Myocarditis

• What does myocarditis refer to?


  Inflammation of the myocardium (heart muscle)
• When does myocarditis often occur?


  Following a viral infection
• In which demographic should myocarditis be considered when presenting with chest pain?


  Young people
• What is the most common viral cause of myocarditis?

  Cocksackie B virus
• What might an ECG show in a patient with myocarditis?


  Non-specific changes
• What blood tests may indicate myocarditis?

  Raised troponin/CK-MB
• What is the gold-standard investigation for myocarditis?


  Endomyocardial biopsy
• What is the primary treatment approach for myocarditis?


  Supportive care and optimizing the underlying cause
• How might patients suffering from viral myocarditis benefit?


  From a course of corticosteroids
• What is the prognosis for acute myocarditis?


  50% of patients make a full recovery within 4 weeks
• What rare condition may develop after myocarditis?


  Dilated cardiomyopathy
• What is another name for myocarditis?


  Inflammatory cardiomyopathy
• What additional inflammation occurs alongside myocarditis?


  Inflammation of the pericardium
• What age group is predominantly affected by myocarditis?


  Young people aged 19 to 35 years old
• What causes myocarditis at the cellular level?


  Infiltration of inflammatory cells into heart tissue
• How can myocarditis be classified?


  • According to cause
  • Most common cause in Europe and the UK: viruses (Cocksackie B)
  • Worldwide: Chagas disease from Trypanosoma cruzi
• What are some viral infections that can cause myocarditis?

  • Cocksackie B virus
  • COVID-19
  • Adenovirus
  • Epstein Barr Virus
• What are some bacterial infections that can cause myocarditis?

  • Diphtheria
  • Clostridia
  • Neisseria gonorrhoeae
• What protozoan infection is associated with myocarditis?


  • Trypanosoma cruzi
• What autoimmune conditions can lead to myocarditis?


  • Kawasaki disease
  • Scleroderma
  • Systemic lupus erythematosus (SLE)
  • Sarcoidosis
  • Systemic vasculitides
• What drug reactions can cause myocarditis?


  • Antipsychotics (including clozapine)
  • Immune-checkpoint inhibitors
  • Mesalazine
• What are the common symptoms of myocarditis?


  • Chest pain (sharp, stabbing)
  • Shortness of breath
  • Palpitations
  • Lightheadedness
  • Syncope
  • Fever and viral prodrome
  • Severe cases: sudden unexplained cardiac death
• What signs may be present in myocarditis?


  • Asymptomatic or non-specific signs
  • Dull heart sounds
  • Pericardial rub (if myopericarditis)
  • Signs of heart failure (in fulminant myocarditis)
• What are the differential diagnoses for myocarditis?


  • Acute Coronary Syndrome (ACS)
  • Similarities: chest pain, ECG changes
  • Differences: ACS pain is crushing, myocarditis pain is sharp
  • Pericarditis
  • Similarities: chest pain, possible overlap
  • Differences: pericarditis pain is pleuritic and positional
  • Pulmonary Embolism (PE)
  • Similarities: chest pain
  • Differences: PE pain is pleuritic, myocarditis is not worsened on inspiration
• What investigations are used for myocarditis?

  • Bedside: ECG (non-specific changes, arrhythmias)
  • Bloods: Raised Troponin and CK-MB, inflammatory markers, viral serology
  • Imaging: Echocardiogram, Cardiac MRI, Endomyocardial biopsy (gold-standard)
• What is the hallmark of myocarditis management?


  • Supportive care
  • Addressing the underlying cause
  • Severe cases may require ITU support and vasopressors
  • Corticosteroids for viral acute myocarditis
  • Limit activity after recovery
• What complications can arise from myocarditis?


  • Heart failure
  • Arrhythmias
  • Dilated cardiomyopathy
• What percentage of patients recover from acute myocarditis within 4 weeks?


  50%
• What long-term condition may develop years after myocarditis?


  Dilated cardiomyopathy