myocarditis

Question 1

what is it

Answer 1

acute inflammation of the myocardium

Question 2

causes

Answer 2

• idiopathic
• infective
• toxic
• autoimune
• alcohol
• hydrocarbons

Question 3

what are the infective causes

Answer 3

• adenovirus
• HIV
• polio
• parasites
• bacterial (streptococcus, diphtheria)
• lyme disease
• fungal

Question 4

what are the toxic causes

Answer 4

• drugs
• penicillin
• radiation

Question 5

what are the autoimmune causes

Answer 5

• giant cell myocarditis

- autoimmune form

Question 6

what is the most common cause in the west

Answer 6

Coxsackie or adenoviral infection

Question 7

what is Chagas’ disease due to

Answer 7

trypansoma cruzi

Question 8

what is the pathology of the acute phase

Answer 8

heart is flabby with focal haemorrhages

Question 9

what is the pathology of chronic phase

Answer 9

heart is enlarged and hypertrophied

Question 10

what is seen histologically

Answer 10

inflammatory infiltrate is present

Question 11

what predominates with viral causes

Answer 11

lymphocytes

Question 12

what predominates with bacterial causes

Answer 12

polymorphonuclear

Question 13

what predominates with allergic and hypersensitivity causes

Answer 13

eosinophils

Question 14

symptoms

Answer 14

• asymptomatic
• fatigue
• palpitations
• chest pain
• dyspnoea
• fulminant congestive cardiac failure

Question 15

physical examination

Answer 15

• soft heart sounds
• prominent third sound
• tachycardia
• pericardial friction rub may be heard

Question 16

what investigations are don e

Answer 16

• CXR
• ECG
• cardiac enzymes
• viral antibody titres
• endomyocardial biopsy
• viral RNA

Question 17

what is seen on CXR

Answer 17

cardiac enlargement

Question 18

what is seen on ECG

Answer 18

• ST and T wave abnormalities
• arrhythmias
• heart block
• lyme disease
• chugs disease

Question 19

what are the cardiac enzymes

Answer 19

elevated

Question 20

what can biopsy show

Answer 20

acute inflammation

Question 21

what is the viral RNA

Answer 21

they PCR it

Question 22

what is the mainstay of treatment

Answer 22

supportive with heart failure medications

Question 23

what is further therapy

Answer 23

antibiotics and steroids

Question 24

what is treatment for acute phase

Answer 24

• bed rest is common

- avoid athletic activities for 6 months

Question 25

what is used to treat heart failure

Answer 25

- diuretics - ACE inhibitors / ARB - beta blocker or - spironolactone

Question 26

when should antibiotics be administered

Answer 26

immediately

Question 27

what is contraindicated in acute phase

Answer 27

NSAIDs

Question 28

what helps resolve left ventricular dysfunction

Answer 28

IV immunoglobulin

Question 29

what is giant cell myocarditis characterised by

Answer 29

presence of multinucleate giant cells within the myocardium

Question 30

what is the cause of giant cell myocarditis

Answer 30

associated with sarcoidosis, thymomas and autoimmune disease

Question 31

what is the cause of chagas' disease

Answer 31

trypanosoma cruzi