Myocardium

Question 1

Most common infective causes of myocarditis?

Answer 1

Usually 10-14 days after a virus

• Coxsackie
• Flu
• CMV
• Parvo
• Adenovirus
• HIV

Post-strep A (ie. rheumatic fever)

Question 2

Myocarditis presentation:

Answer 2

Often young, otherwise healthy person presenting with unexplained arrhythmia, cardiac failure or chest pain/trop rise

Typically 10-14 days post virus

Question 3

Prognosis in myocarditis:

Answer 3

Most run a benign course with full recovery.

Some cases fulminant. If survived, these paradoxically have complete recovery

Survivors may get:
- Chronic myocarditis
- Dilated cardiomyopathy

Question 4

Diagnosis of myocarditis:

Answer 4

Definitive: myocardial biopsy.

In DEM:
- Inflamms, troponin
- ECG: non-specific abnormalities
- Echo: global hypokinesia

ANGIO must be done to rule out CAD

Question 5

Management of myocarditis:

Answer 5

Supportive

Usual Mx of:
- Arrhythmia
- CCF
- Cardiogenic shock

No solid data for immunosuppression, IVIG, steroids

Dilated CM:
–> ICD, VAD, transplant.

Question 6

5 possible ECG findings in myocarditis:

Answer 6

Sinus tachycardia
ST and T wave changes
Pericarditis findings
AV block
QT prolongation
Broad QRS
Arrhythmias

Question 7

Features of this condition:

Answer 7

HOCM/ HCM
Dagger Q waves inf/lat

Most common cause of SCD in young
Autosomal dom, penetrance variable

• LVH
  –> Most common is asymmetrical anterior IV septum
  LEADING TO:
• +/- Dynamic LV outflow obstruction
• Restrictive cardiomyopathy and diastolic failure
  ALSO WITH:
• Abnormal coronaries
• Cellular disarray and arrhythmogenic LV

Young people die from:
A) Exertional outflow obstruction
B) Ventricular arrhythmia

Question 8

Management of HOCM/HCM:

Answer 8

• No HIGH intensity exercise
• ICD
• Septal myomectomy
• Family screening