Introduction
Myocarditis is an acute inflammatory process affecting the myocardium that may occur in association with endocarditis and pericarditis.
Possible causes:
- Infections: viral including HIV, bacterial, protozoa
- Toxins e.g. scorpion sting
- Poisons e.g. alcohol
- Drugs/Allergy e.g. penicillin
- Deficiencies e.g. thiamine
- Physical agents e.g. radiation
Clinical features
- Largely asymptomatic
- A few may present with palpitations; symptoms of cardiac failure
Physical examination:
- Arrhythmias
- Raised JVP
- Tachycardia
- Cardiomegaly
- S3 or S4 (with or without murmurs of regurgitation in the mitral/tricuspid areas)
Differential diagnoses
- Other forms of cardiac failure, e.g.
peripartum cardiomyopathy
Complications
- Cardiac failure
- Arrhythmias
- Thrombus formation
Investigations
- Electrocardiography
- Echocardiography
- Full Blood Count and differentials, ESR
- Urea, Electrolytes and Creatinine
- Cardiac enzymes
- Endomyocardial biopsy
Treatment objectives
- Eliminate/withdraw the offending agent(s)
- Treat the effect on the heart
- Treat complications
Non-drug treatment
- Bed rest
Drug treatment
- Treat underlying cause(s)
- Anti arrhythmics (depends on the type of arrhythmias)
- Anticoagulant: warfarin
- Anti-cardiac failure: digoxin, diuretics, potassium supplements
- Steroids: prednisolone (not in all cases)
- Multivitamins
- Anti-oxidants: ascorbic acid (vitamin C), vitamin E
Notable adverse drug reactions
- Antiarrhythmics may be pro-arrhythmic
- Anticoagulants: bleeding
- Steroids: fluid retention, dyspepsia
- Diuretics: dehydration, electrolyte imbalance
Prevention
- Prevent infection (viral, bacterial, etc)
- Prevent exposure to toxins
- Nutrition education
PAEDIATRIC CARDIAC DISORDERS
(Refer for Specialist Care)