Myocarditis

Question 1

Definition myocarditis

Answer 1

Inflammatory infiltrate of myocardium with necrosis and/or degeneration of adjacent myocytes

Question 2

Rapid Complications of myocarditis

Answer 2

Heart failures
Arrhythmias
Death

Question 3

Which clinical term is synonymous with myocarditis

Answer 3

Inflammatory cardiomyopathy

Question 4

Viral causes of myocarditis

Answer 4

Enteroviruses
Coxsackie B
Adenovirus
Influenza
CMV
Poliomyelitis
EBV
HIV -1
Mumps
Rubeola
Varicella
Variole
A rbovirus
RSV
HSV
Yellow fever virus
Rabies
Parvovirus
Viral hepatitis
SARS - cov2

Question 5

Bacterial causes of myocarditis

Answer 5

Diphtheria
Tb
Streptococci
Meningococci
Brucellosis
Clostridia
Staphylococci
Melioidosis
Mycoplasma pneumonia
Psittacosis

Question 6

Fungal causes of myocarditis

Answer 6

Candidiasis
Aspergillosis
Cryptococcosis
Histoplasmosis
Actinomycosis
Blastomycosis
Coccidioidomycosis
Mucormycosis

Question 7

Spirochetal causes of myocarditis

Answer 7

Syphilis
Leptospirosis / Weil dx
Relapsing fever
Borrelia
Lyme disease

Question 8

Rickettsial causes of myocarditis

Answer 8

Scrub typhus
Rocky Mountain spotted fever
Q fever

Question 9

Protozoan causes of myocarditis

Answer 9

Chagas dx
Toxoplasmosis
Trypanosomiasis
Malaria
Leishmaniasis
Balantidiasis
Sarcosporidiosis

Question 10

Helminthic causes of myocarditis

Answer 10

Trichinosis
Echinococcosis
Shistosomiasis
Heterophyiasis
Cysticercosis
Visceral larva migrants
Filariasis

Question 11

Bites and stings causes of myocarditis

Answer 11

Scorpion venom
Snake venom
Black widow
Spider venom
Wasp venom
Tick paralysis

Question 12

Drugs causing myocarditis

Answer 12

Doxorubicin
Anthracyclines
Streptomycin
Cyclophosphamide
Interleukin 2
Anti HER 2 receptor antibody / herceptin

Methyldopa
Spironolactone

Amphetamines
Cocaine
Catecholamines

Question 13

Chemical agents in myocarditis

Answer 13

Hydrocarbons
Carbo monoxide
Arsenic
Lead
Phosphorus
Mercury
Cobalt

Question 14

Physical agents causing myocarditis

Answer 14

Radiation
Heatstroke
Hypothermia

Question 15

Systemic inflammatory dx causing myocarditis

Answer 15

sarcoidosis
Kawasaki
Crohn dx
SLE
UC
Wegener granulomatosis
Thyrotoxicosis
Scleroderma
Rheumatoid arthritis
Giant cell myocarditis

Question 16

Lieberman classification of myocarditis progression

Answer 16

Fulminant
Acute
Chronic active
Chronic persistent

Question 17

Because diagnosis of myocarditis is usually presumptive what facts do we use to diagnose it from the history

Answer 17

acute décompensation of heart failure with no other underlying cardiac dysfunction

patient demographics

Clinical course Of symptoms with spontaneous recovery following supportive care

Question 18

General symptoms of myocarditis

Answer 18

Mild symptoms of chest pain
Fever
Sweats
Chills
Dyspnoea
Palpitations
Syncope
Sudden cardiac death
Heart failure years later

Question 19

Symptoms of viral myocarditis

Answer 19

Present like flulike illness over 1-2 weeks
Fever
Arthralgias
Malaise
Pharyngitis
Tonsillitis
Upper respiratory tract infection

Question 20

What are the signs of acute décompensation of heart failure

Answer 20

Tachycardia
Gallop
Mitral regurgitation
Edema
Pericardial friction rub

Question 21

Signs of sarcoid myocarditis

Answer 21

Lymphadenopathy
Arrhythmias

Question 22

Signs of acute rheumatic fever

Answer 22

Erythema marginatum
Polyarthralgia
Chorea
Subcutaneous nodules - jones criteria

Question 23

Signs of hypertensive / eosinophilic myocarditis

Answer 23

Pruritic maculopapular rash
Hx of drugs use

Question 24

Signs of giant cell myocarditis

Answer 24

Sustained ventricular tachycardia
Rapid progressive hearts failure

Question 25

Signs of peripartum cardiomyopathy

Answer 25

Heart failure developing in the last month of pregnancy or within 5 months following delivery

Question 26

What is takotsubo cardiomyopathy

Answer 26

Severe hypokinesia of anterioapical an inferno apical regions of the heart for unclear reasons often with complete resolution

Question 27

Main association to takotsubo cardiomyopathy

Answer 27

Psychological or stressful event

Question 28

Differential of myocarditis

Answer 28

Coronary artery vasospasm Isolated coronary artery anomalies Myocardial infarction Myocardial ischemia Cardiogenic pulmonary edema High altitude pulmonary edema Neurogenic pulmonary edema Interstitial pulmonary fibrosis Unstable angina Ventricular tachycardia

Question 29

Lab investigations in cardiomyopathy

Answer 29

FBC - leucocytosis in eosinophilia ESR - elevated CRP - elevated Rheumatologic screening - rule out systemic inflammatory dx Cardiac enzymes - elevated especially troponin I or T Viral antibody titres Viral venom in persistence Biopsy Histology

Question 30

Why do you do echocardiography in myocarditis

Answer 30

To exclude other causes of heart failure Evaluate degree of cardiac dysfunction To gross localize extent of inflammation To distinguish between acute and fulminant myocarditis

Question 31

Is Endomyocardial biopsy a criterion standard for diagnosis of myocarditis

Answer 31

Yes

Question 32

What should patient avoid in early recovery period

Answer 32

Strenuous Exercise Digoxin

Question 33

How can we prevent myocarditis

Answer 33

Vaccination - measles, rubella , mumps , COVID19, influenza , poliomyelitis

Question 34

Short term treatment of myocarditis s

Answer 34

Diet - low sodium Bed rest Avoidance of athletic Activity

Question 35

Long term treatment of myocarditis

Answer 35

ACE inhibitors ARBs B blockers Diuretics Vasodilators Inotropic support Radiation Heatstroke Hypothermia Radiation

Question 36

Main cause of myocarditis

Answer 36

Viral - coxsackie and influenza A and B

Question 37

Fulminant myocarditis clinical presentation

Answer 37

Viral prodrome of influenza like illness followed by severe heart failure or cardiogenic shock

Question 38

Prognosis of myocarditis

Answer 38

Good , self limiting