From the Guidelines
Yes, viral infections can cause myositis and chest pain, as evidenced by the association of influenza infection with myositis, myocarditis, and pericarditis 1. Viral myositis typically develops during or shortly after respiratory symptoms and may present with muscle tenderness, weakness, and elevated muscle enzymes like creatine kinase in blood tests. Common viral causes include influenza viruses, SARS-CoV-2 (COVID-19), coxsackieviruses, and adenoviruses. When a virus infects the body, it can trigger inflammation in muscle tissues, including those in the chest wall and between the ribs (intercostal muscles), leading to pain that may worsen with breathing or movement. Some key points to consider include:
- The incidence of myocarditis with COVID-19 can be significant, with estimates suggesting it may occur in about 450 per million young adults 1.
- Echocardiographic data suggest that myocardial dysfunction may be present in up to 40% of patients hospitalized for COVID-19, which can range from abnormal ventricular strain to overt left and right ventricular systolic dysfunction 1.
- Treatment for viral myositis is generally supportive, including rest, adequate hydration, and over-the-counter pain relievers such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food).
- Most cases of viral myositis resolve within 1-2 weeks as the viral infection clears. However, chest pain can also indicate more serious conditions like myocarditis (heart inflammation) or pericarditis, so medical evaluation is important to rule out cardiac involvement, especially if pain is accompanied by shortness of breath, palpitations, or fever.
From the Research
Viral Infections and Myositis
- Viral infections can cause myositis, which is characterized by muscle pain and elevated muscle enzymes [(2,3,4,5,6)].
- Benign acute myositis is a mild and self-limited condition that can occur during or following recovery from a viral illness, often presenting with symmetric bilateral lower extremity pain [(3,5)].
- The diagnosis of myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by microbiologic or serologic testing 2.
Chest Pain and Viral Infections
- While the provided studies do not directly address chest pain associated with viral infections and myositis, it is possible that chest pain could occur in conjunction with myositis caused by a viral infection [(2,4)].
- Pleurodynia, caused by coxsackievirus B, is a condition that can cause chest pain and is related to viral myositis 2.
Key Features and Management
- Key features of myositis include sudden onset of lower extremity pain, tiptoe gait or refusal to walk, and symmetric bilateral lower extremity pain 5.
- Management of myositis may include rest and analgesia, and in severe cases, screening bloodwork and a urine myoglobin test may be necessary to confirm the diagnosis and rule out complications 5.