What are the other Names for this Condition? (Also known as/Synonyms)
- Myocarditis, Tubercular type
- Tubercular Myocarditis
- Tuberculosis Myocarditis
What is Tuberculous Myocarditis? (Definition/Background Information)
- Tuberculous Myocarditis (or Tubercular Myocarditis) is an infection-mediated heart condition that results in inflammation of the heart muscles due to tuberculosis. The infection occurs in people worldwide, mostly in the underdeveloped or developing countries
- Tuberculosis (TB) is a contagious infection caused by the bacterium Mycobacterium tuberculosis. The disease is characterized by the formation of nodules (tubercles) in the affected tissues
- The infection spreads primarily through air, when infected individuals sneeze, cough, or even sing or speak. This action causes the release of bacteria into air. All individuals, who breathe the contaminated air can become infected with tuberculosis
- The infection normally affects the lungs (pulmonary TB), although other parts of the body may be affected as well. However, involvement of the heart leading to Tubercular Myocarditis is highly uncommon and not well understood
- Tuberculous Myocarditis may cause chest pain, breathing issues, and congestive heart failure. It may result in complications that include arrhythmias, sudden heart failure, or buildup of fluid around the heart (pericardial effusion)
- The diagnosis of Tuberculous Myocarditis may require a thorough physical checkup by the healthcare provider, blood tests, imaging studies of the heart, and an endomyocardial biopsy. Blood tests and imaging studies may be necessary to diagnose tuberculosis
- The treatment of Tuberculous Myocarditis includes steroid therapy, management of arrhythmias using anti-arrhythmic medication, immunotherapy, and heart transplantation, for severe cases. Tuberculosis disease is treated using antibiotic medication
- The prognosis of Tuberculous Myocarditis may be good with appropriate speedy treatment. Untreated tuberculosis infections with heart involvement are known to be severe and often fatal
Who gets Tuberculous Myocarditis? (Age and Sex Distribution)
- Tuberculous Myocarditis is an uncommon condition associated with tuberculosis. It is estimated that anywhere between 1 in 50 to 1 in 700 individuals with the disease may show involvement of the heart
- Individuals of all ages, races, ethnic groups, and both genders are susceptible to tuberculosis
- TB is common in Asia (India, China, and Indonesia), Africa (specifically sub-Saharan Africa, including Nigeria, Congo, and South Africa), and some South American countries. The infections are fewer in developed countries, such as Australia, Europe, and the USA
What are the Risk Factors for Tuberculous Myocarditis? (Predisposing Factors)
Tuberculous Myocarditis is caused by tuberculosis and the potential risk factors for this bacterial infection include:
- HIV infection
- Previous TB infection; within the last 2 years
- The presence of other health conditions/diseases that make it difficult for the body to fight a bacterial infection (such as diabetes)
- Drug and alcohol abuse
- Elderly adults with weak immune system
- Poverty, poor standards of living, and overcrowding conditions/settlements
- Malnutrition, especially among children
- Prolonged stress can weaken the immune system increasing the risk
- Use of medication that can suppress the immune system (such as corticosteroids and infliximab)
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Tuberculous Myocarditis? (Etiology)
The cause of development of Tuberculous Myocarditis may be due to untreated or poorly-treated tuberculosis. The infection usually involves the lung, but can also occur in other areas of the body.
- Cardiac involvement is extremely rare; the spread of infection to the heart may be through blood or lymphatic fluid
- Since, the involvement of the lungs is seen in most cases, it is believed that the heart may be affected due to its proximity to the lungs
Heart involvement may be in the following manner:
- Military tubercle formation from spread of infection via blood
- Formation of nodular tubercles in the heart (tuberculomas)
- Widespread infiltration of the heart
What are the Sign and Symptoms of Tuberculous Myocarditis?
