Myocarditis

Question 1

Define myocarditis

Answer 1

Acute inflammation and necrosis of cardiac muscle or myocardium

Question 2

What are the causes/risk factors of myocarditis?

Answer 2

Infectious
• Viruses
- Coxsackie B
- EBV
- CMV
- Influenza
• Bacterial
- Post-streptococcal
- TB
- Diphtheria
- Lyme disease
• Fungal e.g. candidiasis
• Protozoal e.g. trypanosomiasis (Chagas disease)

Non-infectious
• SLE
• Sarcoidosis
• Chemotherapy
• Heavy metals
• Radiation

Risk Factors
• Infection
• Autoimmune disease
• Peri/post-partum

Question 3

What are the symptoms of myocarditis?

Answer 3

• Fever
• Malaise
• Fatigue
• SOB
• Palpitations
• Pleuritic chest pain
• Symptoms of heart failure

Question 4

What are the signs of myocarditis?

Answer 4

• Pericardial rub
• Signs of heart failure
• Signs of arrhythmia

Question 5

What investigations are carried out for myocarditis?

Answer 5

• 12-lead ECG - most commonly displays non-specific ST-segment and T-wave abnormalities; however, ST-segment elevation and depression frequently occur
• CXR - frequently reveals bilateral pulmonary infiltrates in the setting of myocarditis-induced CHF
• serum CK - often mildly elevated
• serum CK-MB - often mildly elevated
• serum troponin (I or T) - elevated
• serum B-type natriuretic peptide - elevated in response to ventricular distention, such as occurs in CHF due to myocarditis
• two-dimensional echocardiogram - global and regional left ventricular motion abnormalities and dilatation