Morning session on Myocarditia

1. Myocarditis
AETIOLOGY, CLINICAL FEATURES, DIAGNOSIS, TREATMENT, PROGNOSIS
Dr. Nasima Akter Setu
MO, Cardiology Department
Khwaja Yunus Ali Medical College &
Hospital

2. Definition
▪ Myocarditis is an acute
inflammatory condition of the
myocardium (heart muscle)
which can affect the heart's
ability to pump blood
effectively.
▪ Myocarditis is a serious
condition that can lead to
heart failure, arrhythmias, and
even death.
2

3. Aetiology
3

4. Aetiology
▪ Viral Infections (most common);
Examples: Coxsackievirus, Adenovirus, Influenza A & B, HIV,
COVID-19.
▪ Bacterial Infections;
Examples: Lyme disease (Borrelia burgdorferi), Mycoplasma
Pneumoniae
▪ Protozoal;
Examples: Trypanosoma Cruzi (Chaga’s Disease leads to necrosis of
heart muscle), Toxoplasma gandii
4
Infectious Causes

5. Aetiology
▪ Fungal Infections;
Example: Aspergillus
▪ Parasitic;
Example: Shistosoma
▪ Rickettsial Infection
▪ Metazoal Infection
▪ Spirochetal Infection
5
Infectious Causes

6. Aetiology
• Granulomatous inflammatory disease (eg. sarcoidosis,
giant cell myocarditis).
• Autoimmune Diseases;
Example: SLE, Systemic sclerosis, Rheumatoid arthritis,
Sarcoidosis
• Hypersensitivity to penicillin, Sulphonamides, Lead, CO.
6
Non-infectious causes

7. Aetiology
▪ Medications and Toxins;
Example: Alcohol, Anthracyclines, Clozapine, Cocaine,
Lithium.
• Transplant rejection.
• Patients receiving immunosuppressive therapy.
• It can develop in patients with infective endocarditis,
Crohn disease, and systemic lupus erythematous.
7
Non-infectious cause

8. Risk Factors
• Treatment of URI.
• Post Pericarditis.
• Metabolic-lupus.
• Heat stroke .
• Hypothermia.
8

9. Clinical Features
Common Symptoms:
▪ Chest pain or discomfort: Chest pain is common but usually attributable to associated
pericarditis
▪ Heart rate: Tachycardia is common. In diphtheria and dengue, there may be bradycardia
due to heart block
▪ Heart failure: The symptoms and signs of the left and right cardiac failure may develop,
with dyspnea, gallop rhythm, cardiac enlargement and murmurs due to dilatation of the
ventricles
▪ Fatigue or weakness
▪ Shortness of breath
▪ Irregular heartbeats or palpitations
▪ Swelling in the legs, ankles
9

10. Clinical Features
Myocarditis may present in one of four ways:
• Fulminant myocarditis follows a viral prodrome or influenza-like
illness and results in severe heart failure or cardiogenic shock.
• Acute myocarditis presents over a longer period with heart failure; it
can lead to dilated cardiomyopathy.
• Chronic active myocarditis is rare and associated with chronic
myocardial inflammation.
• Chronic persistent myocarditis is characterized by focal myocardial
infiltrates and can cause chest pain and arrhythmia without necessarily
causing ventricular dysfunction.
10

11. 11

12. Pathophysiology
12

13. Diagnosis
13
• General Physical Examination
such as chest pain and fatigue.
Investigations
• Blood Tests
e.g. Troponin I & T, Creatine kinase (Elevated in the early phases),
C-reactive protein -To check for markers of inflammation
• Electrocardiogram (ECG)
To detect abnormal heart rhythms.

14. Diagnosis
14
•Echocardiography
Used to assess heart function and detect abnormalities.
•Cardiac MRI (diagnostic)
Can provide detailed images of the heart muscle and detect inflammation.
•Endomyocardial Biopsy
Rarely done, but used for confirming the diagnosis.

15. Management
15
▪ Lifestyle Modification
Bed rest and avoiding strenuous physical activities during the recovery
phase.
▪ Treatment of myocarditis is primarily supportive.
▪ Oxygen therapy
▪ Specific antimicrobial therapy may be used if a causative organism
has been identified but this is rare. Patients who do not respond
adequately to medical treatment may temporarily require circulatory
support with a mechanical ventricular assist device.

16. Management
16
▪ Treatment for cardiac failure (ACE inhibitors e.g Captopril,
lisinoprill etc, beta-blockers, diuretics) or arrhythmias should be
given, and patients should be advised to avoid intense physical
exertion because there is some evidence that this can induce potentially
fatal ventricular arrhythmias.
▪ Rarely, cardiac transplantation may be required.

17. Complications
17

18. Prognosis
18
•Myocarditis is self-limiting in most patients and the immediate prognosis is
good. Death may occur due to a ventricular arrhythmia or rapidly progressive
heart failure in severe cases.

19. Thank You