lasts

You may be taking ibuprofen for days or several weeks. It can take four to six weeks to recover from myopericarditis. You should avoid exerting yourself during that time.

Outlook for myopericarditis

The prognosis for myopericarditis is very good. Most people don’t have complications or long-term effects from the condition. After treatment, myopericarditis usually doesn’t return.

How do I take care of myself?

Follow your healthcare provider’s instructions while you recover from myopericarditis. Take medicine as prescribed and go to all follow-up appointments. These visits should happen after one month, six months and one year. These appointments may include:

• An echocardiogram.
• An electrocardiogram (EKG).
• Blood tests.
• A cardiac MRI.

When should I see my healthcare provider?

Contact your provider if you have constrictive pericarditis symptoms, such as:

• Heart palpitations.
• Shortness of breath.
• Swelling in your legs and feet (edema).
• Retaining water.
• Severe swelling in your belly.

What questions should I ask my doctor?

Questions to ask your doctor may include:

• Do you know what caused my myopericarditis?
• How long will I need to take medication for it?
• When will I start to feel better?

A note from Cleveland Clinic

Having chest pain can be unnerving, but getting medical care lets you know what you’re dealing with. With a myopericarditis diagnosis, medicines can help your symptoms. Be sure to keep taking the medicines your provider prescribed. Follow-up appointments are important, too.