How long does it take to recover from viral myocarditis?

I’m a 22 yr old male and I’m an athlete (long distance running). Earlier this autumn, I was diagnosed with viral myocarditis. It’s been 5 weeks now and my EF is still only about 25%. I’m on four different meds but my heart is not improving. Can I still hope for a full recovery? How long does it usually take?

Submitted by Jayden from Louisiana on 12/04/2015

by Roberta C. Bogaev, MD

Viral myocarditis can vary dramatically. Some patients may be asymptomatic while others require intensive care in the hospital. It is often diagnosed only after the cardiologist has excluded other possible causes for the systolic heart failure or low EF. Many patients may also undergo additional testing including a cardiac MRI scan to exclude an inherited predisposition to develop heart failure. Nonetheless, medical therapy is the first line treatment for patients who are diagnosed with viral myocarditis and have a low EF.

The mainstay of medical therapy includes beta blockers (carvedilol, metoprolol succinate, or bisoprolol), angiotensin converting enzyme inhibitors (ACE-I) – such as Lisinopril, Ramipril, enalapril, or angiotensin receptor antagonists (valsartan, candesartan, olmesartan), and aldosterone antagonists (spironolactone or eplerenone). Recently the FDA approved a new medication for heart failure, entresto, which is a combination of valsartan and sacubitril. Entresto was studied predominately in Europe and showed a survival benefit over the ACE-I, enalapril. This marks the first new drug for heart failure in the past decade to demonstrate a survival benefit and gain FDA approval.

It takes time to slowly increase these medications to the maximum tolerated dose due to symptomatic lowering of the blood pressure. Once patients reach the maximum tolerated dose, it may take an additional 6-12 months to see an improvement in the EF. The good news is that many patients do improve their EF with medical therapy.

In addition to reduction in the cardiac output of the heart with systolic heart failure, patients are also at risk of sudden abnormal heart rhythms, such as ventricular tachycardia, which can cause sudden death. The current AHA/ACC guidelines require that patients be treated with optimal medical therapy for 3 months or 90 days before considering implantation of a cardiac defibrillator, which can detect ventricular tachycardia and provide a shock to prevent sudden cardiac death. During the 90 day waiting period, patients can wear an external defibrillator, LifeVest, which will monitor for any abnormal heart rhythms and can deliver a life-saving shock.

As an advanced heart failure cardiologist who has been caring for patients similar to you for over 20 years, I would like to give you hope that medications can return your heart to a normal or near normal LVEF. I would encourage you to be compliant with the medications, keep your sodium intake to less than 2000 mg daily, and follow up routinely with your cardiologist. I often refer to these medications as a “heart transplant in a bottle” and wish you a continued recovery of your EF back to normal. Thank you for contacting AAHD.