myocarditis

Question 1

what is myocarditis

Answer 1

any inflammatory process leading to acute, subacute or chronic injury of the myocardium

Question 2

describe the aetiology of myocarditis

Answer 2

viral infection - most common cause
any virus is a potential agent
coxsacievirus is most common in western countries
diptheria is most common worldwide

immune mediated hypersensitivity:
to a drug: eosinophilic myocarditis
to an infection - e.g. rheumatic fever after strep throat
systemic autoimmune disease

Question 3

what are the symptoms of myocarditis

Answer 3

fever
chest pain
dyspnoea
palpitations

Question 4

what are the clinical signs of myocarditis

Answer 4

soft heart sounds, prominent third heart sound
tachycardia
heart failure

Question 5

list the investigations used in suspected myocarditis and what they would show if myocarditis is present (6)

Answer 5

ECG - ST change, T wave insertion, atrial arrhythmia, transient AV block

bloods - raised troponin and creatinine kinase, raised inflammatory markers

CXR - enlarged heart and/ or signs of heart failure

viral PCR - throat swab and stool sample for enteroviruses, throat swab for influenza

endomyocardial biopsy - only definitive test but risky so only done when this may change the management plan

cardiac MRI - can be used to differentiate between acute myocarditis and infarction

Question 6

what is the management for myocarditis

Answer 6

mainly supportive

treat underlying cause if possible