Myocarditis

Question 1

Myocarditis: definition
1. Most common in?

Answer 1

inflammatory disease of the myocardium. It is sometimes concurrent with inflammation of the pericardium, in which case it is referred to as myopericarditis

1. Young people with acute chest pain

Question 2

Myocarditis: features
1. Clinical examination findings

Answer 2

cardiac-type chest pain
fatigue
palpitations
dyspnoea

Myocarditis can in some cases present with sudden unexplained cardiac death

1. Non-specific. May have HF symptoms (including S3 and S4 gallops)
   - If myopericarditis -> pericardial rub on auscultation

Question 3

Myocarditis: investigations

Answer 3

GOLD STANDARD - Endomyocardial biopsy via cardiac catheterisation (invasive and risks associated)

ECG - sinus tachycardia + non-specific ST segment and T wave changes (ST elevation and T wave inversion)
- arrhythmias can be present

Bloods
↑ inflammatory markers in 99%
↑ cardiac enzymes
↑ BNP

Echocardiogram - can reveal ventricular dysfunction (diastolic dysfunction or regional wall motion abnormalities)

Cardiac MRI - inflammation

Question 4

Myocarditis: Management
1. Activity after myocarditis?

Answer 4

Treat underlying cause + supportive management

ITU support (may require vasopressors)

Corticosteroids (only select group of patients with viral myocarditis)

1. After recovery, patients should be advised to limit activity for a few months.

Question 5

Myocarditis: causes

Answer 5

viral: coxsackie B, HIV
bacteria: diphtheria, clostridia
spirochaetes: Lyme disease
protozoa: Chagas’ disease, toxoplasmosis
autoimmune
drugs: doxorubicin

Question 6

Myocarditis: complications

Answer 6

heart failure
arrhythmia, possibly leading to sudden death

LATE COMPLICATION: dilated cardiomyopathy