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Cardiology Secrets > MYOCARDITIS > Flashcards

MYOCARDITIS Flashcards

1
Q

What is myocarditis?

A

Inflammatory disease of the myocardium caused by external triggers (viruses, bacteria, etc.) or internal triggers (autoimmune activation).

Cardiac manifestations include acute heart failure, arrhythmias, and chronic dilated cardiomyopathy.

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2
Q

What are the four clinicopathologic forms of myocarditis?

A
  • Fulminant myocarditis
  • Acute myocarditis
  • Chronic active myocarditis
  • Chronic persistent myocarditis
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3
Q

What was the estimated incidence of myocarditis in 2019?

A

820,000 cases in males and 608,000 cases in females.

Estimated 32,449 deaths or 0.42 deaths per 100,000 in 2019.

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4
Q

What percentage of unexplained nonischemic dilated cardiomyopathy (DCM) cases is caused by myocarditis?

A

9% to 16%

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5
Q

In young athletes, what percentage of sudden deaths is attributed to myocarditis?

A

4% to 12%

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6
Q

What demographic factors influence the prevalence of myocarditis?

A

Higher prevalence and severity in men; peaks in the first year of life and between puberty and age 40.

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7
Q

What primary causes are associated with myocarditis?

A
  • Viral infections
  • Toxic triggers
  • Noninfectious triggers
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8
Q

Which viruses are commonly associated with myocarditis?

A
  • Coxsackievirus
  • Adenovirus
  • Parvovirus B19
  • Human herpes virus 6
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9
Q

What is the role of COVID-19 in myocarditis cases?

A

20% to 35% of hospitalized COVID-19 patients showed evidence of myocardial injury.

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10
Q

What are some primary bacteria associated with myocarditis?

A
  • Corynebacterium diphtheriae
  • Streptococcus viridans
  • Mycobacterium tuberculosis
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11
Q

What is hypersensitivity myocarditis?

A

An uncommon form of myocarditis due to adverse drug reactions, often resolving after medication withdrawal.

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12
Q

What is giant cell myocarditis (GCM)?

A

A rare autoimmune heart disease associated with poor prognosis and ventricular arrhythmias.

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13
Q

What are the three phases of viral myocarditis pathogenesis?

A
  • Phase 1: Acute viral injury
  • Phase 2: Subacute immune response
  • Phase 3: Chronic myopathic
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14
Q

What are common clinical presentations of myocarditis?

A
  • Viral prodrome
  • Chest pain
  • Palpitations
  • Dyspnea
  • Ventricular arrhythmias
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15
Q

What are the clinical phenotypes of myocarditis?

A
  • Acute coronary syndrome mimic
  • Myopericarditis
  • New onset or worsening heart failure
  • Life-threatening arrhythmias
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16
Q

What is the classification based on the level of diagnostic certainty?

A
  • Possible subclinical acute myocarditis
  • Probable acute myocarditis
  • Definite myocarditis
17
Q

What blood tests can guide the diagnosis of myocarditis?

A
  • Inflammatory markers (ESR, CRP)
  • Cardiac biomarkers (CK-MB, troponin I)
18
Q

What noninvasive diagnostic tests are useful in myocarditis?

A
  • ECG
  • Echocardiography
  • Cardiac magnetic resonance imaging (MRI)
19
Q

What is the sensitivity of ECG in diagnosing myocarditis?

A

47%

20
Q

What is the importance of cardiac MRI in myocarditis diagnosis?

A

Distinguishes ischemic from nonischemic cardiomyopathies and correlates with histological areas of viral myocarditis.

21
Q

What is cardiac magnetic resonance imaging (MRI) used for?

A

To distinguish ischemic from nonischemic cardiomyopathies

Patterns of T1 postgadolinium delayed gadolinium enhancement (DGE) signal abnormality correlate with histological areas of viral myocarditis.

22
Q

What do the Lake Louise Criteria recommend for diagnosing myocarditis?

A

Both T1- and T2-weighted sequences should be performed

These sequences also predict the risk of cardiovascular death and ventricular arrhythmias following myocarditis.

23
Q

Is viral serology useful in diagnosing myocarditis?

A

No, it is limited due to low specificity

Antibody levels may wane over time and do not correlate with myocardial viral genomes determined by PCR.

24
Q

What is giant cell myocarditis (GCM)?

A

A rare and progressive cause of acute heart failure that primarily affects young and otherwise healthy patients

It is associated with thymoma or autoimmune diseases in approximately 20% of cases.

25
Q

How is GCM diagnosed?

A

By endomyocardial biopsy (EMB) demonstrating diffuse inflammation and necrosis with T-cell predominance

Associated with eosinophils, histiocytes, and multinucleated giant cells.

26
Q

What is the role of endomyocardial biopsy (EMB) in myocarditis?

A

EMB remains the gold standard for diagnosis but is not indicated in all patients

High specificity but lower sensitivity due to sampling error.

27
Q

How is an endomyocardial biopsy performed?

A

Access the right ventricle through the right internal jugular vein or right femoral vein

Fluoroscopy and/or echocardiography guidance are required to localize the site of biopsy.

28
Q

What are the risks associated with an endomyocardial biopsy?

A

Complications reported in 1% to 6% of procedures

Serious complications such as ventricular perforation are less than 1%.

29
Q

When is it appropriate to proceed with an endomyocardial biopsy?

A

In disorders that cannot be diagnosed by less invasive methods

AHA/ACC/ESC guidelines outline specific clinical scenarios for EMB consideration.

30
Q

What are the limitations of the endomyocardial biopsy (EMB)?

A

Limited availability and low sensitivity

More than 17 samples may be required for 80% sensitivity.

31
Q

What is the first-line therapy for myocarditis?

A

Supportive care and guideline-directed medical therapy for heart failure

Standard doses of beta-blockers, ACE inhibitors, and diuretics are recommended.

32
Q

Should physical exercise be avoided in myocarditis?

A

Yes, continuous aerobic exercise increases mortality

Sustained aerobic physical activity should be avoided for a minimum of 3 months.

33
Q

What are the predictors of mortality in myocarditis?

A

Syncope at presentation, greater ventricular systolic dysfunction, greater pulmonary hypertension, QRS >120 milliseconds, and Q waves in the ECG

Normal ventricular function is a predictor of good outcome.

34
Q

Fill in the blank: The survival time for giant cell myocarditis (GCM) is typically less than ______.

A

4 months

35
Q

True or False: Immunosuppressive therapy is routinely recommended for acute lymphocytic myocarditis.

A

False

Cardiology Secrets (26 decks)

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