Acute Myocarditis

Question 1

Primary myocarditis

Answer 1

acute viral infection, post viral response , protozan
typonsoma cruzi

fulminant myocardis ( require ionotrops , cardiomyopathy)

cardiomyopathy

Question 2

Secondary myocarditis

Answer 2

noninfectious inflammatory response

medication, chemical agents, inflammatory disease ( lupus)

Question 3

Injury to myocardium

Answer 3

direct invasion
production of cardiotoxic substance

chronic inflammation with or without infection

Question 4

mode of entry

Answer 4

respiratory or GI tract

Question 5

Organ receptor specific

Answer 5

coxasackie adenovirus receptor on heart

Question 6

young to middle aged adults

Answer 6

recent viral syndrome
progressive dyspnea weakness , fever , myalgias

Question 7

Heart failure

Answer 7

rales , gallop ect

Question 8

chest pain

Answer 8

mimic pericarditis or AMI

Question 9

EKG/ECG

Answer 9

atrial or ventricular tachyarrthymia

Question 10

Intracardiac thrombi

Answer 10

pulmonary or systemic thrombus

Question 11

fulminant myocarditis

Answer 11

cardiogenic shock
multiorgan failure

Question 12

acute myocarditis diagnostic studies

Answer 12

EKG /ECG
nonspecific with tachycardia or arrhythmias
ventricular conduction abnormalities and ectopy
presence of a Q wave or LBBB
prognostic concern

Question 13

echocardiogram

Answer 13

pulmonary hypertension

Question 14

chest xray

Answer 14

pulmonary edema and cardiomegaly

Question 15

Laboratory

Answer 15

elevated WBC CRP and ESR

Question 16

endomyocardial biopsy

Answer 16

required for biopsy

Question 17

treatment of myocarditis

Answer 17

NSAIDS and Colchicine
myopericarditis chest pain and pericarditis predominate
: avoid if in acute inflammation

Question 18

underlying cardiomyopathy treatment

Answer 18

ACE i , BB , diuretic (if needed)

Question 19

IABP or LvAD

Answer 19

cardiogenic shock

Question 20

ECMO

Answer 20

severe pulm infiltrates

Question 21

limit exercise
antimicrobial therapy specific only when the infective agent is identified

Question 22

parasitic involvement

Answer 22

Chaga’s disease
3rd most common parasitic infection in the world
most common infectious cause of cardiomyopathy
protozoa t cruzi transmitted by reduvid bug

Question 23

manage of cardiomyopathy

Answer 23

heart failure rx
Manage AV node dysfunction and arrhythmias
pacemaker /defib

high risk for dvt and pe
anticouag

antiparasitic therapy
benznidazole & nifurtimox ( only helps with peds)

Question 24

acute myocarditis toxoplasmosis

Answer 24

contracted through various insults
undercooked infected beef or pork products

organ transplant or transfusion

suspect toxoplasmosis in immunocompromised
present with ss of myocarditis
IgG positive

Presentation:
pericardial effusion or constrictive pericarditis
encephalitis, chorioretinitis

Diagnosis;
IgM-positive and IgG-positive

Treatment:
Pyrimethamine and sulfadiazine or clindamycin

Question 25

bacterial myocarditis acute

Answer 25

rare
direct invasion or abscess formation

corynebacterium diphtheria
cardiac involvement in 1/2 cases
toxin release affecting the conduction system
cause of death in infection is cardiac involvement

treatment
diphtheria antitoxin therapy
antitoxin prioritizes over antibiotics

Question 26

acute myocarditis noninfective involvement

Answer 26

Causes of :
cardiac transplant rejection
cardiac sarcoidosis
giant cell myocarditis

presentation
rapid onset HF
vent tachy
conduction blocks
chest pain syndromes

diagnostic finding

chest CT with pulmonary lymphadenopathy
cardiac MRI with inflammatory areas

Question 27

acute myocarditis dx and treatment

Answer 27

high suspicion;
v tach or conduction blocks without CAD

diagnosis;
enlarge lymph node bx suspecting sarcoid

endomyocardial bx for giant cell
treatment
high dose glucocorticoid for sarcoid
additional immunosuppressant for giant cell

treatment for
high dose glucocorticoids for sarcoid
additional immunosuppressant giant cell