Clinical Specialties

Myocarditis: The diagnosis myocarditis describes inflammation of the heart that may be caused by a virus or other triggering factors. We typically see an autoimmune reaction that may sometimes require medications that suppress the immune system. The large majority of cases with myocarditis recover well. Some cases are more severe and require more intense monitoring, therapy and more frequent follow up. After myocarditis, it is strongly recommended not to do any heavy exercise for at least 3 months, as the risk of exercise induced arrhythmias and worsening of the disease has been reported in the literature. We have done the first study in humans resuming sports after 3 months and did not observe any medical issues developing after that interval. If you would like to read more about myocarditis, you may be also interested in the website of the Myocarditis Foundation for which Dr. Heidecker serves as a member of the Board of Directors. More information on myocarditis can be found on the website of the Myocarditis Foundation: https://www.myocarditisfoundation.org
Sarcoidosis: Sarcoidosis is a disease that leads to accumulation of inflammatory cells (the body’s defense cells) in the shape of round-shaped granulomas that may occur in any part of the body. As cardiologist, we treat patients with cardiac involvement, but it affects most commonly the lungs and lymph nodes. The reason why someone develops sarcoidosis is still unknown, but a reaction to environmental factors (dust, chemicals, infectious agents) are suspected to which the immune system responds. Very often patients also report that they had a lot of stress preceding the manifestation of the disease. Stress is a common trigger of autoimmune diseases. Sarcoidosis is treatable, but early diagnosis is crucial to prevent irreversible damage. Under this link you can find additional information and shared experience reports about cardiac sarcoidosis.
Amyloidosis: Amyloid is a misfolded protein that can be deposited in various organs including the heart. In our clinic, we most commonly see Thransthyretin Amyloidosis/ATTR or Light Chain Amyloidosis/AL. Deposition of the protein causes heart stiffness, potentially leading to heart failure and arrhythmias. Appropriate medical therapy that may require frequent dose adjustment is very important for the clinical course of a patient. Endomyocardial biopsy has a very high sensitivity and specificity for amyloidosis (almost 100%). Therefore, it is the preferred diagnostic tool, when there is reasonable suspicion for cardiac amyloidosis. Only if the suspicion is very low, we may perform imaging first. Frequently, also the nervous system is affected by amyloidosis. Therefore, we work closely with our neurology team who will evaluate you as well, if you agree. Should you be diagnosed with AL amyloidosis, we will get you a timely appointment with our hemato-oncologist to make sure effective treatment will be initiated promptly.
Cardiooncology and Checkpoint Inhibitor Induced Myocarditis: Cardiooncology covers the care of patients who have heart disease or who are at risk of heart disease before, during, or after cancer therapy. The goal is to provide the most effective cancer therapy, while reducing the risk of cardiovascular complications to a minimum. The care involves close interdisciplinary collaboration between the cardiologist and the hematologist or oncologist. A specific new field of cardiooncology is checkpoint inhibitor induced myocarditis. The goal of checkpoint inhibitor therapy in oncology is to make the patient’s immune defense stronger and more aggressive against advanced cancer through a mechanism of “disinhibition”, which enables the immune system to fight metastatic disease. However, this disinhibition comes with the price of a higher risk for autoimmune reactions and myocarditis – an inflammation of the heart muscle. If checkpoint inhibitor induced myocarditis occurs, immediate referral for treatment in a specialized center is crucial for a patient’s outcome.
Hypertrophic Cardiomyopathy (HCM): HCM is a disease which is defined by abnormally thickened heart muscle cells. This is also called hypertrophy. As a consequence, the walls of the heart get thickened and stiffer. This sometimes makes it harder for the heart to pump and relax and sometimes the patients feel chest pain or in more advanced stages develop edema in the legs or lungs – fluid accumulation in legs or lungs. Patients may also develop electrical conduction problems or arrhythmias. Sometimes the diagnosis of HCM is made late, as symptoms may develop late.
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a structural disease of the heart muscle, in which normal heart muscle is replaced by fatty fibrous tissue. Due to the fatty replacement, electrical signal conduction in the heart is hampered leading to an irregular rhythm that can become life-threatening. Also, the heart can lose its pump function and get weaker over time leading to symptoms of heart failure. Usually, the right chamber of the heart is primarily affected, which gave the disease its name. However, also the left chamber can be affected in combination and in very rare cases in isolation. ARVC is a genetic disease with first symptom onset from age 10 to 50 years.
Takotsubo Cardiomyopathy / Stress-Induced Cardiomyopathy / Broken Heart Syndrome: Takotsubo cardiomyopathy (TCM) is also called stress-induced cardiomyopathy or broken heart syndrome. TCM was first described in Japan in 1990 and named after Takotsubo - a container that is used in Japan to catch octopus. It refers to the typical shape of a patient’s heart, who presents with TCM. In general, one part of the left chamber of the heart enlarges in a balloon shape form (most of the time the apex of the heart) leading to poor pump function in that area, while the rest of the chamber tries to compensate. Patients with TCM frequently present with severe chest pain, as if they are having a heart attack or shortness of breath and general weakness associated with symptoms of heart failure. TCM in most cases is a temporary condition with high chance for full recovery. However, it requires several days of monitoring, as severe arrhythmias may occur in the acute phase. It can be triggered by high emotional or physical stress and pro-adrenergic medications that are used in the intensive care unit. However, sometimes we find TCM in patients, who were not exposed to any of those known triggers. Certainly, more research is needed in this area to understand its pathophysiology better.
Peripartum Cardiomyopathy: Peripartum cardiomyopathy is a rare disease of the heart muscle that occurs during the final month of pregnancy up to five months after delivery and may lead to heart failure. Importantly, other causes of cardiomyopathy must be ruled out first before making the diagnosis of peripartum cardiomyopathy. In most cases, peripartum cardiomyopathy occurs right after delivery. The degree of the severity of symptoms varies greatly between women and does not seem to affect the chance for recovery. For example, women with severely decreased heart function due to peripartum cardiomyopathy may completely recover their heart function. Overall, compared to other cardiomyopathies (diseases of the heart muscle), patients with peripartum cardiomyopathy have a good chance for recovery. As with other types of cardiomyopathy, early initiation of treatment is key. The risk for recurrence of the disease during subsequent pregnancies is generally increased for patients with peripartum cardiomyopathy and is particularly high for woman who did not fully recover their heart function. Counseling with a specialist in the field is recommended before further pregnancy planning.

