Myocarditis Treatment in Singapore

• Clinical assessment:
  • Medical and Cardiovascular Evaluation: A detailed history is taken to identify recent infections, autoimmune disease, medication or toxin exposure, chest symptoms, palpitations, fainting and exercise intolerance. Physical examination assesses heart rate, blood pressure, heart sounds, signs of fluid retention and other evidence of heart failure or systemic disease.
  • Electrocardiographic Assessment: An electrocardiogram (ECG) assesses heart rhythm and identifies electrical abnormalities that may occur with myocarditis.
  • Blood Tests and Biomarkers: Blood tests may include cardiac troponin to detect myocardial injury, inflammatory markers, a complete blood count, kidney and liver function, and electrolyte levels. Clinically indicated additional infectious, autoimmune, or other laboratory investigations may be performed.
  • Assessment of Heart Function: Echocardiography assesses ventricular function, heart chamber size, wall motion, valve function, and the presence of fluid around the heart. It can also help identify complications such as reduced ejection fraction or pericardial effusion.
  • Tissue Evaluation: Endomyocardial biopsy may be considered in selected patients, particularly when severe or rapidly progressive disease requires a specific diagnosis or when certain treatable forms of myocarditis are suspected. It is not routinely required for every patient.
• Imaging Tests:
  • Cardiac MRI: Provides detailed assessment of myocardial inflammation, oedema, tissue injury and fibrosis and is an important non-invasive test in suspected myocarditis.
  • Echocardiography: Evaluates heart structure, pumping function, wall motion and complications such as pericardial effusion.
  • Chest X-ray: May help identify heart enlargement, pulmonary congestion or other chest abnormalities.
  • Cardiac CT: May be used selectively when additional structural or coronary information is required.
  • Coronary Imaging: Coronary CT angiography or invasive coronary angiography may be considered when coronary artery disease needs to be distinguished from myocarditis, particularly in patients presenting with chest pain.

MediRehab (a chain of Rehab centres, part of MediGence) provides comprehensive tele- rehabilitation services designed to support Myocarditis patients in Singapore. These services include:

• Activity Restriction During Active Disease: Strenuous exercise is generally avoided during active myocarditis, and the treating cardiologist determines activity restrictions.
• Gradual Exercise Rehabilitation: Once inflammation and cardiac function have stabilised, a supervised and gradual return to physical activity may help restore endurance and functional capacity.
• Cardiac Rehabilitation: Selected patients with persistent cardiac dysfunction or reduced exercise tolerance may benefit from structured cardiac rehabilitation with monitoring.

• Medicines for myocarditis depend on the underlying cause and the complications affecting the heart. Antimicrobial treatment may be required when a specific infectious cause is identified, while immunosuppressive therapy may be considered for selected autoimmune or immune-mediated forms after appropriate evaluation. Treatment choice depends on the clinical presentation and should be guided by a cardiologist or appropriate specialist.