Myocarditis Flashcards
Definition myocarditis
Inflammatory infiltrate of myocardium with necrosis and/or degeneration of adjacent myocytes
Rapid Complications of myocarditis
Heart failures
Arrhythmias
Death
Which clinical term is synonymous with myocarditis
Inflammatory cardiomyopathy
Viral causes of myocarditis
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
Bacterial causes of myocarditis
Diphtheria
Tb
Streptococci
Meningococci
Brucellosis
Clostridia
Staphylococci
Melioidosis
Mycoplasma pneumonia
Psittacosis
Fungal causes of myocarditis
Candidiasis
Aspergillosis
Cryptococcosis
Histoplasmosis
Actinomycosis
Blastomycosis
Coccidioidomycosis
Mucormycosis
Spirochetal causes of myocarditis
Syphilis
Leptospirosis / Weil dx
Relapsing fever
Borrelia
Lyme disease
Rickettsial causes of myocarditis
Scrub typhus
Rocky Mountain spotted fever
Q fever
Protozoan causes of myocarditis
Chagas dx
Toxoplasmosis
Trypanosomiasis
Malaria
Leishmaniasis
Balantidiasis
Sarcosporidiosis
Helminthic causes of myocarditis
Trichinosis
Echinococcosis
Shistosomiasis
Heterophyiasis
Cysticercosis
Visceral larva migrants
Filariasis
Bites and stings causes of myocarditis
Scorpion venom
Snake venom
Black widow
Spider venom
Wasp venom
Tick paralysis
Drugs causing myocarditis
Doxorubicin
Anthracyclines
Streptomycin
Cyclophosphamide
Interleukin 2
Anti HER 2 receptor antibody / herceptin
Methyldopa
Spironolactone
Amphetamines
Cocaine
Catecholamines
Chemical agents in myocarditis
Hydrocarbons
Carbo monoxide
Arsenic
Lead
Phosphorus
Mercury
Cobalt
Physical agents causing myocarditis
Radiation
Heatstroke
Hypothermia
Systemic inflammatory dx causing myocarditis
sarcoidosis
Kawasaki
Crohn dx
SLE
UC
Wegener granulomatosis
Thyrotoxicosis
Scleroderma
Rheumatoid arthritis
Giant cell myocarditis
Lieberman classification of myocarditis progression
Fulminant
Acute
Chronic active
Chronic persistent
Because diagnosis of myocarditis is usually presumptive what facts do we use to diagnose it from the history
acute décompensation of heart failure with no other underlying cardiac dysfunction
patient demographics
Clinical course Of symptoms with spontaneous recovery following supportive care
General symptoms of myocarditis
Mild symptoms of chest pain
Fever
Sweats
Chills
Dyspnoea
Palpitations
Syncope
Sudden cardiac death
Heart failure years later
Symptoms of viral myocarditis
Present like flulike illness over 1-2 weeks
Fever
Arthralgias
Malaise
Pharyngitis
Tonsillitis
Upper respiratory tract infection
What are the signs of acute décompensation of heart failure
Tachycardia
Gallop
Mitral regurgitation
Edema
Pericardial friction rub
Signs of sarcoid myocarditis
Lymphadenopathy
Arrhythmias
Signs of acute rheumatic fever
Erythema marginatum
Polyarthralgia
Chorea
Subcutaneous nodules - jones criteria
Signs of hypertensive / eosinophilic myocarditis
Pruritic maculopapular rash
Hx of drugs use
Signs of giant cell myocarditis
Sustained ventricular tachycardia
Rapid progressive hearts failure
Signs of peripartum cardiomyopathy
Heart failure developing in the last month of pregnancy or within 5 months following delivery
What is takotsubo cardiomyopathy
Severe hypokinesia of anterioapical an inferno apical regions of the heart for unclear reasons often with complete resolution
Main association to takotsubo cardiomyopathy
Psychological or stressful event
Differential of myocarditis
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
Lab investigations in cardiomyopathy
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
Why do you do echocardiography in myocarditis
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
Is Endomyocardial biopsy a criterion standard for diagnosis of myocarditis
Yes
What should patient avoid in early recovery period
Strenuous Exercise
Digoxin
How can we prevent myocarditis
Vaccination - measles, rubella , mumps , COVID19, influenza , poliomyelitis
Short term treatment of myocarditis s
Diet - low sodium
Bed rest
Avoidance of athletic Activity
Long term treatment of myocarditis
ACE inhibitors
ARBs
B blockers
Diuretics
Vasodilators
Inotropic support
Radiation
Heatstroke
Hypothermia Radiation
Main cause of myocarditis
Viral - coxsackie and influenza A and B
Fulminant myocarditis clinical presentation
Viral prodrome of influenza like illness followed by severe heart failure or cardiogenic shock
Prognosis of myocarditis
Good , self limiting