Bio

PD Dr. Bettina Heidecker, MD, FESC, FACC is the Head of the Heart Failure and Cardiomyopathy Clinic at the Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin. She trained as Post-Doctorate Fellow at the Johns Hopkins University. In 2007, she followed her mentor Dr. Joshua Hare to the University of Miami, where she completed her research projects and residency training in internal medicine. After that, she successfully completed a cardiology fellowship at the University of California, San Francisco (UCSF). Following her training as a clinician-scientist, she returned to Europe and established a myocarditis clinic at Zurich University Hospital. In 2018, she accepted her position at the Charité.

Her research areas include inflammatory cardiomyopathies, amyloidosis, biomarkers, and precision medicine. She received research 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); the Samuel A. Levine Clinical Young Investigator Award, AHA and a grant from the Swiss National Science Foundation. Recently, Dr. Heidecker held the 30th Annual Lemberg Lectureship at the University of Miami and received an honorary professorship named after Miriam Lemberg. In prior years, world renowned cardiologists such as Peter Libby, Eugene Braunwald (Harvard Medical School), and Valentin Fuster (Mount Sinai Hospital New York) received this award. Link to press release.

She serves as member of the Board of Directors of the Myocarditis Foundation and collaborates in international research projects that focus on improved diagnosis and treatment of myocarditis and other inflammatory cardiomyopathies. Dr. Heidecker is accredited as a cardiologist and as an internist in Germany, Switzerland, Austria, and the United States. She is board certified in cardiology, internal medicine and echocardiography in the United States and Europe. Dr. Heidecker completed training in genetic analysis and counseling at the University of Würzburg, Germany.

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

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Bettina Heidecker, MD

Specialist in heart failure and rare diseases