Can monkeypox cause heart-related issues? Here’s what experts say

A 31-year-old male patient with confirmed monkeypox infection, reportedly, developed acute myocarditis days after the eruption of skin lesions, according to a report published in Journals of the American College of Cardiology (JACC) on September 2, 2022. Myocarditis or inflammation of the heart muscle (myocardium) is a condition that can reduce the heart’s ability to pump blood. Additionally, it can cause chest pain, shortness of breath, and rapid or irregular heart rhythms (arrhythmias).
For the unversed, monkeypox is a viral zoonotic disease (a virus transmitted to humans from animals) with symptoms similar to those (seen in the past) in smallpox patients, although it is clinically less severe, according to the World Health Organization (WHO) whose Director-General, Tedros Adhanom Ghebreyesus, PhD, declared the current monkeypox outbreak a Public Health Emergency of International Concern (PHEIC) in July this year.
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Based on the cardiac magnetic resonance study, the case study confirmed myocardial inflammation. Subsequently, the patient was treated with supportive care and had full clinical recovery. But this case highlights cardiac involvement as a potential complication associated with monkeypox, the case study noted.
Monkeypox is caused monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.(Representative/Wiki Commons)
According to Dr Sheela Murali Chakravarthy, director- internal medicine, Fortis Hospital, Bannerghatta Road, Bengaluru, viral diseases evoke an inflammation in the body, both as a cause and effect. “Any organ can get inflamed but the most common are the nerves and the heart as they need lot of energy. This inflammation may, in turn, influence and cause myocarditis (inflammation of heart muscle) causing heart issues and encephalitis (inflammation of the brain),” said Dr Murali Chakravarthy.
So, should everyone be concerned? Dr Ankita Baidya, consultant – infectious disease, HCMCT Manipal Hospital, Dwarka said that just like this “special case study”, the chances are rare in a clinical scenario. “As we see, in the case report, the patient was a special case in the situation that recently covered from covid-19 and was on pre-exposure prophylaxis for HIV,” she said.

She, too, agreed that viral myocarditis is not new, and that chickenpox can also cause it in some complicated cases. “Similarly, monkeypox can also cause myocarditis in the form of viral myocarditis. Patients usually present with severe tachycardia, but it is not very common. So, the concern about monkeypox causing myocarditis is there, but it is not very serious in the current situation,” she said.
Treatment 
The condition may need hospitalisation and ICU monitoring. However, treatment is supportive, mentioned Dr Murali Chakravarthy. Recently, a few studies have suggested that “neuropsychiatric symptoms are not uncommon”. “We are not expecting a tide of serious brain problems, but complications such as encephalitis and seizure may occur in a small proportion of people,” mentioned James Brunton Badenoch, Academic Foundation Doctor, Queen Mary University of London  in the journal eClinicalMedicine.
Know all about monkeypox
Dr Anita Mathew, Infectious Disease Special, Fortis Hospital, Mulund told in an earlier interaction that the symptoms of monkeypox include swollen lymph nodes, lesions, low energy, back pain, skin rashes, fever, muscle aches, and intense headaches.
“Generally, the infected person starts getting a rash on the face which resembles the one a smallpox patient gets. The rash, which starts as a little red elevated region later gets filled with bler-like whitish fluid, before drying up and healing. As the WHO describes it as a ‘self-limited disease’ with symptoms lasting from two to four weeks, the virus is clinically less severe,” said Dr Mathew.
According to a report in the New England Journal of Medicine, before April this year, monkeypox virus infection in humans was seldom reported outside African regions, where it is endemic.
WHO also notes that in the current outbreak, countries and amongst the reported monkeypox cases, “transmission appears to be occurring primarily through close physical contact, including sexual contact”. “Transmission can also occur from contaminated materials such as linens, bedding, electronics, clothing, that have infectious skin particles,” it notes.
“If any individual gets in contact with a person showing symptoms of monkeypox, one should isolate themselves for three to four weeks. Also, we need to continue following hygiene practices like frequent washing of hands, masking, and social dancing. Following correct precautionary measures and proctors will help us control the further spread of the virus,” Dr Mathew advised.
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