- Carditis is a broad medical term referring to inflammation of the heart, which may involve one or more of its three main layers: the endocardium (inner lining), the myocardium (muscular wall), or the pericardium (outer sac).
- Depending on the site of inflammation, the condition is classified as endocarditis, myocarditis, or pericarditis. In some cases, inflammation may affect multiple layers simultaneously, a condition known as pancarditis. Carditis can arise from infections, autoimmune reactions, toxins, or other systemic diseases, and it often compromises the heart’s ability to function effectively, sometimes leading to serious complications.
- The causes of carditis vary widely. Infectious etiologies are particularly important: bacterial infections such as Streptococcus and Staphylococcus species are major causes of endocarditis, while viruses including coxsackievirus, adenovirus, or parvovirus B19 commonly cause myocarditis. Fungal and parasitic infections, though less common, can also contribute. Non-infectious causes include autoimmune disorders (such as systemic lupus erythematosus, rheumatoid arthritis, and vasculitis), post-infectious immune reactions like rheumatic fever, and exposure to certain medications, toxins, or radiation. In some patients, no clear cause is identified, leading to a diagnosis of idiopathic carditis.
- The clinical manifestations of carditis depend on the specific layer involved but often include chest pain, fever, fatigue, palpitations, and shortness of breath. In endocarditis, patients may present with fever, new or changing heart murmurs, and signs of embolism due to fragments of infected material breaking off and traveling through the bloodstream. Myocarditis may present subtly with flu-like symptoms or progress to arrhythmias, heart failure, or even sudden cardiac death in severe cases. Pericarditis often causes sharp chest pain that worsens with inspiration or lying down and improves when sitting forward, sometimes accompanied by a pericardial friction rub detectable on auscultation. Pancarditis, though rare, is usually severe and life-threatening, as it impairs multiple heart structures simultaneously.
- Diagnosis of carditis typically involves a combination of clinical assessment, laboratory testing, and imaging. Blood cultures are essential in suspected infective endocarditis to identify the responsible pathogen. Electrocardiography (ECG) may reveal arrhythmias, conduction abnormalities, or diffuse ST-segment changes in pericarditis. Echocardiography plays a central role, allowing visualization of heart valves, wall motion abnormalities, or pericardial effusion. Cardiac MRI is particularly valuable in diagnosing myocarditis by detecting inflammation and tissue damage. Blood tests, including inflammatory markers (C-reactive protein, ESR) and cardiac enzymes (troponins), can further support diagnosis.
- Treatment depends on the underlying cause and severity. Infective carditis requires prolonged courses of targeted antibiotics or antifungal therapy, and in some cases, surgical intervention to repair or replace damaged valves. Viral myocarditis often relies on supportive care, including management of heart failure and arrhythmias, since no specific antiviral therapies are widely effective. Pericarditis is usually treated with anti-inflammatory drugs such as NSAIDs, colchicine, or corticosteroids when indicated. Autoimmune-related carditis may respond to immunosuppressive therapy. Severe complications, such as heart failure, pericardial tamponade, or life-threatening arrhythmias, require urgent medical intervention.
- The prognosis of carditis varies according to its type, cause, and the timeliness of treatment. While mild cases may resolve completely, severe or untreated carditis can result in chronic heart disease, such as valvular damage in endocarditis, dilated cardiomyopathy in myocarditis, or recurrent pericarditis leading to constrictive pericarditis. Preventive strategies, including early treatment of infections, prophylaxis for at-risk patients undergoing invasive procedures, and management of autoimmune diseases, are key to reducing incidence and long-term complications.
