OVERVIEW

What is tuberculous myocarditis?

Tuberculous myocarditis, also known as myocardial tuberculosis or tuberculous cardiomyopathy, is an inflammatory reaction caused by toxins produced by Mycobacterium tuberculosis entering the bloodstream and damaging myocardial cells.

Pulmonary tuberculosis is a rare cause of myocarditis, but once tuberculous myocarditis occurs, the mortality rate is relatively high. Symptoms may include palpitations, chest tightness, fatigue, and other discomforts. It often coexists with active pulmonary tuberculosis and usually requires aggressive anti-tuberculosis treatment.

Is tuberculous myocarditis common?

It is uncommon and more likely to occur in young adults. The prevalence of tuberculous myocarditis in men is twice that in women.

Is tuberculous myocarditis serious?

The severity of tuberculous myocarditis depends on the extent and degree of myocardial damage. In severe cases, it may lead to cardiac insufficiency or even life-threatening cardiogenic shock.

Is tuberculous myocarditis contagious?

Tuberculous myocarditis itself is not contagious. However, patients with tuberculous myocarditis often also have active pulmonary tuberculosis, which is contagious and typically spreads through airborne droplets.

SYMPTOMS

What are the common manifestations of tuberculous myocarditis?

The clinical manifestations of tuberculous myocarditis are similar to other types of myocarditis:

• Arrhythmia: Symptoms may include palpitations, chest tightness, or discomfort. In severe cases, transient blackouts, sudden fainting, or even convulsions may occur.

• Heart failure: Symptoms may include difficulty breathing, fatigue, loss of appetite, and in severe cases, inability to lie flat.

• Cardiogenic shock: Manifestations may include restlessness, lethargy, pale skin, cold and clammy limbs, profuse sweating, nausea, and vomiting.

• It is often accompanied by pericarditis or pleuritis, leading to chest pain.

What severe consequences can tuberculous myocarditis cause?

Similar to other forms of myocarditis, tuberculous myocarditis can lead to severe heart failure or even sudden death. Critically ill patients often succumb to cardiogenic shock.

CAUSES

Who is commonly affected by tuberculous myocarditis?

Tuberculous myocarditis primarily occurs in tuberculosis patients, most frequently affecting young adults (12-40 years old), with males being more susceptible than females.

It mostly coexists with active pulmonary tuberculosis and rarely occurs as isolated tuberculous myocarditis. The incidence is relatively higher in cases of acute hematogenous disseminated tuberculosis and tuberculous serositis.

DIAGNOSIS

Under what circumstances should tuberculosis patients consider tuberculous myocarditis?

Tuberculosis patients who suddenly experience palpitations, chest tightness, or syncope should consider the possibility of tuberculous myocarditis.

What tests should be performed to diagnose tuberculous myocarditis?

• Electrocardiogram (ECG): To detect arrhythmias, etc.;

• Myocardial injury markers: Elevated levels may be observed;

• Cardiac ultrasound or cardiac magnetic resonance imaging (MRI): To identify structural abnormalities in the heart;

• Myocardial biopsy: Can be used to confirm tuberculous myocarditis.

How should tuberculous myocarditis be diagnosed?

• Presence of tuberculosis symptoms such as fever, fatigue, and night sweats.

• No prior history of heart disease, but symptoms such as palpitations, chest tightness, dyspnea, tachycardia, and lower limb edema appear.

• ECG shows ST-T changes, arrhythmias (atrioventricular block, intraventricular block, abnormal Q waves, supraventricular tachycardia, etc.).

• Elevated myocardial injury markers.

• Imaging tests (echocardiography or cardiac MRI) reveal structural or functional abnormalities in the heart.

• Exclusion of myocardial damage caused by other conditions such as viral myocarditis, cardiomyopathy (hyperthyroid cardiomyopathy, alcoholic cardiomyopathy, etc.), coronary artery disease, or anemia.

• Symptoms and signs improve with anti-tuberculosis treatment.

TREATMENT

Which department should I visit for tuberculous myocarditis?

The vast majority of patients with tuberculous myocarditis also have active pulmonary tuberculosis and should seek treatment at the respiratory department or a chest hospital to receive active anti-tuberculosis therapy.

For cases where tuberculosis affects the heart, causing myocardial damage with arrhythmia or cardiac insufficiency, consultation with the cardiology department should be requested for collaborative treatment.

How should tuberculous myocarditis be treated?

• Active treatment of tuberculosis: The use of anti-tuberculosis drugs should follow the principles of early, combined, appropriate, regular, and full-course therapy.

• Application of myocardial-nourishing drugs to improve myocardial cell metabolism.

• For patients with heart failure, anti-heart failure medications such as diuretics should be used to reduce cardiac load and improve heart function.

• Patients with arrhythmia may receive anti-arrhythmic drugs. Those with severe sinus node dysfunction or high-degree atrioventricular block should consider pacemaker implantation.

DIET & LIFESTYLE

Can patients with tuberculous myocarditis work or exercise normally?

Patients with tuberculous myocarditis are not advised to work. They may engage in low-intensity activities such as moderate walking but should avoid overexertion.

What should patients with tuberculous myocarditis pay attention to in daily life?

• Patients should focus on improving nutrition, maintaining a positive mood, and following a regular routine to ensure adequate sleep.

• Avoid triggers of acute heart failure such as fatigue, catching a cold, or emotional stress.

• Take medications as prescribed, do not stop treatment without medical advice, and attend regular follow-ups.

PREVENTION

How to prevent tuberculous myocarditis?

• Maintain a balanced diet and improve physical fitness to avoid malnutrition or weakened immunity. Avoid close contact with tuberculosis patients to prevent Mycobacterium tuberculosis infection.

• If tuberculosis diseases such as pulmonary tuberculosis are detected, seek timely treatment to control disease progression.