Myocarditis

Question 1

Myocarditis definition

Answer 1

Inflammatory condition of the heart

Inflammatory infiltrate of the myocardium with necrosis and degeneration of adjacent myocytes (not due to ischemia )

Question 2

Classification of myocarditis

Answer 2

Acute
Resolving
Resolved

Question 3

Acute myocarditis

Answer 3

Inflammatory infiltrate and necrosis of adjacent myocytes

Question 4

Ongoing myocarditis

Answer 4

Degree of myocarditis unchanged from previous biopsy

Question 5

Resolving myocarditis

Answer 5

Reduction or inflammatory cell infiltrate

Question 6

Resolved myocarditis

Answer 6

Very little or no evidence of inflammation.

Fibrosis may be extensive

Question 7

Myocarditis etiology

Answer 7

Infective
Idiopathic
Immune mediated
Miscellaneous

Question 8

Infective myocarditis

Answer 8

Bacteria (diphtheria, neisseira)

Ricketssial

Viral (cockackie, echo…)

Protozoaires

Parasitic

Fungal

Question 9

Most common cause of myocarditis

Answer 9

Infective myocarditis

Question 10

Most common cause of infective myocarditis

Answer 10

Coxackie

Entero virus

Question 11

Idiopathic myocarditis

Answer 11

Diffuse
Interstitial
Granulomatous

Question 12

Immune mediated myocarditis

Answer 12

Rheumatic fever 
Rheumatoid arthritis 
Lupus erythematosus
Polyarteritis nodosa 
Dermatomyositis
Drugs (sulfonamides , a methyldopa)
Transplant rejection

Question 13

Miscellaneous myocarditis

Answer 13

Trauma 
Irradiation 
Chemical agent 
Drugs 
Uraemia
Hypokalemia
Others

Question 14

Viral myocarditis pathogenesis

Answer 14

Initial viral infection elsewhere
Few weeks later heart affected

First mechanism :
Direct viral cytotoxicity
Death of my sites with inflammation
Infrequent

2nd mechanism :
T cell dependence mechanism
Initial myocardial or extra cardiac infection
Clearance of infection by monocytes and humoral immune system
Immunologic phase with t lymphocytes against Antigens from the virus-myocardial interaction or cross reaction with viral antigen apart of heart

3rd mechanism:
Bacterial toxins leading to inflammation

4rth mechanism :
Immune mediated reaction dragons used or autoimmune disease causing inflammation

Question 15

Primary myocarditis

Answer 15

When myocardium is the only site or major focus of viral infection

Question 16

Majority of viral myocarditis due to what type of virus

Answer 16

Enterovirus group

especially Group B Coxsackie virus (more than half)

Question 17

How do you demonstrate that there is a viral infection leading to myocarditis

Answer 17

Evidence of viral infection based on rising or high serum antibody titres to the virus

Question 18

Viral myocarditis morphology

Answer 18

Interstitial edema
Mononuclear cell infiltration (lymphocytes)
Focal necrosis of myocytes adjacent to inflammatory cells

Question 19

When do you have suppurative myocarditis

Answer 19

Pyogenic bacteria

Question 20

Bacterial myocarditis morphology

Answer 20

Cardiac hypertrophy and dilatation
Pale flabby myocardium

Localised abscess I’m Steph aureus
Spreading infection with necrosis strep pyogenes

Granulomatous inflammation of myocardium in tuberculosis , tularaemia, brucellosis
Tuberculous myocarditis rare (nodular, miliary, diffuse infiltrative types)

Question 21

Fungal myocarditis occurs in

Answer 21

Immunosuppresseur individuals

Question 22

Main fungus involved in fungal myocarditis

Answer 22

Candida

Aspergillus

Question 23

Fungal myocarditis morphology please

Answer 23

White to yellow nodules up to 15mm in diameter
Microcolonies of radially arranged pseudohyphae
Microabscesses
Chronic inflammatory cells

Question 24

Aspergillus myocarditis

Answer 24

Fibrinopurulent infiltrate in the endocardium with necrosis and inflammation in myocardium

Question 25

Protozoal myocarditis population at risk

Answer 25

Toxoplasmosis in immunocompromised

Question 26

Organs damaged in protozoal myocarditis

Answer 26

Brain and heart

Question 27

Findings in protozoal myocarditis il

Answer 27

Paeudocysts with Bradyzoites/ macrophages | Tachyzoites

Question 28

Metazoal myocarditis

Answer 28

Patchy interstitial myocarditis Many neutrophils Many giant cells Eosinophilic myocarditis in onchocerca volvulus

Question 29

Toxic myocarditis morphology

Answer 29

Numerous small foci of coagulative necrosis surrounded by macrophages, lymphocytes, neutrophils Necrotic fibres replaced by small fibrous scars

Question 30

Adriamycin cardiotoxicity characteristics

Answer 30

Myofibre swelling & vacuolisation Fatty change Myocytolysis

Question 31

Cyclophosphamide cardiotoxicity

Answer 31

Large areas of necrosis Capillary thombosis Considerable fibrosis

Question 32

Where do you find Granulomatous myocarditis

Answer 32

In patients with active sarcoidosis

Question 33

Idiopathic granulomatous myocarditis characteristics

Answer 33

Small and large granulomas without caseation ``` Macrophages Giant cells Foreign body Langhans Leucocytes ```

Question 34

Giant cell myocarditis second name

Answer 34

Fiedlers giant cell myocarditis

Question 35

Giant cell myocarditis morphology

Answer 35

Focal Frequently extensive myocaradial necrosis Multinucleate giant cells of myope if Macrophages origin Mixed infiltrate of eosinophils, lymphocytes, plasma cells, macrophages

Question 36

Allergic/hypersensitivity myocarditis morphology

Answer 36

Interstitial inflammatory infiltrate Eosinophils Mononuclear cells