Condition- Myocarditis

Question 1

What is myocarditis?

Answer 1

Acute inflammation and necrosis of cardiac muscle (myocardium)

Question 2

What is the most common cause of Myocarditis and Pericarditis in Europe and USA?

Answer 2

Coxsackie B virus

Question 3

What is the most common cause of myocarditis in S. America?

Answer 3

Chaga’s Disease

Question 4

State one autoimmune disease which is associated with both myoarditis and pericarditis…

Answer 4

SLE

Question 5

List some symptoms of myocarditis

Answer 5

• Prodromal flu-like illness with:
  
  • Fever
  • Malaise
  • Fatigue
  • Lethargy
• Breathlesness (due to pericardial effusion/ myocardial dysfunction)
• Palpitations
• Note may get sharp chest pain (suggesting also pericarditis)

Question 6

List some of the signs of myocarditis

Answer 6

• Soft S1
• S3 gallop
• Sinus Tachycardia
• Signs of CHF
  
  • Rales
  • Elevated JVP
• Signs of arrhythmias

Question 7

List one key symptom of pericarditis

Answer 7

• Sharp chest pain relieved by sitting forwards

Question 8

List two key signs of pericarditis

Answer 8

• Pericardial friction rub (squeaking sound)
• Cardiac Tamponade signs:
  
  • Beck’s triad:
    
    • Raised JVP
    • Low Blood Pressure
    • Muffled Heart Sounds

Question 9

List three signs of cardiac tamponade and what is the name for this triad?

Answer 9

BECK’S TRIAD:

• Raised JVP
• Low BP
• Muffled Heart sounds

Question 10

What might you see in an ECG of someone with myocarditis?

Answer 10

• non-specific ST-segment and T-wave abnormalitis
• Can get ST-elevaion + depression
  
  • Pericarditis signs:
    
    • Saddle- ST elevation
    • PR depression

Question 11

What could you look for in the bloods of someone with Myocarditis? + What can confirm the diagnosis?

Answer 11

• Elevated WCC =infective
• ESR/ CRP raised
• Cardiac Enzymes = if troponin elevated confirms diagnosis
• To ID cause: Viral/ bacterial serology, ANA, TFT

Question 12

Which test could you conduct to identify the cause of myocarditis?

Answer 12

1. Bloods:
   
   • Viral/bacterial serology
   • ANA for SLE
   • TFT
   • Drugs + Tox screen
2. Pericardial fluid drainage + MC&S: ID organism