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2 - Cardiovascular Medicine > Myocarditis > Flashcards

Myocarditis Flashcards

1
Q

Definition myocarditis

A

Inflammatory infiltrate of myocardium with necrosis and/or degeneration of adjacent myocytes

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2
Q

Rapid Complications of myocarditis

A

Heart failures
Arrhythmias
Death

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3
Q

Which clinical term is synonymous with myocarditis

A

Inflammatory cardiomyopathy

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4
Q

Viral causes of myocarditis

A

Enteroviruses
Coxsackie B
Adenovirus
Influenza
CMV
Poliomyelitis
EBV
HIV -1
Mumps
Rubeola
Varicella
Variole
A rbovirus
RSV
HSV
Yellow fever virus
Rabies
Parvovirus
Viral hepatitis
SARS - cov2

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5
Q

Bacterial causes of myocarditis

A

Diphtheria
Tb
Streptococci
Meningococci
Brucellosis
Clostridia
Staphylococci
Melioidosis
Mycoplasma pneumonia
Psittacosis

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6
Q

Fungal causes of myocarditis

A

Candidiasis
Aspergillosis
Cryptococcosis
Histoplasmosis
Actinomycosis
Blastomycosis
Coccidioidomycosis
Mucormycosis

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7
Q

Spirochetal causes of myocarditis

A

Syphilis
Leptospirosis / Weil dx
Relapsing fever
Borrelia
Lyme disease

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8
Q

Rickettsial causes of myocarditis

A

Scrub typhus
Rocky Mountain spotted fever
Q fever

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9
Q

Protozoan causes of myocarditis

A

Chagas dx
Toxoplasmosis
Trypanosomiasis
Malaria
Leishmaniasis
Balantidiasis
Sarcosporidiosis

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10
Q

Helminthic causes of myocarditis

A

Trichinosis
Echinococcosis
Shistosomiasis
Heterophyiasis
Cysticercosis
Visceral larva migrants
Filariasis

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11
Q

Bites and stings causes of myocarditis

A

Scorpion venom
Snake venom
Black widow
Spider venom
Wasp venom
Tick paralysis

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12
Q

Drugs causing myocarditis

A

Doxorubicin
Anthracyclines
Streptomycin
Cyclophosphamide
Interleukin 2
Anti HER 2 receptor antibody / herceptin

Methyldopa
Spironolactone

Amphetamines
Cocaine
Catecholamines

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13
Q

Chemical agents in myocarditis

A

Hydrocarbons
Carbo monoxide
Arsenic
Lead
Phosphorus
Mercury
Cobalt

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14
Q

Physical agents causing myocarditis

A

Radiation
Heatstroke
Hypothermia

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15
Q

Systemic inflammatory dx causing myocarditis

A

sarcoidosis
Kawasaki
Crohn dx
SLE
UC
Wegener granulomatosis
Thyrotoxicosis
Scleroderma
Rheumatoid arthritis
Giant cell myocarditis

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16
Q

Lieberman classification of myocarditis progression

A

Fulminant
Acute
Chronic active
Chronic persistent

17
Q

Because diagnosis of myocarditis is usually presumptive what facts do we use to diagnose it from the history

A

acute décompensation of heart failure with no other underlying cardiac dysfunction

patient demographics

Clinical course Of symptoms with spontaneous recovery following supportive care

18
Q

General symptoms of myocarditis

A

Mild symptoms of chest pain
Fever
Sweats
Chills
Dyspnoea
Palpitations
Syncope
Sudden cardiac death
Heart failure years later

19
Q

Symptoms of viral myocarditis

A

Present like flulike illness over 1-2 weeks
Fever
Arthralgias
Malaise
Pharyngitis
Tonsillitis
Upper respiratory tract infection

20
Q

What are the signs of acute décompensation of heart failure

A

Tachycardia
Gallop
Mitral regurgitation
Edema
Pericardial friction rub

21
Q

Signs of sarcoid myocarditis

A

Lymphadenopathy
Arrhythmias

22
Q

Signs of acute rheumatic fever

A

Erythema marginatum
Polyarthralgia
Chorea
Subcutaneous nodules - jones criteria

23
Q

Signs of hypertensive / eosinophilic myocarditis

A

Pruritic maculopapular rash
Hx of drugs use

24
Q

Signs of giant cell myocarditis

A

Sustained ventricular tachycardia
Rapid progressive hearts failure

25
Q

Signs of peripartum cardiomyopathy

A

Heart failure developing in the last month of pregnancy or within 5 months following delivery

26
Q

What is takotsubo cardiomyopathy

A

Severe hypokinesia of anterioapical an inferno apical regions of the heart for unclear reasons often with complete resolution

27
Q

Main association to takotsubo cardiomyopathy

A

Psychological or stressful event

28
Q

Differential of myocarditis

A

Coronary artery vasospasm
Isolated coronary artery anomalies
Myocardial infarction
Myocardial ischemia
Cardiogenic pulmonary edema
High altitude pulmonary edema
Neurogenic pulmonary edema
Interstitial pulmonary fibrosis
Unstable angina
Ventricular tachycardia

29
Q

Lab investigations in cardiomyopathy

A

FBC - leucocytosis in eosinophilia
ESR - elevated
CRP - elevated
Rheumatologic screening - rule out systemic inflammatory dx
Cardiac enzymes - elevated especially troponin I or T
Viral antibody titres
Viral venom in persistence
Biopsy Histology

30
Q

Why do you do echocardiography in myocarditis

A

To exclude other causes of heart failure
Evaluate degree of cardiac dysfunction
To gross localize extent of inflammation
To distinguish between acute and fulminant myocarditis

31
Q

Is Endomyocardial biopsy a criterion standard for diagnosis of myocarditis

A

Yes

32
Q

What should patient avoid in early recovery period

A

Strenuous Exercise
Digoxin

33
Q

How can we prevent myocarditis

A

Vaccination - measles, rubella , mumps , COVID19, influenza , poliomyelitis

34
Q

Short term treatment of myocarditis s

A

Diet - low sodium
Bed rest
Avoidance of athletic Activity

35
Q

Long term treatment of myocarditis

A

ACE inhibitors
ARBs
B blockers
Diuretics
Vasodilators
Inotropic support
Radiation
Heatstroke
Hypothermia Radiation

36
Q

Main cause of myocarditis

A

Viral - coxsackie and influenza A and B

37
Q

Fulminant myocarditis clinical presentation

A

Viral prodrome of influenza like illness followed by severe heart failure or cardiogenic shock

38
Q

Prognosis of myocarditis

A

Good , self limiting

2 - Cardiovascular Medicine (16 decks)

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