Myocarditis

Question 1

Three layers of the heart:

Answer 1

Epicardium, Myocardium, Endocardium.

Question 2

is defined as inflammation of the myocardium.

Answer 2

Myocarditis

Question 3

(1) Myocarditis is defined as inflammation of the myocardium.
(2) Caused by several viral and bacterial agents.
(a) Viruses: Influenza, Epstein Barr, Hepatitis B, HIV.
(b) Bacteria: Beta-Hemolytic strep (cause of Rheumatic fever), Lyme, Neisseria meningitides.

Answer 3

Pathophysiology: Myocarditis

Question 4

(a) Alcohol
(b) Cocaine
(c) Medications: PCN, cephalosporin, sulfonamides, diuretics.
(d) Insect bites
(e) Snake bites
(f) Inflammatory bowel disease
(g) Celiac disease (an immune reaction to eating gluten)
(h) Sarcoidosis (granulomas)

Frequently will be accompanied by pericarditis due to the large amount of inflammation spreading out to the pericardium.

Answer 4

Non-Infectious causes: Myocarditis

Question 5

(1) Fever

(2) SINUS TACHYCARDIA out of proportion to TEMPERATURE

(3) Retrosternal chest pain (back)

(4) Excessive fatigue or exercise intolerance.

(5) S3, S4

(6) Pericardial friction rub if pericarditis is also present.

(7) Clinical illness may overshadow clinical signs of myocardial dysfunction.

(8) In severe cases, signs of progressive congestive heart failure may be seen.

Answer 5

Symptoms and Physical Findings: Myocarditis

Question 6

(1) **CARDIAC ENZYMES (troponin, CK-MB) will be positive (This is what distinguishes myocarditis from pericarditis).
(2) CBC: Will have an elevated WBC because of infection and
inflammation.
(3) ESR or Sedimentation rate (a marker of inflammation) will be elevated.
(4) C-reactive protein (a marker of inflammation) will be elevated.
(5) EKG: May show signs of pericarditis with diffuse ST-segment elevation.
(6) Echocardiogram is performed in all patients to examine heart function.
(7) Cardiovascular Magnetic Resonance imaging.
(8) Endomyocardial biopsy is the confirmatory test performed for diagnosis.

Answer 6

Labs/Studies/EKG: Myocarditis

Question 7

(1) In idiopathic and viral myocarditis, treatment is supportive and symptom-directed (Rest, fluids, pain control with morphine).
(2) ***AVOID NSAIDS as it is not effective and can worsen heart failure symptoms if they have them.
(3) In Meningococcemia or Rheumatic fever, use directed antibiotic therapy.
(4) Manage congestive heart failure with diuretics.

MEDevac

Answer 7

Treatment: Myocarditis

Question 8

(1) Stabilize and transfer to a higher level of care.
(2) Initiate Morphine therapy for pain.
(3) Avoid all alcohol
(4) Restrict activity if you cannot get them to a higher level of care right away.

Answer 8

Initial Care: Myocarditis

Question 9

(1) AMI
(2) CHF

Answer 9

Complications: Myocarditis