Myocarditis Flashcards
What is myocarditis?
inflammation of myocardium – inflammatory cardiomyopathy
What are the risk factors for myocarditis?
- HIV + other infections
- Smallpox vaccination
- Autoimmune/immune mediated disease
- Peri-partum and postnatal periods
- <50 years
What are some signs and symptoms for myocarditis?
- More Acute
1. Flu-like prodrome
2. Chest pain (worse when lying down)
3. SOB
4. Palpitations
What are possible differential diagnosis for myocarditis?
- Acute coronary syndrome
- Dilate cardiomyopathy
- Pericarditis
- Stress-induced cardiomyopathy
What imaging should you order for myocarditis?
- 12 lead ECG
- CXR
- 2D echo
What would a 12 lead ECG show in myocarditis?
- non-specific ST-segment and T-wave abnormalities
- ST-segment elevation and depression frequently occur
What could a CXR for myocarditis show?
bilateral pulmonary infiltrates in the setting of myocarditis-induced CHF
What would a 2D echo for myocarditis show?
global and regional left ventricular motion abnormalities and dilatation
What blood would you order for suspected myocarditis?
- serum ck
- serum ck-mb
- serum troponin
- serum B type natriuretic peptide
What would serum ck show in myocarditis?
midly elevated
What would serum ck-mb show in myocarditis?
midly elevated
What are some causes of myocarditis?
- Infectious
- Drugs (cocaine)
- Metals
- Radiation
What is most common cause of myocarditis?
Coxscakie B virus is most common cause of myocarditis in Europe
What are signs for myocarditis?
- Palpitations
- Rales
- Elevated neck veins
- S3 gallop
- Sinus tachycardia
- Atrial and ventricular arrhythmias
What is diagnostic for myocarditis?
endomyocardial biopsy: diagnostic but not routinely performed – if myocarditis treatment isn’t helping
What would serum troponin be like in myocarditis?
elevated
What would serum B type natriuretic peptide show in myocarditis?
elevated in response to ventricular distention, such as occurs in CHF due to myocarditis
What is the acute treatment of myocarditis with no evidence of left ventricular systolic dysfunction?
1st line: supportive care ± treatment of underlying cause – methylprednisolone
What is the acute treatment of myocarditis with evidence of left ventricular systolic dysfunction?
1st line: ACE inhibitors or Angiotensin II receptor blockers
Plus: treatment of underlying cause
What adjuncts may be used in treatment for myocarditis?
- Beta blockers
- oral vasodilators/nitrates
- diuretics
- aldosterone antagonists
- long-term anticoagulation therapy
What is the treatment of myocarditis in haemodynamically unstable patient?
1st line: IV arterial vasodilator + invasive haemodyanmic monitoring e.g. nitroprusside
Plus: treatment of underlying cause
What adjunct is used in haemodynimcially unstable patients with myocarditis?
Adjunct:
- IV glyceryl trinitrate
- IV inotropes or vasopressors e.g. dobutamine
How do you treat refractory cardiogenic shock in myocarditis?
Refractory cardiogenic shock: adult patients
Plus: intra-aortic ballow pump
Adjunct: left ventricular assist device
What is 1st and 2nd line for ongoing myocarditis (end stage heart failure or refractory life-threatening arrhythmias)?
1st line: heart transplantation + existing heart failure medication
2nd line: destination left ventricular assist device therapy + anticoagulation + existing heart failure therapy e.g. warfarin
What criteria is used for myocarditis?
Dallas
What are possible complications of myocarditis?
- Atrial fibrillation
- Ventricular tachyarrhythmias
- Dilated cardiomyopathy
- Sudden cardiac death
- Multisystem organ failure
