Tuesday, 14 April 2015

Myocarditis


There are lots of things that cause myocarditis, but we think it's an immunological thing. It affects children and adults. More likely in immuno-compromised patients - who are more likely to get CMV.

- 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)
- hypersensitivity
- autoimmune (SLE, polymyositis, scleroderma, sarcoidosis, DM, thyrotoxicosis, IBD)
- infectious
- giant cell myocarditis
- (HIV is normally another infection rather than being causative)

Symptoms- Chest pain, fatigue, dyspnoea & palpitations
- 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.

Signs
Fever, tachycardia, pericardial rub + signs of failure. 

Investigations
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

Treatment
Supportive - inotropes if needed
Immunosuppressive therapy has no evidence.

Prognosis
Heart failure, syncope, BBB or reduced ejection fraction on echo all are associated with poor outcome.



References
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