myocarditis

Question 1

presentation of myocarditis

Answer 1

Myocarditis is often asymptomatic.
Development of symptoms may be acute (e.g., in fulminant myocarditis) or chronic.
Features of upper respiratory or gastrointestinal viral infection (e.g., flu-like symptoms, fever, vomiting) may have been present in the preceding 1–2 weeks.

Question 2

classic features of symptomatic myocarditis

Answer 2

chest pain, clinical features of pericarditis
clinical features of acute heart failure
symptoms of cardiac arrhythmia: palpitations, syncope, pre syncope

Question 3

features of fulminant myocarditis

Answer 3

Classic features of myocarditis, plus either of the following requiring intervention:
Hemodynamic instability (e.g., cardiogenic shock)
Electrical instability (e.g., Mobitz type II, ventricular tachycardia)

Question 4

ECG appearance of myocarditis

Answer 4

often abnormal but non-specific
sinus tachycardia
arrhythmia: atrial or ventricular premature beats, supra ventricular arrythmia, VF
conduction abnormality
repolarisation abnormalities
low voltage due to pericardial effusion or myocardial oedema
abnormal Q waves

Question 5

echo findings in myocarditis

Answer 5

Global or regional wall motion abnormality (systolic or diastolic)
Reduced ejection fraction
Ventricular dilation
Increased wall thickness
Pericardial effusion
Complications (e.g., endocavitary thrombus)

Question 6

indications for end-myocardial biopsy

Answer 6

Fulminant myocarditis
Symptomatic myocarditis with:
Impaired left ventricular function or symptomatic heart failure
Arrhythmias (e.g., high-degree atrioventricular block, ventricular arrhythmias)
Peripheral eosinophilia
Patients with asymptomatic myocarditis receiving immune checkpoint inhibitors