Myocarditis

Question 1

What is the most common cause of myocarditis?

Answer 1

Viral infections:

• Enteroviruses especially Coxsackievirus B
• HHV-6
• Parvovirus B19
• Influenza A
• HIV

Question 2

What bacterial infections can cause myocarditis?

Answer 2

1) Rheumatic fever (GAS)

2) Chagas disease (Trypanosoma cruzi - parasite)

3) Diptheria

Question 3

What is the most common cause of myocarditis worldwide?

Answer 3

Diphtheria

Question 4

What 2 drugs can cause myocarditis?

Answer 4

1) Clozapine

2) Pembrolizumab

Question 5

Presentation of myocarditis?

Answer 5

1) Chest pain

2) Systemic upset:
- fatigue
- fevers

3) SOB

4) Reduced exercise tolerance

5) Palpitations (may indicate an underlying arrhythmia)

6) Collapse

7) Sudden death

8) Signs of HF e.g. raised JVP, pulmonary oedema, peripheral oedema etc

Question 6

What does chest pain in myocarditis suggest?

Answer 6

Concurrent pericarditis

Question 7

ECG findings in myocarditis?

Answer 7

1) ST-segment elevation/depression

2) T wave inversion

3) Atrial arrhythmias

4) Transient AV block

Question 8

What autoimmune conditions can cause myocarditis?

Answer 8

1) SLE

2) Sarcoidosis

Question 9

What is the mainstay of mx of myocarditis?

Answer 9

Supportive

Question 10

Complications of myocarditis?

Answer 10

1) Cardiogenic shock

2) Cardiac arrhythmias

3) Sudden death

4) Dilated cardiomyopathy

5) HF

Question 11

Is abx prophylaxis to prevent infective endocarditis routinely recommended for dental procedures?

Answer 11

No

Question 12

Does the murmur in mitral regurgitation become more pronounced during inspiration?

Answer 12

No

Question 13

Does the murmur in tricuspid regurgitation become more pronounced during inspiration?

Answer 13

Yes

Question 14

What HTN medication can worsen glucose tolerance?

Answer 14

Thiazides e.g. Bendroflumethiazide

Question 15

Stage 1 vs 2 HTN?

Answer 15

Stage 1: HBPM ≥135/85 mmHg

Stage 2: HBPM ≥150/95 mmHg

Question 16

Mx of stage 1 HTN?

Answer 16

Treat if <80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a QRISK ≥10%

Question 17

Mx of stage 1 HTN if ≥80 y/o?

Answer 17

Advise lifestyle changes

Question 18

Mx of stage 2 HTN?

Answer 18

offer drug treatment regardless of age

Question 19

Ventricular hypertrophy on an ECG?

Answer 19

Increased amplitudes of R waves e.g. in HOCM

Question 20

What is the commonest side effect caused by ivabradine?

Answer 20

Transient luminous phenomenon, such as bright spots appearing in their field of vision.

Question 21

What medication should be considered during CPR if a PE is suspected?

Answer 21

Thrombolytic drugs e.g. alteplase

Question 22

What 2 conditions are associated with HOCM?

Answer 22

1) WPW

2) Friedrich’s ataxia

Question 23

What valve defect can ankylosing spondylitis cause?

Answer 23

Aortic regurgitation

Question 24

Is amlodipine a dihydropyridine CCB or non-dihydropyridine CCB?

Answer 24

dihydropyridine CCB

Question 25

1st line investigation for stable angina of suspected coronary artery disease aetiology?

Answer 25

Contrast-enhanced CT coronary angiogram