Myocarditis

Question 1

What is myocarditis?

Answer 1

Inflammation of the myocardium that commonly occurs following a viral inection

Question 2

What is the most common cause of myocarditis?

Answer 2

Cocksackie B virus

Question 3

What are the common causes of myocarditis?

Answer 3

Viral infections:
- Cocksackie B virus
- COVID-19
- Adenovirus
- EBV

Bacterial infections:
- Diphtheria
- Clostridia
- Neisseria gonorrhoea

Autoimmune
- Kawasaki disease
- Scleroderma, SLE, sarcoid and systemic vasculitidies

Drug reaction
- Antipsychotics
- Mesalazine

Question 4

What is the clinical presentation of myocarditis?

Answer 4

Chest pain - sharp/stabbing
Shortness of breath
Palpitations
Lightheadedness
Syncope
Fever and viral prodrome

Question 5

What are the signs of myocarditis on examination?

Answer 5

Dull heart sounds
If myopericarditis - pericardial rub may be heard
In fulminant myocarditis - may have signs of heart failure

Question 6

What are the differentials of myocarditis?

Answer 6

ACS
Pericarditis
Pulmonary embolism

Question 7

What investigations are performed in the diagnosis of myocarditis?

Answer 7

ECG - non specific ST segment and T wave changes
Troponin - raised
Inflammatory markers
Viral serology
Echocardiogram
Cardiac MRI

Question 8

What is the gold standard investigation for myocarditis?

Answer 8

Endomyocardial biopsy - histopathology shows infiltration of inflammatory cells into the myocardium and myocardial necrosis

Question 9

What is the management of myocarditis?

Answer 9

Supportive/addressing the underlying cause
- Patients with severe myocarditis may require ITU support and vasopressors
- Patients with viral acute myocarditis may benefit from corticosteroids

Question 10

What are the complications of myocarditis?

Answer 10

Heart failure
Arrhythmias
Dilated cardiomyopathy