Myocarditis

Question 1

define:

Answer 1

acute inflammation and necrosis of cardiac muscle (myocardium)

Question 2

Aetiology/risk factors:

Answer 2

Idiopathic - 50%

Viral - coxascakie B, CMV, hepatitis, EBV, HIV, polio, mumps, adenovirus, rubella

Bacterial - post strep, TB, mennigicoccal, clostridia

Protozoa - chagas disease

Helminths

Drugs e.g. chemotherpay

Cocaine

toxins

SLE

sarcoidosis

radiation

Question 3

Epidemiology:

Answer 3

in N. america and europe most common cause is Coxasackie B

In S.america it is Chagas disease

Question 4

Symtoms:

Answer 4

Symptoms of flu:

• fever
• malaise
• lethargy
• fatigue

sharp chest pain - can often be positional (indicates pericarditis)

palpitations

breathlessness

Question 5

Signs:

Answer 5

signs of pericarditis

S4 gallop

soft S1

tachycardia

signs of heart failure

arrhythmias

Question 6

Investigations:

Answer 6

Bloods:

• FBC –> WCC up if it is an infectious cause
• CRP and ESR will be up
• Troponin I and T may be elevated
• U+ E’s
• -ve antimysosin

ECG:

• inverted T wave
• Saddle shaped ST elevation (pericarditis)
• Transient AV block
• arrythmias

Echo:
-may show wall abnormalities

CXR
-normal or cardiomegaly

pericardial fluid damage:
-glucose, protein, cytology, sensitivity, culture

Biopsy - very rare