Myocarditis & Pericarditis Explained: What’s Really Happening to the Heart?

Myocarditis. Pericarditis. You’ve likely heard these terms more in recent years — but what do they actually mean, and how serious are they?

In this episode of Ultra Life Today, board-certified cardiologist Dr. Royce Bargas breaks down:
* The difference between myocarditis and pericarditis
* Why these conditions can be more serious than they sound
* What actually happens to the heart during inflammation
* Whether damage is temporary… or lifelong
* How symptoms show up (and when they don’t)
* What role exercise, lifestyle, and inflammation play in recovery

💡 One key insight: myocarditis involves actual damage to heart muscle cells — and once those cells die, they don’t regenerate. 

We also dive into:
* Troponin testing and what it reveals
* Common causes of chest pain (many not heart-related)
* What recovery and long-term heart health can look like
If you’ve been hearing about these conditions and wondering what’s real vs hype —this episode brings clarity from a clinical perspective.

Listen to the full episode here or watch it on YouTube here: https://youtu.be/PBYkDaSSl3M

Visit UltraBotanica.com to learn more about us and how you can get a free sample of our products.

Transcript

0:00:00 - (Dr. Royce Bargas): Pericarditis is just inflammation of that pericardial sac. Myocarditis. Myo means muscle. And so myocarditis is an inflammation of the actual heart muscle itself. They are two very different things, but they can often go together. In fact, there's a term, myopericarditis, which is when they're both inflamed. So pericarditis is a little bit more common than myocarditis. I looked this up the other day.

0:00:27 - (Dr. Royce Bargas): Two to three people per 10,000 will get pericarditis.

0:00:32 - (Josh Bellieu): Low incidence.

0:00:33 - (Dr. Royce Bargas): One to two per 10,000 will get myocarditis.

0:00:46 - (Josh Bellieu): Hi, everyone. Welcome back to Ultralife today. I'm Josh Bellew. We've got a great guest here. You've seen her before and if you have, that's why you're coming back and telling other people about her. Her name is Dr. Royce Borges. She's a doctor of osteopathy, a board certified cardiologist, does electrophysiology. Not so much anymore. But myocarditis, pericarditis, it's been something we've been hearing about in the legacy media around the country.

0:01:15 - (Josh Bellieu): Is it a new epidemic? What in the world is it? And maybe why are we seeing that? So, Dr. Vargas, welcome once again to Ultra Life today. It is so cool to have you here. I've been hearing about this for a while now. It's something I'd really never heard about until the last four or five years. Can you explain to us what myocarditis and pericarditis are? Do they differ from one another? Causes effects on the heart?

0:01:44 - (Dr. Royce Bargas): Sure. So pericarditis is inflammation of the sac around the heart. So your heart in your chest sits within this fibrous sac, and there's this tiny bit of fluid in the sac between the heart and the sac. And so it allows the heart to kind of move like this. And the sac protects the heart and contains the heart. That's called the pericardium. And so more than 50% of pericarditis is idiopathic. We really don't know why the person got it.

0:02:34 - (Dr. Royce Bargas): Viruses can cause it, bacteria can cause it, sarcoidosis can cause it, cancer can cause it. If cancer infiltrates into the pericardial sac, it can cause a lot of inflammation. Autoimmune disease causes it, like lupus, rheumatoid can cause it. I think those are the big ones for pericarditis. Problems with pericarditis, it's very painful, exquisitely painful. It affects younger people in general. It causes severe Chest pain, you can't lay flat, because when you lay flat, the pericardium will go against the heart. And every time the heart beats, it irritates it. The pericardium is exquisitely sensitive, just like the lungs, lining around the lung is called the pleura.

0:03:25 - (Dr. Royce Bargas): Super important.

0:03:26 - (Josh Bellieu): I've had pleurisy before, so I know exactly what you're talking about.