The signs and symptoms of Tuberculous Myocarditis vary from one individual to another; it may be mild in some and severe in others. Symptoms specific to the heart may include:
- Chest pain and discomfort; acute chest pain can mimic heart attacks
- Fatigue
- Decreased ability to exercise, or decreased exercise tolerance
- Palpitations; abnormal heart beats
- Heart rhythm abnormalities (arrhythmias) including ventricular tachycardia
- If the individual has congestive heart failure, then it can result in shortness of breath, tiredness, and swelling of the extremities
- Inflammation of the heart is observed during both the acute and chronic phase of the disease
Besides the above, tuberculosis may cause a variety of symptoms.
How is Tuberculous Myocarditis Diagnosed?
A healthcare provider may use some of the following methods to diagnose Tuberculous Myocarditis:
- Complete evaluation of family (medical) history, along with a thorough physical examination, including examination of the heart
- The TB skin test, also known as purified protein derivative (PPD) test or tuberculin test
- TB screening blood test, also called interferon-gamma release assay or IGRA
- If the blood or skin TB test is positive, follow-up tests are conducted to confirm latent or active infection:
- Chest X-rays and other imaging studies such as a chest CT scan
- Sputum and blood culture
- Advanced molecular testing on sputum or blood specimen
- Bronchoscopy: A technique for visualizing the insides of the airways for diagnostic purposes
- Blood tests to evaluate the heart:
- Calcium test and vitamin D blood level test
- Angiotensin-converting enzyme blood test
- Erythrocyte sedimentation rate (ESR) test
- C-reactive protein levels in blood
- Cardiac enzyme panel test; tests for cardiac enzymes
- Imaging studies that include:
- Chest X-ray
- Doppler ultrasound: Sound waves are used to measure the speed and direction of blood flow
- CT scan of the heart
- Contrast-enhanced MRI scan of heart
- Positron emission tomography (PET) scan
- Echocardiography, to procure moving pictures of the heart
- Electrophysiological studies, to determine where arrhythmia is getting generated in the heart
- Endomyocardial biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Tuberculous Myocarditis?
Some potential complications of Tuberculous Myocarditis include:
- Abnormal heart rhythms and conduction disorders
- Inflammation of the sac surrounding the heart (called pericarditis) and collection of fluid around the heart (called pericardial effusion)
- Partial or complete heart block
- Sudden heart failure and sudden death
Additionally, complications arising from the underlying tuberculosis infection may be noted.
How is Tuberculous Myocarditis Treated?
Tuberculous Myocarditis may be treated through the following measures:
- Steroid therapy; prescription of anti-inflammatory drugs
- For those with arrhythmias, anti-arrhythmic medication may be administered
- Insertion of a pacemaker for cardiac arrhythmias
- Pericardiocentesis (removal of fluid from pericardial sac) may be performed in case of pericardial effusion
- If the pumping of blood is compromised, heart transplantation may be an option, if deemed necessary by healthcare providers and specialists
- Observation and periodic checkups to monitor the condition is recommended
The treatment for TB infection involves the use of antibiotics to destroy the bacteria causing the infection. The treatment regimen may vary between latent and active infections. It is extremely important to take the full regimen of medications, so that the bacteria may be eliminated from an individual’s body.
How can Tuberculous Myocarditis be Prevented?
Tuberculous Myocarditis may be prevented by promptly diagnosing and adequately treating tuberculosis.
What is the Prognosis of Tuberculous Myocarditis? (Outcomes/Resolutions)
The prognosis of tuberculosis infection is good with treatment using medications, which are taken regularly and for the entire length of the prescribed period.
- The prognosis of Tuberculous Myocarditis is good with early diagnosis and prompt treatment
- However, without adequate treatment Tuberculous Myocarditis is described as a high-mortality heart condition, especially in young individuals with poor immune system. It can result in sudden deaths too
Additional and Relevant Useful Information for Tuberculous Myocarditis:
The following article link will help you understand other heart conditions:
http://www.dovemed.com/healthy-living/heart-center/
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