Myocarditis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • An inflammatory change in the heart muscle characterized by myocyte necrosis and subsequent myocardial destruction
  • Direct cytotoxic effect of causative agent followed by a secondary immune response
  • True incidence is unknown because many cases are asymptomatic.
  • Autopsy studies have demonstrated evidence of myocarditis in 1–7% of cases and >50% in HIV patients.
  • Male > female (1.5:1)
  • Average age of patients with myocarditis is 42 yr.
  • Major cause of unexpected sudden death (15–20% of cases) <40 yr old

Etiology

  • Viral:
    • Enteroviruses (coxsackie B)
    • Adenovirus
    • Herpesvirus (including cytomegalovirus [CMV])
    • Hepatitis C
    • Influenza
    • Echovirus
    • Herpes simplex virus
    • Varicella-zoster
    • Epstein–Barr virus
    • Cytomegalovirus
    • Mumps
    • Rubeola
    • Variola/vaccinia
    • Yellow fever
    • Rabies
    • HIV
  • Bacteria:
    • Diphtheria
    • Tuberculosis
    • Brucellosis
    • Psittacosis
    • Meningococcus
    • Mycoplasma
    • Group A streptococcus
  • Protozoa:
    • Leishmaniasis
    • Malaria
    • Toxoplasmosis in the immunocompromised host
    • Treponema cruzi (Chagas disease):
      • Most common cause of heart failure and myocarditis worldwide
      • 20 million persons infected in Central and South America
    • Trichinosis
    • Trypanosomiasis
  • Spirochetes:
    • Borrelia burgdorferi, the spirochete agent in Lyme disease
    • Syphilis
  • Rickettsial:
    • Scrub typhus
    • Rocky Mountain spotted fever
    • Q fever
  • Fungal:
    • Candidiasis
    • Aspergillosis
    • Cryptococcosis
    • Histoplasmosis
    • Actinomycosis
    • Helminthic
    • Trichinosis
    • Echinococcosis
    • Schistosomiasis
    • Cysticercosis
  • Drugs:
    • Acetaminophen
    • Ampicillin
    • Chemotherapeutic agents (anthracyclines)
    • Cocaine
    • Hydrochlorothiazide
    • Lithium
    • Methyldopa
    • Penicillin
    • Sulfamethoxazole
    • Sulfonamides
    • Zidovudine
    • Radiation
    • Hypersensitivity
    • Heavy metals
    • Hydrocarbons
    • Carbon monoxide
    • Arsenic
  • Autoimmune disorders:
    • Systemic lupus erythematosus (SLE)
    • Wegener granulomatosis
    • Kawasaki disease
    • Giant cell arteritis
    • Sarcoidosis
  • Peripartum cardiomyopathy
  • Bites/stings:
    • Scorpion
    • Snake
    • Black widow venom

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Myocarditis ID - 307186 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307186/all/Myocarditis ER -