0:03:29 - (Dr. Royce Bargas): Yeah, pericarditis is like that. And then because it's inflammation, and where there's inflammation, there can be fluid development. You can get a fluid collection in that sac, and that is a very closed space. And your hemodynamic system in your heart cannot tolerate pressure on it. And so if any significant amount of fluid gets in there, if it occurs quickly and the heart has not been allowed to compensate, it can cause problems.

0:03:55 - (Dr. Royce Bargas): The main problem is called tamponade, which is basically where the fluid crushes the heart and it can't fill. And people can faint and have hemodynamic collapse, which is like profound hypotension. It can be bad, and you have to drain the sac. Now, that's a rare complication of pericarditis, but that's really kind of the worst thing that's gonna happen from pericarditis. Myocarditis, again, an inflammation and damage to the heart muscle cell, and the viruses can cause that. Coxsackie B, which is a common cold, viru, is the most common virus that causes it.

0:04:30 - (Dr. Royce Bargas): It's incredibly rare. Like, we all have had Coxsackie B probably at some point, but we don't all obviously get myocarditis. And most of those cases resolve. And then other viruses, not so much bacterial infections for myocarditis. Oh, fungus can actually cause pericarditis, too. And then there's other just toxins in life, like alcohol is a big cause of myocarditis. Cocaine, methamphetamine damage, and inflammation of the heart cells are why those things ultimately can lead to heart failure and a very weak heart muscle.

0:05:06 - (Dr. Royce Bargas): And so when you have inflammation and destruction of the actual muscle cell, then you have weakening of the heart muscle and you can have problems with the electrical system. And so the big acute concern with myocarditis is that you can have a lethal cardiac arrhythmia and have sudden cardiac death. Long term, it can weaken the heart muscle. And if that doesn't resolve, then you're left with heart failure.

0:05:30 - (Josh Bellieu): Okay, you mentioned the word resolve, and so you let me right into my next question. I've. I've heard a lot about myocarditis and pericarditis in the last few years. And I'm wondering, is this an event related thing that people get over and then there's never any issues down the road for that individual? Or are these conditions something that create some level of permanent damage to the heart moving forward?

0:06:00 - (Dr. Royce Bargas): Well, they're two very different conditions. So pericarditis, the vast majority of people with pericarditis resolve and get better. Lasts a couple of weeks. We treat it with super high dose aspirin therapy. Actually it's one of the only things that we still like use super high doses of aspirin for. It usually gets better. Now there is. You can get recurrent pericarditis, which is a problem. It's rare. I have one person in my whole entire practice that has recurrent periodic artitis.

0:06:30 - (Dr. Royce Bargas): And so that kind of stems from something is happening in their inflammatory system that keeps causing that sac to get inflamed and we don't know what. It's a problem. There are some newer medications that can treat it. A lot of these people end up on steroids, which long term steroids are obviously horrible for many aspects of your health. And then the very long term sequelae, something called constrictive pericarditis. And so when that sac around the heart has been inflamed over and over and over again, it gets kind of stiff and it's no longer compliant and doesn't allow the heart to really move around within that sac like it needs to.

0:07:12 - (Dr. Royce Bargas): And that can cause swelling and shortness of breath and just other hemodynamic issues and result in the need actually to get the pericardium removed. Interestingly, people who have had prior heart surgery are kind of protected because we open the pericardial sac to get to the heart and we never close it back up. And so although opening the sac and going in there and operating is actually a risk factor for pericarditis, so is a big heart attack. Because if you get a big heart attack on the outside of your heart, even though the damage has been to the heart muscle, that inflammation can affect the sac around the heart. That's actually not uncommon cause of pericarditis.

0:07:55 - (Dr. Royce Bargas): So myocarditis is very different in my opinion, much more concerning for long term,

0:08:01 - (Josh Bellieu): because that was my thought.

