Myocarditis is inflammation of the myocardium.
Presentation is highly variable and includes:
- Prodrome of flu-like symptoms or gastroenteritis
- Chest pain
- Collapse
- Heart failure
Causes of myocarditis include:
- Viral
- Adenovirus
- Coxsackie
- Parvovirus
- HIV
- HCV
- Bacterial
- Streptococcal
- Mycoplasma pneumonia
- Syphilis
- Fungal
- Drugs
- Cocaine
- TCA
- Digoxin
- Diuretics
- Antibiotics – Cephalosporins, penicillin
- Dobutamine
- Other
- Sarcoidosis
- Wegener’s granulomatosis
- Churg-Strauss
- IBD
- SLE
- Thyrotoxicosis
- Trypanosomiasis
- Schistosomiasis
Myocarditis may be classified by its cell type:
- Lymphocytic (commonest; just over half of cases)
- Granulomatous
- Giant cell
- Eosinophillic
Investigations
- Bloods
- Troponin/CKMB may be raised
- ECG may show
- Abnormal ST/T waves
- Conduction disturbances
- Echo findings may include
- Transient wall thickening
- Reduced wall motion
- Pericardial effusion
- Cardiac MRI
- Cardiac catherisation with endomyocardial biopsy
- Nuclear imaging
Management
- Treat underlying cause
- Support circulation as required
Complications
- Dilated cardiomyopathy
- Sudden cardiac death
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