Myocarditis

Today in morning report we heard about a young woman with myocarditis.

Here were some key points:

1) Dangerous causes of chest pain in a young person:
Cardiac: 
- pericarditis
- myocarditis
- myocardial ischemia from drug use, thrombophilia, coronary artery dissection or premature atherosclerosis
- aortic dissection with condition predisposing to aortopathy such as Marfan's, Ehler's-Danlos, Ankylosing spondylitis or bicuspid aortic valve
Lung:
- pulmonary embolism
- pneumothorax
GI:
- Esophageal rupture

2) Causes of Myocarditis:
- Viral and post-viral: mostly Coxsackie, adenovirus, parvovirus and herpes viruses
- Bacterial: Borrelia burgdorferi and Ehrlichia species
- Parasites: Babesia, Trypanosoma cruzi
- Toxic: alcohol, radiation, chemicals (hydrocarbons and arsenic), and drugs, including doxorubicin
- Hypersensitivity: sulphonamides and penicillins
- Idiopathic: giant-cell myocarditis (autoimmune) and cardiac sarcoidosis

3) Complications of Myocarditis
- heart failure and cardiogenic shock
- arrythmias including high degree heart block
- sudden cardiac death as a result of either of the above


Check out this negative trial of cyclosporine and azathioprine for myocarditis.
Here is a great review of Myocarditis