- active viral
* coxsackie virus B - enterovirus
* parasitic - Chagas' disease is the most common cause. Endemic in Central and South America
- post viral (lymphocytic - or rheumatic fever)
- autoimmune (SLE, polymyositis, scleroderma, sarcoidosis, DM, thyrotoxicosis, IBD)
- giant cell myocarditis
- (HIV is normally another infection rather than being causative)
- Often with a prodrome of fever, malaise and arthralgia (89%)
- 60% have a fever, 15% have palpitations
- May be with myopericarditis.
May be quite hard to differentiate from ACS, especially with troponin rises.
Fever, tachycardia, pericardial rub + signs of failure.
Cardiac biomarkers may be elevated - but only 1/2 of patients had an elevated troponin
ECG: non-specific ST segment and T wave changes. Sinus tachycardia. ECG changes not normally in single vessel territory.
CXR: Normal, or features of cardiomegaly
Echo: Let ventricular dysfunction in 69% of patients
Supportive - inotropes if needed
Immunosuppressive therapy has no evidence.
Heart failure, syncope, BBB or reduced ejection fraction on echo all are associated with poor outcome.