0:08:02 - (Dr. Royce Bargas): If it resolves, then great. And the vast majority of time it does resolve, but sometimes it doesn't and then you're left with myocardial dysfunction. And so you have a weak heart muscle. If you have severe dysfunction, then you maintain this risk of having these malignant arrhythmias that are the most common cause of cardiac death. And a lot of people that have cardiomyopathy is the term for you have a weakened dysfunctional heart muscle long term.

0:08:32 - (Josh Bellieu): So I had listened to an internationally renowned cardiologist. I won't mention the name, but they were the former chair of a very prestigious university in the cardiology, very published doctor. And as it relates to myocarditis, one of the things that I picked up in listening to this doctor was, is it's like, it isn't a nothing burger. Because they were saying that in instances of myocarditis, often there is an actual damage to the heart that then is with that individual for the rest of their life. Is that.

0:09:08 - (Dr. Royce Bargas): Yes. If you. So when a heart cell dies, it will never become live again.

0:09:15 - (Josh Bellieu): And that does happen in the instance of myocarditis. Right?

0:09:18 - (Dr. Royce Bargas): Yeah. Myocarditis implies that heart cells have died.

0:09:21 - (Josh Bellieu): Okay.

0:09:22 - (Dr. Royce Bargas): And the way we diagnose this, diagnose it is by measuring an enzyme in the blood that gets elevated, and the only way it's elevated is if your heart cell has died.

0:09:32 - (Josh Bellieu): Is that the D dimer thing?

0:09:34 - (Dr. Royce Bargas): No, it's called a troponin.

0:09:35 - (Josh Bellieu): Oh, troponin. Yeah. Thank you.

0:09:37 - (Dr. Royce Bargas): A D dimer gets high if you've had any blood clot inflammation.

0:09:40 - (Josh Bellieu): Gotcha. That's right. Okay.

0:09:41 - (Dr. Royce Bargas): Yeah, it's called a troponin. And so that's the enzyme we use to determine have you had a heart attack when classically, like, we're looking for a blockage in your heart artery, but anything that strains the heart enough to have some cells die will leak troponin into the blood and make it abnormal. And so myocarditis certainly leaks troponin into the blood.

0:10:02 - (Josh Bellieu): Okay, so tell me this. How often does a doctor order a troponin test for someone?

0:10:10 - (Dr. Royce Bargas): It is really. It should only be ordered when somebody comes into the ER and they're like, I have chest pain. And we're like, do you have. Are you having a heart attack? Like, that's how we know. I mean, the EKG is obviously, if you're having a big heart attack, you can see it right away. You don't wait for a troponin. But the troponin is really how we determine is there damage to the heart. And we cycle them and follow them serially until they start coming back down. Because how high it goes is directly representative of how much damage did you have to the heart.

0:10:43 - (Josh Bellieu): If an event has been triggered by myocarditis. Are you going to say in pretty much every instance that individual is going to experience some level of pain and discomfort? And so there it would be the sign of, I really do need to go see my doctor.

0:10:59 - (Dr. Royce Bargas): I mean, or does it go on?

0:11:01 - (Josh Bellieu): Does it go undetected? I'm just so curious about that.

0:11:04 - (Dr. Royce Bargas): There's been a lot of hype in the media recently about this asymptomatic myocarditis. I don't really know how much validity there is to that. If, if you have such minimal cardiac damage that you never were, shortness of breath, no chest pain, there's probably not gonna be a lifelong lasting effect of enough damage to your heart. I mean, I don't really know what the long term data shows about that. Classically, we're not really taught about asymptomatic myocarditis. Myocarditis is a pretty serious event.

0:11:48 - (Josh Bellieu): Wow.

0:11:48 - (Dr. Royce Bargas): But when it comes to, can you have a tiny bump in your troponin number and not be symptomatic? For sure.

0:11:58 - (Josh Bellieu): Okay.

