MYOCARDITIS

Question 1

Definition (2)

Answer 1

Inflammation of the myocardium
Typical patients is YOUNG MALE

Question 2

Causes (4)

Answer 2

1- Viruses: HHV6, Coxsackie “most common cause in UK”, Parvovirus B19
2- Bacteria: Group A beta hemolytic strept, Lyme disease, Mycoplasma
3- SLE
4- Medications: sulfonamides, adriamycin

Question 3

Symptoms

Answer 3

Fatigue, chest pain, pericarditis, arrhythmias, CHF, or maybe asymptomatic

Question 4

Investigations (6)

Answer 4

1- ECG: sinus tachycardia, low voltage, electrical alternans, ST elevation (may have any ECG pattern)
2- Look for cardiac enzyme levels (elevated)
3- Increased ESR, serum viral titres
4- CXR: cardiomegaly
5- Echo: may have decreased EF
6- Most accurate test: biopsy

Question 5

Treatment (2)

Answer 5

1- Bed rest and treatment of heart failure (if low EF): beta blockers, ACEI
2- NSAIDS and steroids contraindicated (‘worsen viral myocarditis)