Was inflammation the muscle, lining?

Dear Dr. Roach: In September 2017, my son, then 17, was rushed to a nearby children’s hospital and ultimately diagnosed with myocarditis, but did not have a biopsy. Hewas given an infusion ofimmuneglobulin that left him quite ill for about 10 hours. Upon discharge the pediatric cardiologist reassured us that my son was free of this.

In January 2020, my son returned to the emergency room in considerable pain and was diagnosed with pericarditis. Can he get pericarditis again?— J.A.

Myocarditis is an inflammation of the heart muscle. It is caused commonly by infection. In a 17-year-old, viruses are the most common infections. The symptoms are nonspecific: fever and not feeling well during the virus phase, followed by symptoms of poor heart function when the heart is affected. The diagnosis is suspected when blood tests show injury to the heart. Abnormal heart rhythms are dangerous.

Pericarditis is an inflammation of the tough fibrous sac around the heart, the pericardium. Like myocarditis, pericarditis is most common in association with a viral infection, but can have other causes. The major symptom of pericarditis is chest pain. The electrocardiogram can serve to identify the inflammation. Colchicine and anti-inflammatory drugs are the mainstays of treatment, but symptoms usually go away by themselves.

I suspect your son had an overlap syndrome, called myopericarditis. This has elements of both inflammation of the heart muscle and the pericardial sac. In this condition, which is also caused by viruses most frequently, the blood enzymes showing heart injury will be positive, causing the physicians to think it ismyocarditis. The EKG should showpericarditis.

Although pericarditis can recur, treatment with colchicine reduces this.