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Raza Q π¬π§
"It has absolutely everything for medical school, so many histories with detailed differential diagnoses, how to approach emergencies, commonly prescribed drugs..every kind go examination youβll ever need in osces"
John R π¬π§
"Thank you SO MUCH for the amazing educational resource. Iβve tried lots of platforms and books with mock OSCE stations and yours is by far and away the best Iβve tried"
Ed M π³πΏ
"Get this right away. So helpful for OSCEs but also general clinical learning and understanding. Wish I had brought it sooner"
Emma W π¬π§
"Without a doubt, your platform outshines all other OSCE resources currently available. In all honesty, I can confidently attribute my success in securing a distinction in my finals to OSCEstop."
Harish K π¬π§
"OSCEstop distinguishes itself from many other platform banks by offering a wealth of questions that mimic the demanding and complex aspects of our finals. This platform played a crucial role in ensuring I was ready for the level of difficulty that awaited me in my final exams."
The inflammation of the heart muscle (myocardium).
Epidemiology
There is uncertainty regarding true prevalence, but some global estimates report 1.8 million new cases annually.
Incidence rates increase as age increases.
Pathophysiology
Damage to the myocardium (e.g. from viruses, toxins, bacteria) β Immune mediated response and inflammatory responseΒ (e.g. cytokine release, T cell activation) Β β Chronic inflammation and fibrosis OR resolution of inflammatory response.
Aetiology
Most commonly caused by viral infectionssuch as Coxsackievirus, Adenovirus, and Parvovirus B19.
Other causes include bacterial infections, fungal infections, parasitic infections, drugs, toxins, and systemic diseases like SLE and sarcoidosis.
Clinical Features π‘οΈ
Symptoms
Symptoms can range from mild(fatigue, chest pain, dyspnoea)Β to severe(cardiogenic shock, sudden death).
Other symptoms include arrhythmias, heart failure, and pericarditis symptoms.
Signs
Tachycardia
Murmurs
S3 heart sound
Signs of heart failure
Investigations π§ͺ
Initial Tests
Electrocardiogram (ECG):Non-specific ST and T wave changes, arrhythmias.
Blood tests:Elevated cardiac enzymes (Troponin), inflammatory markers, and viral titres.
Diagnostic Tests
Echocardiogram: Can show reduced ejection fraction, ventricular dilatation, and other structural abnormalities.
Cardiac MRI: Considered the gold standard for diagnosis; shows inflammation and oedema.
Endomyocardial biopsy: Histological confirmation but used selectively due to invasiveness.
Management π₯Ό
Management
Supportive care: Rest, oxygen, and treatment of heart failure symptoms.
Immunosuppressive therapy: In certain cases, especially if related to systemic disease.
Management of arrhythmias and heart block as needed.
Consideration of antiviral therapy based on the specific causative agent.
Prognosis
Variable, depending on the cause and severity.
Some may have complete recovery while others progress to chronic heart failure.
Complications
Cardiac arrhythmias
Dilated cardiomyopathy
Heart failure
Thromboembolism
Sudden cardiac death
Key Points
Inflammation of the myocardium most commonly caused by a viral infection (e.g Coxsackievirus, Adenovirus).
Cardiac MRI is the gold standard tool for diagnosis.
Management depends on the underlying cause e.g. antiviral therapy if caused by a viral agent or immunosuppressive therapy if caused by systemic disease such as sarcoidosis.
Complications include: arrhythmias, heart failure and dilated cardiomyopathy.
References
Brociek, E., Agata TymiΕska, Andrea Silvio Giordani, Alida L.P. Caforio, Romuald Wojnicz, Grabowski, M. and Krzysztof OzieraΕski (2023). Myocarditis: Etiology, Pathogenesis, and Their Implications in Clinical Practice. Biology, 12(6), pp.874β874. doi:https://doi.org/10.3390/biology12060874.
Golpour, A., Patriki, D., Hanson, P.J., McManus, B. and Heidecker, B. (2021). Epidemiological Impact of Myocarditis. Journal of Clinical Medicine, [online] 10(4), p.603. doi:https://doi.org/10.3390/jcm10040603.