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myocarditis
Etiology: (see etiology of myocarditis)
1) infectious
- viral
- bacterial
- fungal
- parasitic
2) non-infectious
- connective tissue diseases
- thyrotoxicosis
- thrombotic thrombocytopenic purpura (TTP)
- pheochromocytoma
- peripartum
- radiation
- pharmaceutical agents
- Kawasaki disease
- giant cell myocarditis
- sarcoidosis
- spider bites
- wasp stings
- scorpion bites
Clinical manifestations:
1) preceeding acute viral syndrome
2) acute biventricular dysfunction
3) ventricular arrhythmias
4) may mimic acute coronary insufficiency
Laboratory:
1) serum creatine kinase MB (serum CK-MB) may be elevated
2) cardiac-specific troponin-I may be elevated
3) myocardial biopsy
a) myocarditis in a patient who resides in an area where Trypanosoma cruzi is endemic
b) eosinophilia & trichinosis is suspected
Special laboratory:
- electrocardiogram:
a) ventricular arrhythmias
b) T-wave inversions
c) ST segment changes may occur
Differential diagnosis:
- idiopathic cardiomyopathy is not associated with elevated cardiac biomarkers
Management:
1) first-line treatment is standard heart failure therapy [3]
a) diuretics
b) ACE inhibitor, ARB or ARNI
c) beta-blocker (unless decompensated heart failure)
d) aldosterone antagonist
2) rest
3) salt & fluid restriction
4) no benefit of corticosteroids, azathioprine or cyclosporine [3,4]
5) complete functional recovery in most patients
Interactions
disease interactions
Related
etiology of myocarditis
Specific
giant cell myocarditis
General
carditis
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Journal Watch 21(9):70, 2001
Sarda L, Colin P, Boccara F et al
Myocarditis in patients with clinical presentation of
myocardial infarction and normal coronary angiograms.
J Am Coll Cardiol 37:786, 2001
PMID: 11693753 Free Article
- NEJM Knowledge+ Question of the Week. Oct 18, 2016
http://knowledgeplus.nejm.org/question-of-week/164/
- Mason JW, O'Connell JB, Herskowitz A et al
A clinical trial of immunosuppressive therapy for myocarditis.
The Myocarditis Treatment Trial Investigators.
PMID: 7596370 Free Article
- Cooper LT Jr
Myocarditis.
N Engl J Med. 2009 Apr 9;360(15):1526-38
PMID: 19357408
- Kindermann I, Barth C, Mahfoud F et al
Update on myocarditis.
J Am Coll Cardiol. 2012 Feb 28;59(9):779-92
PMID: 22361396 Free Article