Causes and Management of Myocarditis

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Question 1 of 10

1. Question
With respect to acute myocarditis, which one of the following statements is correct?
- The 5 year mortality from all forms of the condition is 10-15%
- The condition may present as sudden death in a previously healthy adult
- Greater than 90% of patients have normal cardiac function 1 year after presentation
- It cannot be diagnosed at post mortem
- It can be definitively diagnosed in the emergency department
Question 2 of 10

2. Question
Which one of the following statements regarding the pathophysiology of myocarditis is INCORRECT?
- Myocarditis is unlikely to have an infectious aetiology in the developed world
- Inflammation of the myocardium may be focal or diffuse
- Myocarditis is endemic in some parts of South America
- No clear cause of myocarditis can be identified in some patients
- The disease may progress to a dilated cardiomyopathy
Question 3 of 10

3. Question
Which one of the following HAS NOT been implicated in the aetiology of myocarditis?
- Varicella zoster
- Cocksackie virus
- Lyme disease
- Recreational cocaine use
- Ischaemic heart disease
Question 4 of 10

4. Question
A 60 year old woman who is receiving doxorubicin as chemotherapy for ovarian cancer presents to the emergency department with a 2 day history of palpitations. Her ECG shows a sinus tachycardia of 120 but there are no other abnormal clinical findings.

Which one of the following statements is true?
- A normal troponin rules out a diagnosis of acute myocarditis in this patient
- A normal creatinine kinase rules out myocarditis in this patient
- An absence of ischaemic changes on the ECG rules out myocarditis in this patient
- A normal CXR rules out myocarditis in this patient
- None of the above
Question 5 of 10

5. Question
A 44-year-old lady with no previous medical problems presents with a 12 hour history of left sided chest pain. An ECG shows widespread ST elevation.

Which one of the following is correct?
- Coronary angiography may be required to differentiate between acute myocardial infarction and acute myocarditis
- If acute myocarditis is suspected intravenous immunoglobulin should be given with out delay
- An elevated troponin will help differentiate between acute myocarditis and acute myocardial infarction
- Urgent endomyocardial biopsy may be required to distinguish between acute myocardial infarction and acute myocarditis
- ECG changes of acute myocarditis are usually confined to the territory of a single coronary artery
Question 6 of 10

6. Question
A previously healthy 6 month old baby presents with a 2 day history of fever, poor feeding and increased work of breathing. On examination the child is floppy with a capillary refill time of 6 seconds, HR of 200 bpm and cardiomegaly and signs of heart failure on a CXR. Acute myocarditis is suspected.

Which one of the following statements is correct?
- Antibiotics are contraindicated in this patient
- An intravenous fluid bolus is contraindicated in this patient
- An echocardiogram should be performed immediately
- Assessment and stabilisation of airway, breathing and circulation should be performed without delay
- An ECG is unhelpful in a child of this age
Question 7 of 10

7. Question
Which one of the following ECG findings may be present in acute myocarditis?
- Prolonged QT interval
- PR interval depression
- ST segment elevation
- Atrioventricular block
- All of the above
Question 8 of 10

8. Question
A 25 year old female presents with a 4 day history of fever, sore throat and pleuritic left sided chest pain. She has a raised troponin. A bedside echocardiogram is performed.

Which one of the following is not consistent with acute myocarditis?
- Pericardial effusion
- Left ventricular hypertrophy
- Reduced left ventricular ejection fraction
- Global hypokinesis
- Multichamber dilatation
Question 9 of 10

9. Question
Which one of the following is of proven benefit in the management of a patient with haemodynamic compromise and acute myocarditis of viral aetiology?
- 24 week course of oral prednisolone
- 24 week course of oral prednisolone and oral azathioprine
- Supportive therapy with inotropic support if required
- Intravenous immunoglobulin
- 24 week course of oral cyclosporine
Question 10 of 10

10. Question
Which one of the following factors is NOT associated with a poor prognosis in a patient with acute myocarditis?
- Syncope
- Ejection fraction less than 40%
- Bundle branch block on the ECG
- Presenting complaint of chest pain
- Ventricular arrhythmia

Causes and Management of Myocarditis – Post Test

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