Myocarditis

Question 1

What is myocarditis?

Answer 1

Myocarditis is inflammation of the myocardium, the muscular layer of the heart, often caused by infections, toxins, or autoimmune conditions.

Question 2

What are the common causes of myocarditis?

Answer 2

Viral infections (e.g., Coxsackievirus, adenovirus), bacterial infections (e.g., Lyme disease), autoimmune diseases, drugs, and toxins.

Question 3

What are the viral causes of myocarditis?

Answer 3

Coxsackievirus, adenovirus, Epstein-Barr virus, and parvovirus B19 are common viral causes.

Question 4

What are the typical symptoms of myocarditis?

Answer 4

Symptoms include chest pain, dyspnoea, fatigue, palpitations, and, in severe cases, syncope or sudden cardiac death.

Question 5

How does myocarditis present in severe cases?

Answer 5

Severe myocarditis can lead to heart failure, cardiogenic shock, or life-threatening arrhythmias.

Question 6

What is the pathophysiology of myocarditis?

Answer 6

Inflammation damages the myocardial tissue, leading to impaired contractility, electrical instability, and, in severe cases, ventricular dysfunction.

Question 7

What are the risk factors for developing myocarditis?

Answer 7

Recent viral or bacterial infection, autoimmune diseases, exposure to cardiotoxic drugs, and certain vaccines or immune therapies.

Question 8

How is myocarditis diagnosed?

Answer 8

Diagnosis is based on clinical presentation, blood tests, ECG, echocardiography, cardiac MRI, and sometimes endomyocardial biopsy.

Question 9

What are the common ECG findings in myocarditis?

Answer 9

Non-specific changes such as ST-segment elevation, T-wave inversion, or arrhythmias like ventricular tachycardia.

Question 10

What is the role of cardiac MRI in myocarditis?

Answer 10

Cardiac MRI helps detect myocardial inflammation, oedema, and fibrosis, confirming the diagnosis.

Question 11

What blood tests are useful in diagnosing myocarditis?

Answer 11

Troponins (elevated in myocardial injury), inflammatory markers (CRP, ESR), and viral serology.

Question 12

What are the complications of myocarditis?

Answer 12

Complications include dilated cardiomyopathy, heart failure, arrhythmias, and sudden cardiac death.

Question 13

How is myocarditis differentiated from myocardial infarction?

Answer 13

Myocarditis may mimic myocardial infarction on ECG and with elevated troponins, but coronary angiography shows no significant coronary artery disease.

Question 14

What is the treatment for mild viral myocarditis?

Answer 14

Supportive care, including rest, analgesics, and anti-inflammatory medications such as NSAIDs.

Question 15

What medications are used in severe myocarditis with heart failure?

Answer 15

ACE inhibitors, beta-blockers, diuretics, and, in some cases, inotropes like dobutamine.

Question 16

When is immunosuppressive therapy used in myocarditis?

Answer 16

Immunosuppressive therapy may be used in autoimmune or giant cell myocarditis, under specialist guidance.

Question 17

How is myocarditis managed in patients with arrhythmias?

Answer 17

Anti-arrhythmic medications, implantable cardioverter-defibrillators (ICD), or temporary pacing may be required.

Question 18

What is the role of endomyocardial biopsy in myocarditis?

Answer 18

Biopsy is used to confirm the diagnosis and identify specific causes, such as giant cell myocarditis, when clinical suspicion is high.

Question 19

What lifestyle modifications are recommended for patients with myocarditis?

Answer 19

Avoid strenuous exercise, adhere to a heart-healthy diet, and follow up regularly with a cardiologist.

Question 20

How is myocarditis related to dilated cardiomyopathy?

Answer 20

Chronic myocarditis can lead to dilated cardiomyopathy due to prolonged myocardial damage and remodelling.

Question 21

What is the prognosis for myocarditis?

Answer 21

Prognosis depends on the severity; mild cases often resolve, but severe cases may lead to chronic heart failure or death.

Question 22

What is giant cell myocarditis?

Answer 22

Giant cell myocarditis is a rare, severe form of myocarditis characterised by widespread inflammation and multinucleated giant cells.

Question 23

What is the significance of troponin elevation in myocarditis?

Answer 23

Troponin elevation indicates myocardial injury but does not differentiate myocarditis from other causes like myocardial infarction.

Question 24

How does myocarditis affect young, healthy individuals?

Answer 24

Myocarditis can cause sudden cardiac death in young, healthy individuals, often during or after a viral illness.

Question 25

Why is early recognition of myocarditis important?

Answer 25

Early diagnosis and management reduce complications like heart failure, arrhythmias, and progression to dilated cardiomyopathy.