Clinical Specialties

Myocarditis: The diagnosis of myocarditis refers to inflammation of the heart, which may be caused by a virus or other triggering factors. It often involves an autoimmune reaction that, in some cases, requires medications to suppress the immune system.

The majority of myocarditis cases recover well. However, more severe cases may necessitate closer monitoring, intensive therapy, and more frequent follow-ups. Following myocarditis, it is strongly advised to avoid intense physical activity for at least three months, as the risk of exercise-induced arrhythmias and worsening of the condition has been documented in medical literature. Dr. Heidecker and her team conducted the first human study on resuming sports after three months and observed no medical complications after this period.

For additional information about myocarditis, you may find the website of the Myocarditis Foundation helpful. Dr. Heidecker serves as a member of the foundation’s Board of Directors.
Sarcoidosis: Sarcoidosis is a disease characterized by the accumulation of inflammatory cells (the body’s defense cells) forming round-shaped granulomas, which can occur in any part of the body. As cardiologists, we treat patients with cardiac involvement, although the disease most commonly affects the lungs and lymph nodes.

The exact cause of sarcoidosis remains unknown, but it is suspected to result from an immune response to environmental factors such as dust, chemicals, or infectious agents. Many patients also report experiencing significant stress prior to the onset of the disease, which is a known trigger for autoimmune conditions.

Sarcoidosis is treatable, but early diagnosis is essential for preventing irreversible damage.
Amyloidosis: Amyloid is a misfolded protein that can accumulate in various organs, including the heart. In our clinic, the most common types we encounter are transthyretin amyloidosis (ATTR) and light chain amyloidosis (AL). Protein deposition in the heart causes stiffness, which can lead to heart failure and arrhythmias.

Proper medical therapy, often requiring frequent dose adjustments, is crucial for managing a patient’s clinical course. When there is reasonable suspicion of cardiac amyloidosis, endomyocardial biopsy is the preferred diagnostic tool due to its very high sensitivity and specificity (nearly 100%). If the suspicion is low, imaging may be performed first.

Amyloidosis often affects the nervous system as well. For this reason, we work closely with our neurology team, who can evaluate you with your consent. If you are diagnosed with AL amyloidosis, we will promptly arrange an appointment with our hemato-oncologist to ensure effective treatment is initiated without delay.
Cardiooncology and Checkpoint Inhibitor Induced Myocarditis: Cardiooncology focuses on the care of patients with heart disease or those at risk of developing it before, during, or after cancer therapy. The primary goal is to deliver the most effective cancer treatment while minimizing the risk of cardiovascular complications.

This field requires close interdisciplinary collaboration between cardiologists and hematologists or oncologists. A specific and emerging area within cardiooncology is checkpoint inhibitor-induced myocarditis. Checkpoint inhibitor therapy aims to enhance the immune system’s ability to fight advanced cancer by “disinhibiting” it, enabling a stronger response against metastatic disease.

However, this enhanced immune activity increases the risk of autoimmune reactions, including myocarditis — an inflammation of the heart muscle. If checkpoint inhibitor-induced myocarditis occurs, immediate referral to a specialized center is critical for ensuring the best possible outcome for the patient.
Hypertrophic Cardiomyopathy (HCM): HCM (Hypertrophic Cardiomyopathy) is a condition characterized by abnormally thickened heart muscle cells, a process known as hypertrophy. As a result, the walls of the heart become thicker and stiffer.

This can sometimes make it more difficult for the heart to pump or relax properly, causing symptoms such as chest pain. In more advanced stages, patients may develop fluid accumulation (edema) in the legs or lungs. Additionally, patients with HCM may experience electrical conduction issues or arrhythmias.

The diagnosis of HCM is sometimes delayed because symptoms often develop later in the disease progression.
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a structural heart muscle disease in which normal heart muscle is replaced by fatty fibrous tissue. This fatty replacement disrupts electrical signal conduction in the heart, leading to irregular rhythms that can become life-threatening. Over time, the heart may also lose its pump function, resulting in symptoms of heart failure.

The disease primarily affects the right chamber of the heart, which is how it got its name. However, the left chamber can also be involved, either in combination with the right or, in very rare cases, in isolation. ARVC is a genetic condition, with symptoms typically appearing between the ages of 10 and 50 years.
Takotsubo Cardiomyopathy / Stress-Induced Cardiomyopathy / Broken Heart Syndrome: Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy or broken heart syndrome, was first described in Japan in 1990. It is named after the takotsubo, a Japanese container used to catch octopus, due to the characteristic shape of the heart in patients with TCM.

In TCM, part of the left chamber of the heart - most often the apex - enlarges into a balloon-like shape, resulting in poor pump function in that area. The rest of the chamber compensates to maintain overall function. Patients typically present with severe chest pain, resembling a heart attack, or symptoms such as shortness of breath, weakness, and signs of heart failure.

