Myocarditis

Question 1

define myocarditis?

Answer 1

it is the acute inflammation and necrosis of the cardiac muscle.

Question 2

what is the epidemiology of myocarditis?

Answer 2

Coxsackie B virus is most common in Europe and USA

Chagas disease is most common in South America

Question 3

what are the causes of myocarditis?

Answer 3

• viruses
• bacteria
• fungal
• protozoal
• helminths
• non infective
• drugs
• others

Question 4

example of a virus bacteria fungal, protozoal and helminth cause of myocarditis?

Answer 4

virus - coxsackie b 
bacteria - post streptococcal 
fungal - candidiasis
protozoal - Trypanosomiasis 
helminth - trichinosis

Question 5

example of a non-infective cause of myocarditis?

Answer 5

can be either systemic or hypersensitive

• systemic = SLE
• hypersensitive = sulphonamides (ADR)

Question 6

what drugs can cause myocarditis?

Answer 6

• chemotherapy agents eg. doxorubicin

Question 7

what other things can cause myocarditis?

Answer 7

• cocaine
• heavy metals
• radiation

Question 8

what are the presenting symptoms of myocarditis?

Answer 8

flue like symptoms like …

• fever
• malaise
• fatigue
• lethargy
• breathlessness
• palpitations
• sharp chest pain

Question 9

what are the signs of myocarditis on examination?

Answer 9

• Signs of pericarditis

- Signs of complications (e.g. heart failure, arrhythmia)

Question 10

what investigations should be carried out for myocarditis?

Answer 10

• bloods
• ECG
• CXR
• pericardial fluid drainage
• echo
• myocardial biopsy

Question 11

what might bloods of myocarditis show?

Answer 11

• FBC = raised WCC
• Us and Es
• ESR/CPR raised
• cardiac enzymes raised

Question 12

what might an ECG show?

Answer 12

• non-specific T wave and ST changes

- any pericarditis will show widespread saddle-shaped ST elevation

Question 13

what might a CXR show?

Answer 13

• could be normal

- might show cardiomegaly

Question 14

what does the pericardial fluid drainage measure?

Answer 14

• Measure glucose, protein, cytology, culture and sensitivity
• it will help to identify the causative agent

Question 15

what will an echo show?

Answer 15

• it assesses systolic and diastolic function
• will detect wall motion abnormalities
• can detect pericardial effusions.