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Myocarditis

Definition
  • Myocarditis refers to the inflammation of the heart muscle (myocardium).
Etiology
  • Most commonly caused by viral infections such 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
  • Symptoms can range from mild (fatigue, chest pain, dyspnoea) to severe (cardiogenic shock, sudden death).
  • Other symptoms include arrhythmias, heart failure, and pericarditis symptoms.
  • Physical examination may reveal tachycardia, murmurs, S3 heart sound, and signs of heart failure.
Investigations
  • Electrocardiogram (ECG): Non-specific ST and T wave changes, arrhythmias.
  • Echocardiogram: Can show reduced ejection fraction, ventricular dilatation, and other structural abnormalities.
  • Cardiac MRI: Considered the gold standard for diagnosis. Shows inflammation and edema.
  • Blood tests: Elevated cardiac enzymes (Troponin), inflammatory markers, and viral titres.
  • Endomyocardial biopsy: Histological confirmation but used selectively due to invasiveness.
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.
Complications
  • Cardiac arrhythmias, dilated cardiomyopathy, heart failure, thromboembolism, and sudden cardiac death.
Prognosis
  • Variable, depending on the cause and severity. Some may have complete recovery while others progress to chronic heart failure.

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