Myocarditis

Question 1

Define myocarditis

Answer 1

Acute inflammation & necrosis of cardiac muscle (myocardium)

Question 2

Aetiology of myocarditis

general +8

Answer 2

Usually IDIOPATHIC

Viruses 
Bacteria
Fungal
Protozoal
Helminths
Non-infective
Drugs 
Others

Question 3

Aetiology of myocarditis - viruses

5

Answer 3

Coxsackie B
EBV
CMV
Adenovirus
Influenza

Question 4

Aetiology of myocarditis - bacterial

3

Answer 4

Post streptococcal
Tuberculosis
Diphtheria

Question 5

Aetiology of myocarditis - fungal

Answer 5

Candidiasis

Question 6

Aetiology of myocarditis - protozoal

Answer 6

Trypanosomiasis (Chagas disease)

Question 7

Aetiology of myocarditis - helminths

Answer 7

Trichinosis

Question 8

Aetiology of myocarditis - non infective

2

Answer 8

Systemic: SLE, sarcoidosis, polymyositis

Hypersensitivity myocarditis: sulphonamides

Question 9

Aetiology of myocarditis - drugs

Answer 9

Chemotherapy agents (e.g. doxorubicin, streptomycin)

Question 10

Aetiology of myocarditis - others

3

Answer 10

Cocaine, heavy metals, radiation

Question 11

Epidemiology of myocarditis

prevalence, causes x2

Answer 11

Incidence difficult to measure accurately
Coxsackie B virus is most common in Europe & USA
Chagas disease most common in South America

Question 12

Presenting symptoms of myocarditis

1.4 +3

Answer 12

Prodromal flu like illness
fever
malaise
fatigue
lethargy
Breathlessness (due to pericardial effusion/myocardial dysfunction)
Palpitations
Sharp chest pain (suggesting pericarditis also)

Question 13

Signs of myocarditis on physical examination

2

Answer 13

Signs of pericarditis

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

Question 14

Investigations for myocarditis

6 types

Answer 14

Bloods
ECG
CXR
Pericardial fluid drainage
Echocardiography
Myocardial biopsy

Question 15

Investigations for myocarditis - bloods

5

Answer 15

FBC - raised WCC if infective cause
U&Es
ESR/CRP - raised
Cardiac enzymes - may be raised
Tests to identify cause (e.g. viral/bacterial serology, ANA, TFT)

Question 16

Investigations for myocarditis - ECG

2

Answer 16

Non-specific T wave & ST changes

PERICARDITIS = widespread saddle shaped ST elevation

Question 17

Investigations for myocarditis - CXR

2

Answer 17

May be normal

May show cardiomegaly

Question 18

Investigations for myocarditis - pericardial fluid drainage

2

Answer 18

Measure glucose, protein, cytology, culture & sensitivity

Helps identify causative organism

Question 19

Investigations for myocarditis - echocardiography

3

Answer 19

Assesses systolic/diastolic function
Wall motion abnormalities
Pericardial effusions

Question 20

Investigations for myocarditis - myocardial biopsy

Answer 20

Rarely required