Myocarditis Flashcards
Define Myocarditis?
Acute inflammation and necrosis of cardiac muscle (myocardium)
What is the epidemiology of Myocarditis?
Incidence is difficult to measure accurately
Coxsackie B virus is most common in Europe and USA
Chagas disease is most common in South America
What is Myocarditis usually?
Usually Idiopathic
What are the viral causes of Myocarditis?
Coxsackie B EBV CMV Adenovirus Influenza
What are the bacterial causes of Myocarditis?
Post-streptococcal
Tuberculosis
Diphteria
What is a fungal cause of Myocarditis?
Candidiasis
What is a Protozoal cause of Myocarditis?
Trypanosomiasis (Chagas Disease)
What Helminth can cause Myocarditis?
Trichinosis
What are the Non-Infective causes of Myocarditis?
Systemic: SLE, Sarcoidosis, Polymyositis
Hypersensitivity myocarditis: sulphonamides
What drugs can cause Myocarditis?
Chemotherapy agents (e.g. doxorubicin, streptomycin)
What are some other causes of Myocarditis?
Cocaine
Heavy Metal
Radiation
What are the presenting symptoms of Myocarditis?
Prodromal flu-like illness symptoms
Breathlessness
Palpitations
Sharp Chest Pain
What are the Prodromal Flu-like illness symptoms in Myocarditis?
Fever
Malaise
Fatigue
Lethargy
What is the Breathlessness in Myocarditis due to?
Pericardial effusion/myocardial dysfunction
What does sharp chest pain in Myocarditis suggest?
Also pericardium is present
What are the signs of Myocarditis on physical examination?
Signs of pericarditis
Signs of complications (e.g heart failure, arrhythmia)
What bloods would you do for Myocarditis and what would you expect?
FBC - raised WCC if infective cause U&E ESR/CRP - raised Cardiac enzymes - may be raised Tests to identify cause (e.g. viral/bacterial serology, ANA, TFT)
What would you see on an ECG for Myocarditis?
Non-specific T wave and ST changes
Pericarditis: widespread saddle-shaped ST elevation
What would you see on a CXR for Myocarditis?
May be Normal
May show cardiomegaly
Why do we do Pericardial Fluid Drainage for Myocarditis?
Measure glucose, protein, cytology, culture and sensitivity
Helps identify causative organism
Why do we do Echocardiography for Myocarditis?
Assesses systolic/diastolic function
Wall motion abnormalities
Pericardial effusions
What else can we do to investigate Myocarditis?
Myocardial Biopsy
rarely required
