Myocarditis

Question 1

What is the rough estimate of the prevalence of myocarditis in the UK?

1 - 0.36/100,000
2 - 3.6/100,000
3 - 36/100,000
4 - 360/100,000

Answer 1

3 - 36/100,000

Question 2

All of the following are causes of myocarditis, but what is the most common cause, accounting for 50% of cases?

1 - viral infection
2 - bacterial infection
3 - idiopathic
4 - medication
5 - toxins (cocaine, lithium, alcohol)
6 - drugs/immunological

Answer 2

3 - idiopathic
- viral is also very common

• drugs/immunological = hypersensitivity causing eosinophils enter blood vessels in myocardium
• immunological = giant cell myocarditis, where macrophages group together and form a giant cell

Question 3

Which of the following is NOT a common spirochetes (phylum of bacteria) that is responsible for causing myocarditis?

1 - chagas
2 - leishmania
3 - staphylococcus aureus
4 - toxoplasmosis

Answer 3

3 - staphylococcus aureus
- gram-positive spherically shaped bacterium

Question 4

Which of the following is NOT a common protozoa (single cell parasite) that is responsible for causing myocarditis?

1 - chagas
2 - leishmania
3 - staphylococcus aureus
4 - toxoplasmosis

Answer 4

3 - staphylococcus aureus

• chagas = very common in south America

Question 5

Which of the following is NOT a common spirochetes (phylum of bacteria) that is responsible for causing myocarditis?

1 - leptospirosis
2 - chagas
3 - syphilis
4 - lyme disease

Answer 5

2 - chagas
- form of protozoa (single cell parasite) infection

Question 6

All of the following are viral causes that can lead to myocarditis, EXCEPT which one?

1 - human herpesvirus 6
2 - epstein–Barr virus
3 - cytomegalovirus
4 - meningococcus
5 - mycoplasma
6 - chagas
7 - polio
8 - mumps
9 - HIV
10 - herpes simplex virus
11 - cocksackie virus

Answer 6

6 - chagas
- form of protozoa (single cell parasite) infection

• cocksackie virus = most common cause in north America of myocarditis

Question 7

Myocarditis relates to inflammation of the cardiac tissue. What effect does inflammation of the cardiac tissue have on the hearts ability to pump blood effectively?

1 - decreased SV
2 - increased SV
3 - reduced HR
4 - all of the above

Answer 7

1 - decreased SV
- cardiac tissue becomes swollen

Question 8

Myocarditis relates to inflammation of the cardiac tissue, which can impair the hearts ability to pump blood effectively. If this becomes severe enough, what can this lead to?

1 - HF
2 - MI
3 - ACS
4 - infective pericarditis

Answer 8

1 - HF
- ejection fraction would be <40%
- can also lead to dilated cardiomyopathy

Question 9

Myocarditis relates to inflammation of the cardiac tissue, which can impair the hearts ability to pump blood effectively. If this becomes severe enough, it can lead to HF. What happens to the cardiac tissue?

1 - eccentric hypertrophy
2 - concentric hypertrophy
3 - fibrosis deposits
4 - haemorrhage

Answer 9

3 - fibrosis deposits
- heart becomes stiff and cannot contract properly

Question 10

All of the following are signs and symptoms of myocarditis, EXCEPT which one?

1 - ACS like symptoms
2 - palpitations
3 - tachycardia/arrhymias
4 - aortic murmur
5 - heart murmurs
6 - positional pain and fever
7 - fatigue and dyspnoea

Answer 10

4 - aortic murmur
- could occur but not common

Question 11

When trying to diagnose a patient with myocarditis, we can perform an ECG. What might we see on an ECG?

1 - saddle shaped ST-elevations
2 - tachycardia
3 - T wave inversion
4 - QT prolongation
5 - all of the above

Answer 11

5 - all of the above

Question 12

When trying to diagnose a patient with myocarditis, we can perform a full blood workup. Which 3 of the following are likely to be raised in myocarditis?

1 - troponin
2 - CRP
3 - Na+
4 - BNP
5 - ESR
6 - D-dimer

Answer 12

1 - troponin
2 - CRP
5 - ESR

• blood samples should also be cultured to identify the cause

Question 13

When trying to diagnose a patient with myocarditis, we can perform an echocardiogram. Is this always abnormal?

Answer 13

• no, can be normal
• can also show LV dysfunction

Question 14

If a patient is stable, what is often the most useful imaging technique to use to diagnose myocarditis?

1 - X-ray
2 - ultrasound
3 - MRI
4 - PET-CT

Answer 14

3 - MRI

• gold standard for diagnosis is cardiac biopsy, but this has obvious risks

Question 15

If a patient has LV dysfunction due to myocarditis we would prescribe all of the following in a similar manner to HF, EXCEPT which one?

1 - Furosemide
2 - Doxazosin
3 - Ramipril or Candesartan
4 - Bisoprolol or Carvedilol
5 - Spironolactone or Eplerenone
6 - Dapagliflozin

Answer 15

2 - Doxazosin
- alpha blocker not indicated in myocarditis

Question 16

Some patients with myocarditis can develop into fulminant myocarditis, a rare syndrome characterised by sudden and severe hemodynamic compromise that presents as profound cardiogenic shock, life-threatening ventricular arrhythmias and/or electrical storm. If this develops how should the patient be managed?

1 - antibiotics and HF medication
2 - antibiotics and steroids
3 - transfer to ICU
4 - all of the above

Answer 16

3 - transfer to ICU

• ensure ventilation
• inotropes/pressors
• a corporeal membrane oxygenation (ECMO)