0:11:59 - (Dr. Royce Bargas): Okay. In the hospital, people order them all the time. And they will always, not always. They will often be elevated. Like somebody comes in with kidney failure from a kidney stone or something, and their troponin will be high, or they have pneumonia and their troponin will be high. And everybody says they had a heart attack and they didn't have a heart attack. Did they lose a couple heart cells from profound inflammation and low blood pressure, low oxygen, whatever stressor has affected the heart? Yes.

0:12:33 - (Josh Bellieu): Well, it makes sense that other events and other organ systems that might be acute situations are absolutely going to stress your heart. Right. Because it's doing everything. It's doing all the work, it's feeding everything, you know, supplying to everybody. So from a functional medicine perspective, if you have a patient that has, let's, let's just dial in on, on myocarditis, you truly have an individual that has had that kind of event.

0:13:00 - (Josh Bellieu): As a functional medicine doctor, how do you approach that person ongoing to help them manage that event that is obviously had some level of damage on the heart? And I guess that leads me to a question. How do you know how much damage has happened to a heart? You say heart cells die. That seems so general to me. Can you tell that someone had had a much heavier case of myocarditis than someone else? And then how do you manage that from a functional perspective?

0:13:28 - (Dr. Royce Bargas): Well, if somebody had troponins measured during their acute event, then you can tell by how high the Troponin went, how much damage there was to the heart. And then, I mean, in my practice, I would use an echocardiogram to assess their pump function. Like, what is your ejection fraction? How well are all the walls moving in your heart? Now? You can have microscopic scarring that isn't necessarily gonna make the whole anterior wall of your heart or inferior wall of your heart not move. And you can't see it on echo.

0:14:01 - (Dr. Royce Bargas): You can detect scarring by a cardiac mri. And so if you were significantly concerned, you could get a cardiac MRI and look for scarring. But again, I would. If you didn't have a significant enough episode of myocarditis to land you in the hospital with chest pain and shortness of breath, your MRI is probably going to be normal, too, and you're going to just go about your business for the rest of your life and don't get completely fixated on it.

0:14:32 - (Josh Bellieu): Are there other things that create the same kind of symptom that someone might think I've got myocarditis, and yet they really don't, or pericarditis. So what are some other things that would trigger intermittent chest pain for someone, and then it goes away and they don't ever experience it again for years, and then maybe they do again. I mean, I would think stress could tie into that. I feel like I've had some stress events before where I literally.

0:15:00 - (Josh Bellieu): I mean, you were in another episode, we were talking about trauma, and I was thinking to myself, oh, my goodness, I can. I can undergo certain types of stress that create high anxiety. And I feel it all right here.

0:15:13 - (Dr. Royce Bargas): It's like, wow, there are so many different causes of chest pain, it's hard to even list them. I mean, any sort of respiratory issue, if you have any inflammation in your lung, pneumonia, even viral pneumonia, any inflammation in the chest wall, like pleurisy, this can cause chest pain. Super common cause of chest pain is just reflux. Heartburn causes. People think for all the world, they're having, you know, a heart attack, esophageal spasm, not uncommon, and actually relieved by nitroglycerin that we give people that have a heart attack and so they are convinced it's their heart. Without a doubt, it's my heart and it's their esophagus.

0:15:57 - (Dr. Royce Bargas): Anxiety and panic attacks. I mean, there's hardly a panic attack that doesn't come with some level of chest pain.

0:16:03 - (Josh Bellieu): Right. Would mold exposure. Would mold exposure potentially trigger that as well? Or. Not necessarily.

0:16:08 - (Dr. Royce Bargas): It can. The inflammatory response. I mean, you can get every single symptom known to man from mold exposure. I wouldn't. In my practice, chest pain isn't really a common thing. Lots of GI things can cause it. Just musculoskeletal. Like you worked too hard in the yard pulling the trees, and then you get it. Any sort of costochondritis. That's super common. That's just an inflammation of the muscle, the tiny muscle that connects the ribs together.

0:16:37 - (Dr. Royce Bargas): If you can push on your chest and it's like, oh, the pain is right there. That is not your heart. Yeah, I'd say myocarditis is probably the most rare cause of chest pain.