In most cases, TCM is a temporary condition with a high likelihood of full recovery. However, it requires several days of monitoring, as severe arrhythmias can occur during the acute phase. TCM is often triggered by intense emotional or physical stress or pro-adrenergic medications commonly used in intensive care. Yet, TCM is occasionally observed in patients without exposure to any known triggers.

Further research is needed to better understand the pathophysiology of this condition.
Peripartum Cardiomyopathy: Peripartum cardiomyopathy is a rare heart muscle disease that occurs during the final month of pregnancy or up to five months after delivery and may lead to heart failure. Before diagnosing peripartum cardiomyopathy, it is essential to rule out other potential causes of cardiomyopathy.

In most cases, peripartum cardiomyopathy develops shortly after delivery. The severity of symptoms can vary widely among women but does not appear to impact the likelihood of recovery. Women with severely reduced heart function due to peripartum cardiomyopathy may still experience a full recovery.

Overall, compared to other types of cardiomyopathies, peripartum cardiomyopathy carries a relatively good prognosis for recovery. As with other cardiomyopathies, early initiation of treatment is crucial.

The risk of recurrence during subsequent pregnancies is generally higher for patients with peripartum cardiomyopathy, particularly for those who did not fully recover their heart function. Consultation with a specialist is strongly recommended before planning future pregnancies.

Bio

PD Dr. Bettina Heidecker, MD, FESC, FACC, serves as the Head of Heart Failure and Cardiomyopathy at the Deutsches Herzzentrum der Charité (DHZC), Universitätsmedizin Berlin, Campus Benjamin Franklin. She completed her postdoctoral fellowship at Johns Hopkins University and, in 2007, joined her mentor, Dr. Joshua Hare, at the University of Miami. There, she conducted research projects and completed her internal medicine residency training. She then completed a cardiology fellowship at the University of California, San Francisco (UCSF).

As a clinician-scientist, Dr. Heidecker returned to Europe to establish a myocarditis clinic at Zurich University Hospital. In 2018, she assumed her current role at the Deutsches Herzzentrum der Charité (DHZC).

Her research focuses on inflammatory cardiomyopathies, amyloidosis, biomarkers, and precision medicine. She has received numerous awards, including the Paul Dudley White International Scholar Award (American Heart Association, AHA), the Jay N. Cohn New Investigator Integrative Physiology/Clinical Award (Heart Failure Society of America, HFSA), and the Samuel A. Levine Clinical Young Investigator Award (AHA). She was also awarded a grant from the Swiss National Science Foundation. Recently, she delivered the 30th Annual Lemberg Lectureship at the University of Miami and received an honorary professorship named after Miriam Lemberg. In previous years, this prestigious award has been given to renowned cardiologists such as Peter Libby, Eugene Braunwald (Harvard Medical School), and Valentin Fuster (Mount Sinai Hospital, New York).

Dr. Heidecker is a member of the Board of Directors for the Myocarditis Foundation and collaborates on international research projects aimed at advancing the diagnosis and treatment of myocarditis and other inflammatory cardiomyopathies. She is accredited as a cardiologist and internist in Germany, Switzerland, Austria, and the United States, holding board certifications in cardiology, internal medicine, and echocardiography across Europe and the U.S. Additionally, she completed training in genetic analysis and counseling at the University of Würzburg, Germany.

Watch Dr. Heidecker's 2023 UCSF Cardiology Grand Rounds on Myocarditis and the COVID-19 Pandemic

Warriors is a documentary about life with sarcoidosis. Dr. Heidecker and some of her patients take part in the film. In 2023 the film was honored with the "Most Impactful Documentary" award by the Hollywood Florida Film Festival.

Listen to Dr. Heidecker speak on Myocarditis on BMJ's Heart Podcast, Jan 2023

Dr. Heidecker receiving an honorary professorship from the University of Miami after giving the 30th Annual Lemberg Lectureship in 2022.

Dr. Heidecker speaking at the annual meeting of the Myocarditis Foundation in New York City in 2019. Dr. Heidecker was one of the first research grant recipients of the Myocarditis Foundation and has become a member of its Board of Directors in 2021.

Dr. Heidecker presenting about Artificial Intelligence and Myocarditis at the cardiovascular meeting CHORUS in Seoul in 2019. The following year Dr. Heidecker was the keynote speaker at the conference.

Dr. Heidecker together with her fellow Dr. Jan Kottwitz receiving the Paul Dudley White International Scholar Award from the American Heart Association in 2018.

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Bettina Heidecker, MD

Specialist in heart failure and rare diseases

Clinical Specialties

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Bettina Heidecker, MD Specialist in heart failure and rare diseases

Clinical Specialties

Bio

Recent Patient Testimonial

Latest Updates

Bettina Heidecker, MD

Specialist in heart failure and rare diseases