Myocarditis

Question 1

what is myocarditis?

Answer 1

inflammation of the myocardium

Question 2

causes of myocarditis

Answer 2

most commonly viral, Cox-sackie virus

• HIV
• diphtheria
• rheumatic fever
• radiation injury
• drug-induced

Question 3

clinical features of myocarditis

Answer 3

• acute illness
• fever
• biventricular failure
• cardiac arrhythmias
• pericarditis

Question 4

management of myocarditis

Answer 4

• bed rest

- treat like heart failure

Question 5

clinical findings on echo for myocarditis

Answer 5

• pericardial effusion

- hypokinesia

Question 6

types of myocarditis

Answer 6

• autoimmune myocarditis (either exclusive involvement of the heart eg Churg-Strauss syndrome or a systemic autoimmune condition like SLE)
• giant cell myocarditis
• drug-induced myocarditis
• sarcoidosis
• hypersensitive and toxic myocarditis
• eosinophilic myocarditis (rare but fatal; can be caused by a number of different reasons)

Question 7

how would you diagnose myocarditis?

Answer 7

tissue biopsy

Question 8

3 phases of myocarditis

Answer 8

• direct viral damage to the myocyte (the virus causing cell death)
• triggered immune system attacks the heart
• myocardium undergoes remodelling, causing the development of dilated cardiomyopathy (can cause HF)

Question 9

Characteristics of acute myocarditis

Answer 9

• lymphocytic infiltrates

- myocyte necrosis

Question 10

characteristics of borderlines necrosis

Answer 10

• inflammatory infiltrates

- no evidence of myocyte necrosis