Myocarditis

Question 1

What is myocarditis [1]

Answer 1

Inflammation of the heart muscle

Question 2

What causes myocarditis? [5]

Answer 2

Infection (Coxsackie virus, fungal, bacterial or parasitic)
Cocaine
Chemo & other drugs
Autoimmune e.g. rheumatic fever and SLE, sarcoid
Idiopathic 50%

Question 3

How does myocarditis present? [5]

Answer 3

• Prodrome - days to weeks
• Palpitations caused by sinus, tachy, vent extrasystole, VT, VF
• Chest pain mimics angina
• SOBOE from sudden heart failure
• Syncope

Question 4

Investigations [3]

Answer 4

Bloods - troponin
ECG - AV block, bundle branch block, Q waves, ST depression, TWI.
ECHO
Encomyocardial biopsy

Question 5

How do we treat myocarditis? [4]

Answer 5

Mostly its self limiting
Exclude reversible causes like MI
In-patient monitoring
Immunosuppressant drugs - steroids, azathioprine, interferon B

Question 6

Causative organisms
Virus [7]
Bacterial [9]
Protozoa

Answer 6

Virus:
flu, hepatitis, mumps, rubella, coxsackie, polio, HIV

Bacterial
clostridium, diphtheria, TB, tetanus, meningococci, mycoplasma, brucellosis, psittacosis, spirochetes

Protozoa: Chagas

Question 7

Drugs that cause myocarditis [4]

Answer 7

Cyclophosphamide, Herceptin
Penicillin, chloramphenicol sulphonamides
Methyldopa, spironolactone
Phenytoin, carbamazepine

Question 8

Signs on cardiac examination [3]

Answer 8

Tachycardia
Soft 1 murmur
S4 gallop