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A brief description on myocarditis & its management

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

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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) T o detect abnormal heart rhythms.

14. Diagnosis 14 Echocardiogra phy 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