Myocarditis

Question 1

Define

Answer 1

Acute inflammation of the myocardium. Leads to decreased contraction power of heart»> Reduced CO and eventually heart failure

Question 2

Aetiology (5)

Answer 2

Idiopathic= 50%
Virus= coxsackie B, HIV
Bacteria= staph A, syphillis
Autoimmune= SLE, Giant cell myocarditis
Drugs= adverse hypersensitivity reaction

Question 3

Symptoms? (4)

Answer 3

Flu prodrome
Dyspnoea» because of heart failure symptoms
Chest pain relieved on sitting up
Palpitations because of arrhythmias (because the inflammation damages the pacemaker cells on myocardium)

Question 4

Signs? (3) ONE OF THE SIGNS IS A MAYBE

Answer 4

Auscultation= Soft S1 and gallop S4
Arrhythmias
MAYBE Ankle swelling (oedema) due to heart failure symptoms

Question 5

App Ix?

Answer 5

Bloods» troponin, fbc, esr, crp, CK&raquo_space; all elevated
ECG
Echo» will see inflamed heart
CXR» enlarged heart

Question 6

What will be seen on ecg of myocarditis pt? (3)

Answer 6

ST elevation/depression
Transient AV block
Inverted T wave

Question 7

Mx? (4)

Answer 7

Viral= will improve w/ time
Bacterial- ABx
If it has lead to heart failure» ACEi
Arrhythmias» will resolve with time as inflammation improves

Question 8

Complication? and why?

Answer 8

Heart failure» chronic inflammation of the heart will eventually lead to fibrosis and put a constrictive force on the heart meaning it cannot contract as much blood out.
Reduced CO