Updated: 6/3/2020

Myocarditis

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?? Parasitic (eg, Trypanosoma cruzi, Toxoplasma gondii)
?? Bacterial (eg, Borrelia burgdorferi, Mycoplasma pneumoniae)
?? Toxins (eg, carbon monoxide, black widow venom)
?? Rheumatic fever
??Drugs (eg, doxorubicin, cocaine)
?? Autoimmune (eg, Kawasaki disease, sarcoidosis, SLE, polymyositis/dermatomyositis?? Parasitic (eg, Trypanosoma cruzi, Toxoplasma gondii)
?? Bacterial (eg, Borrelia burgdorferi, Mycoplasma pneumoniae)
?? Toxins (eg, carbon monoxide, black widow venom)
?? Rheumatic fever
??Drugs (eg, doxorubicin, cocaine)
?? Autoimmune (eg, Kawasaki disease, sarcoidosis, SLE, polymyositis/dermatomyositis)
Snapshot
  • A 26-year-old man presents to his primary care physician due to shortness of breath and mild palpitations. He reports that his symptoms have progressively worsened over the course of a month. His shortness of breath is most apparent with climbing the stairs or low-intensity jogging. Approximately 2 months ago, he experienced an upper respiratory infection. Physical examination is unremarkable. An electrocardiogram demonstrates nonspecific cardiac abnormalities and cardiac biomarkers and chest radiograph are unremarkable. Preparations are made to obtain a cardiac echocardiogram.
Introduction
  • Clinical definition
    • inflammation of the myocardium that results in myocardial necrosis and degeneration
  • Etiology
    • infectious
      • viruses
        • coxsackievirus B  
        • HIV
        • adenovirus
        • parvovirus B19
        • HHV-6
      • parasitic
        • Toxoplasma gondii
        • Trichinella spiralis
        • Trypanosoma cruzi (Chagas disease)
      • bacterial
        • Borrelia burgdorferi (Lyme disease)
        • Mycoplasma pneumoniae
        • Corynebacterium diphtheriae
      • toxins
        • carbon monoxide
        • black widow venom
      • medications
        • doxorubicin
      • autoimmune disease
        • Kawasaki disease
        • sarcoidosis
        • systemic lupus erythematosus
        • polymyositis/dermatomyositis
  • Pathophysiology
    • in active cases, there is an interstitial inflammatory infiltration of lymphocytic cells in the myocardium
      • this is associated with myocyte necrosis
Presentation
  • Symptoms/physical exam
    • the clinical presentation is broad
      • asymptomatic
      • heart failure findings
        • e.g., dyspnea on exertion, fatigability, and volume overload
      • arrhythmia findings
        • e.g., palpitations and lightheadedness 
      • chest pain
      • fever
Studies
  • Making the diagnosis
    • based on clinical presentation and a number of diagnostic tests (e.g., ECG, serum biomarkers, and cardiac imaging)
    • biopsy (most accurate test) showing myocardial necrosis 
Differential
  • Acute coronary syndrome
    • differentiating factors
      • ECG changes (NSTEMI and STEMI) with increased biomarkers (cardiac troponins)
Treatment
  • Treatment is directed at the underlying cause of myocarditis
Complications
  • Dilated cardiomyopathy
  • Heart failure
  • Sudden cardiac death

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