0:16:48 - (Josh Bellieu): Yeah, I think the greatest level of pain I've ever had in my life is on two occasions I bruised my ribs. Close, close enough to almost break them, but they didn't. Oh, my gosh. You really do realize how important breathing is. When you do that, you immediately start doing costal breathing and no deep breathing for a few weeks just to try to get better.

0:17:08 - (Dr. Royce Bargas): Then you get pneumonia because you didn't take a bit, you didn't breathe deep enough.

0:17:13 - (Josh Bellieu): So where does physical activity tie in? Because, you know, the heart and physical activity are so completely married together in a beautiful way. And we know, we know high performance athletes really, really, really stress their heart and yet they have bigger hearts and they're, you know, typically have very incredible cardiovascular health. But how does one who may have had a myocarditis event that may have been significant enough to recognize, okay, we had some, some pretty good damage to the heart.

0:17:46 - (Josh Bellieu): How does that relate to the rest of their life and what they can do in terms of sports performance and exercise and things like that? Is it going to really impinge that? Do they need to be concerned or if they're not in pain, can they just go for it?

0:18:02 - (Dr. Royce Bargas): Well, there's a difference between the acute event and long term. So acutely, you should not do professional athletics if you have acute myocarditis. I think that's pretty clear.

0:18:14 - (Josh Bellieu): And is there a timeout period where you should rest and then.

0:18:18 - (Dr. Royce Bargas): I don't really know. It's been validated, like exactly how long? Certainly if you have any troponin elevation, that means you have ongoing damage to your heart cells. And I would not recommend any sort of high level exercise beyond that if it were my patient. And to be clear, I've actually never seen this patient. That's how rare it is.

0:18:42 - (Josh Bellieu): Right.

0:18:44 - (Dr. Royce Bargas): I would probably say a minimum of three months. Now, the higher level of your activity, you know, high school basketball is Going to be a little bit different than playing for the thunder.

0:18:55 - (Josh Bellieu): Sure.

0:18:55 - (Dr. Royce Bargas): You know, and so you have to be careful about that. You have to take it on a case by case business basis. Are there ongoing echocardiographic changes? Are there ongoing inflammatory changes? Long term, if the whole entire thing completely resolves, your heart function is totally normal. You have no abnormal wall motion. I think you can go back to doing what you previously did.

0:19:20 - (Josh Bellieu): Okay. And you're going to be, I'm assuming as it would relate to diet. So you know, you're probably going to be the normal Roy Spargus that I've come to know and love as it relates to diet is you people to eat the rainbow. Yes. Eat fruits. But be selective about how often you eat fruit. Get sugar out of the way because that's immediately going to have a benefit on the heart. Right.

0:19:43 - (Dr. Royce Bargas): Sure. You want to avoid an inflammatory diet like always. I don't think that we really, the conditions are so rare. We're not going to have any data that says if you eat a steak, your myocard is, I mean we're not gonna, we're never gonna have that kind of data. But you want to eat whole foods and support your immune system and support a robust anti inflammatory process to give your damaged cells the best opportunity to repair themselves and clean up all inflammation and have a clean slate when it's all over.

0:20:22 - (Josh Bellieu): Thank you for the information on myocarditis and pericarditis. You have been listening to Dr. Royce Vargas, Doctor of Osteopathy, Board certified cardiologist, functional medicine specialist. And you can get in touch with her through bargiswellness.com that's B A R G A S wellness.com she does do consults that do not create a doctor patient relationship for those individuals that may be outside the states that she's licensed to practice in. So go to vargas wellness.com I believe you can even get a really cool little, little mini free assessment there on her website.

0:21:01 - (Josh Bellieu): I'm Josh Bailew, that's Dr. Roy Spargus. You've been listening to this is Ultra Life Today. If you like what we're doing, like subscribe and share. It helps us so much. Give us a five star rating wherever you find us for podcasts. La.