COUGHING, sneezing, sore throat, nasal congestion, fever and joint pains. The annual common cold season is upon us yet again! Causative viruses such as rhinovirus, coronavirus, influenza and adenovirus circulate widely between the months of October and May every year, infecting millions globally and wreaking havoc in homes, schools and workplaces. This year we have a new nuisance — the novel coronavirus (COVID-19), which up to Friday had infected over 64,000 people and caused over 1,300 deaths. The mortality associated with the novel coronavirus belies the fact that viral infections are not always benign. Today, let us examine one of the most feared complications of viral infections — that of viral myocarditis.
Melissa was bright, vivacious and promising. She was in her second year at a local tertiary institution and had aspirations of pursuing a career in hotel management. After final exams, she travelled to the American midwest on an overseas work-study programme. While there, she developed flu-like symptoms which, of course, she ignored. It was, after all, just a common cold and colds are only supposed to last a few days in young, healthy people. But unfortunately, Melissa got worse by the day. Two weeks into her illness, she developed chest pain and shortness of breath. She could no longer lie flat and now had to sleep propped up on two pillows.
She also had leg swelling, abdominal pain and a cough productive of pink, frothy sputum. Melissa saw a physician who dropped a bombshell — the virus she had contracted had caused severe weakness of her heart muscle with resulting heart failure. She was admitted to the intensive care unit. But it was too late. Several weeks later, Melissa was pronounced dead. She was only 24 years old. The cause of death was viral myocarditis.
Viral myocarditis — what is it?
Respiratory viruses enter the body when infected secretions come into contact with cells lining the mouth, nose or upper airways. The viruses enter these cells and replicate rapidly. Eventually the infected cells rupture and release viral particles into adjacent tissue where the process repeats. Some also enter the bloodstream and circulate to distant tissues and organs where they continue on their path of destruction. Viral myocarditis is a rare complication in which the primary affected tissue organ is the heart muscle.
Meanwhile, the immune system tries to contain the infection by recruiting white blood cells to the infected areas. But unfortunately, some of these white cells, in the course of trying to destroy the viruses and viral infected tissues, add to the destruction of normal tissue. In the case of the heart, the heart muscle weakens. Heart failure, abnormal heart rhythms, cardiac arrest and in rare cases, death, ensues.
What are its symptoms?
Typical symptoms of viral myocarditis include fever, sore throat, nasal congestion, cough, joint and muscle pain followed weeks later by the development of chest pain, shortness of breath, fatigue, leg swelling, palpitations and dizziness.
How is it treated?
Patients with viral myocarditis and heart failure are treated initially with drugs which relieve shortness of breath and limb swelling. These are known as diuretics (water pills) and they work by forcing the kidneys to excrete large amounts of urine. Gradually, other drugs are introduced which work at a cellular level to slow the heart rate or to block the formation of toxic metabolites. By so doing, they prevent further complications, prolong life and prevent death.
While most patients with viral myocarditis will recover fully, some, like Melissa, will not. They will instead require advanced therapies such as pacemakers, defibrillators, mechanical artificial hearts and in extreme cases, heart transplantation.
As we negotiate yet another inevitable “common cold” season, let us be aware of the complications which may attend the common cold. Secondly, let us take the necessary precautions to mitigate its impact on our lives and those of our loved ones.
Dr Handel Emery is a consultant cardiologist at the Winchester Heart Centre.