Myocarditis

Question 1

What is myocarditis?

Answer 1

Inflammation of the myocardium most often caused by viral infections

Myocarditis can lead to serious complications if not addressed.

Question 2

What are the main viral infections that can cause myocarditis?

Answer 2

• enteroviruses (especially coxsackie virus B)
• human herpes virus 6
• parovirus B19
• influenza A
• HIV

Viral infections are the most common cause of myocarditis.

Question 3

Name two bacterial or parasitic infections that can lead to myocarditis.

Answer 3

• rheumatic fever (strep A)
• Chagas disease (trypanosoma cruzi)

These infections can lead to myocarditis through different mechanisms.

Question 4

What are some other causes of myocarditis apart from infections?

Answer 4

• radiation to chest
• autoimmune disorders (SLE, sarcoid, giant cell myocarditis, Kawasaki)

Autoimmune disorders can trigger inflammation in the myocardium.

Question 5

Which drug is known to be associated with myocarditis?

Answer 5

Clozapine

Clozapine is an antipsychotic medication that may have this rare side effect.

Question 6

What are the key mechanisms involved in viral myocarditis pathophysiology?

Answer 6

• direct cellular injury from viral infection
• immune response arising from viral proteins intracellularly

These mechanisms can lead to inflammation and damage to heart tissue.

Question 7

What are common clinical features of myocarditis?

Answer 7

• chest pain (35%)
• systemic upset (fatigue >50%, fevers 20%)
• shortness of breath
• reduced exercise tolerance
• palpitations
• collapse
• sudden death

Symptoms can vary widely and may overlap with other conditions.

Question 8

What is the significance of chest pain in myocarditis?

Answer 8

May also suggest concurrent pericarditis

Chest pain can be a key symptom but may indicate other cardiac issues.

Question 9

What are some examination findings in myocarditis?

Answer 9

• signs of heart failure (raised JVP, pulmonary oedema, peripheral oedema)
• pericardial friction rub (if concurrent pericarditis)
• pansystolic murmur (if mitral regurgitation)

Physical examination can reveal critical signs of cardiac dysfunction.

Question 10

What are some important investigations for myocarditis?

Answer 10

• ECG (ST elevation/depression, T-wave inversion, AV block)
• respiratory viral screening
• raised CRP and ESR
• raised cardiac enzymes (CK and troponin)

These tests help confirm the diagnosis and assess the severity.

Question 11

What is the primary management approach for myocarditis?

Answer 11

• supportive treatment (oxygen, monitoring for arrhythmias, fluid balance, treat underlying cause)

Management is generally supportive, focusing on stabilizing the patient.

Question 12

What are some short-term complications of myocarditis?

Answer 12

• cardiogenic shock
• cardiac arrhythmias
• sudden death

These complications can arise rapidly and require immediate intervention.

Question 13

Name a medium to long-term complication of myocarditis.

Answer 13

Dilated cardiomyopathy

This condition can develop as a sequela of myocarditis, leading to chronic heart failure.

Question 14

True or False: Sudden death can occur from previously undiagnosed myocarditis.

Answer 14

True

Approximately 8.6% of sudden cardiac deaths are attributed to undiagnosed myocarditis.