ASK THE GP: Was my heart attack really just a nasty bug?
ASK THE GP: Was my heart attack really just a nasty bug? Dr Martin Scurr answers your health questions
Recently, I was in hospital after a suspected heart attack, which turned out to be viral myocarditis. On being discharged I was given no treatment apart from aspirin and no advice. There seems to be very little known about this condition, the opinion being you are lucky to survive as many die. Can you give any more insight?
Deb Dormer, Northampton.
Myocarditis refers to inflammation of the heart muscle and it is often caused by an infection — not just viral, but bacterial or fungal, too.
However, viruses are the most common cause — there are 21 different types that can lead to myocarditis, including adenoviruses, which cause the common cold, and the Epstein-Barr virus, which leads to glandular fever.
Myocarditis can also be caused by an autoimmune disease — when the immune system turns on the body — or toxins such as alcohol, and in some cases, no cause is ever determined.
Health fact: Myocarditis refers to inflammation of the heart muscle and it is often caused by an infection — not just viral, but bacterial or fungal, too
To simplify matters I am going to limit my reply to viral myocarditis.
The symptoms vary depending on the severity of the inflammation: mild cases may go undetected or only cause minimal fatigue, but those with more severe inflammation may experience chest pain, breathlessness, abnormal heart rhythms, ankle swelling and reduced exercise capacity.
These occur as the inflammation tips the heart into what we call failure — but which actually means it becomes inefficient.
Whether this becomes a long-term issue varies from case to case.
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Diagnosing myocarditis is not always straightforward — sometimes the symptoms of the infection that caused the heart to inflame may overshadow any heart failure symptoms.
One example is the Coxsackie virus, which usually causes headache, fever, blisters on the hands and feet, along with mouth ulcers.
Studies have shown that up to 5 per cent of cases have cardiac inflammation when the infection occurs in adults, but mostly this is mild and remains undetected.
Tell-tale signs: The symptoms vary depending on the severity of the inflammation, but can include: chest pain, breathlessness, abnormal heart rhythms and ankle swelling
Write to Dr Scurr
To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details.
Dr Scurr cannot enter into personal correspondence.
His replies cannot apply to individual cases and should be taken in a general context.
Always consult your own GP with any health worries.
Another difficulty is that there are no precise tests to prove the diagnosis save one: an endomyocardial muscle biopsy, an invasive procedure to obtain a piece of heart muscle, which involves a tube being threaded into the heart from an artery in the arm.
On the end is a device with small jaws that takes a sample to be checked for infection or inflammation (it’s not always possible to identify the virus).
During the procedure, pressure can also be measured within the heart to determine how effectively it’s working. However, as this procedure carries a risk of introducing abnormal heart rhythms or infection, it’s restricted to those most seriously ill.
In others, it’s diagnosed from the cardiac symptoms — such as abnormal heart rhythm — coinciding with a viral illness.
If myocarditis is suspected, then detailed investigations to check the condition of the heart will be carried out to assess the level of inflammation and failure: these may include an electrocardiogram (recording the electrical activity of the heart), and echocardiogram (an ultrasound scan of the beating heart) and possibly an MRI scan.
The treatment depends on the severity of the inflammation and the virus behind it.
Bed rest, oxygen, diuretics if the heart failure has led to fluid building up (often around the ankles because blood flow is inefficient), medications to help steady abnormal rhythms, and anticoagulants to help reduce the risk of clots, which increases when the action of the heart becomes sluggish, might be suggested.
For many, once the infection has passed, the heart recovers with no long-term ill effects. Others aren’t so lucky and retain a degree of heart failure.
The fact that you’re home on no medication apart from aspirin is reassuring.
This suggests you were at the mild end of the spectrum with the prospect of making a full and uncomplicated recovery — a great relief.
IN MY VIEW: We should only expect basic care from the NHS…
It is 50 years ago this month that I found myself perched on a stool in front of a corpse covered in a white sheet for my first lesson in human anatomy.
I shared the examination of that corpse with three other first-year medical students and, just as my professor of anatomy, J.Z. Young, had predicted the previous week, 50 per cent of us would ultimately go on to become general practitioners.
But I doubt that ratio still holds true. General practice does not have the appeal it once did. The fact that GPs are as much business managers and administrators as medics, not to mention the burden of rising patient lists, is increasingly putting candidates off.
Much else has changed, too — some to the benefit of our patients: take the Vocational Training Act 1976, prior to which any doctor registered with the General Medical Council could become a GP.
Over the next few years, general practice would become recognised as a specialty, and all entrants had to undergo three years of postgraduate training to gain additional skills needed for the role.
But there is a more tectonic shift taking place: the very principle of the NHS and free health care for all is being undermined by lack of funds and cost-cutting.
A more appropriate phrase, and we had better all get used to it, is free, simple — basic, minimal — care for all, and only when essential. It’s not something my fellow students and I envisaged when I started out in medicine half a century ago, when all we presumed that the future held was progress.
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