Myocarditis Flashcards¶
Anki-compatible flashcards for pediatric myocarditis board review.
Q: What is the most common cause of myocarditis in children? A: Viral infection (particularly enteroviruses, adenovirus, parvovirus B19; COVID-19 in recent years) Tags: myocarditis, etiology, viral, high-yield
Q: What are the three classic presentation patterns of pediatric myocarditis? A: 1) Acute decompensated heart failure, 2) Chest pain with ST changes (mimicking MI), 3) Arrhythmias (often out of proportion to LV dysfunction) Tags: myocarditis, presentation, high-yield
Q: What cardiac biomarkers are typically elevated in acute myocarditis? A: Troponin (sensitive), BNP/NT-proBNP (reflects heart failure severity), CRP/ESR (inflammatory markers) Tags: myocarditis, diagnosis, labs
Q: What are the ECG findings in acute myocarditis? A: Sinus tachycardia, low voltage, ST-T changes (diffuse or localized), arrhythmias (PVCs, VT), conduction abnormalities (AV block) Tags: myocarditis, ecg
Q: What echocardiographic findings suggest acute myocarditis? A: LV dilation with decreased function, regional wall motion abnormalities, pericardial effusion, MR, increased wall thickness (edema) Tags: myocarditis, echo
Q: What is the role of cardiac MRI in myocarditis diagnosis? A: Can confirm diagnosis; Lake Louise criteria include edema (T2), hyperemia (early gadolinium enhancement), and necrosis/fibrosis (late gadolinium enhancement) Tags: myocarditis, mri, lake-louise, high-yield
Q: What percentage of pediatric acute myocarditis patients recover normal LV function? A: ~60-70% recover completely; ~20% have persistent dysfunction; ~10% progress to DCM or death Tags: myocarditis, prognosis
Q: What is the treatment for acute myocarditis? A: Supportive care (diuretics, inotropes, mechanical support if needed); standard HF therapy (ACEi/ARB, beta-blockers when stable); IVIG has limited evidence but often used Tags: myocarditis, treatment
Q: What arrhythmias can occur in myocarditis? A: Sinus tachycardia (common), PVCs, VT (can be polymorphic), AV block (any degree), atrial arrhythmias Tags: myocarditis, arrhythmia
Q: What is the minimum return-to-play restriction after myocarditis? A: 3-6 months minimum; requires normal echo, Holter/event monitor, AND exercise stress test before clearance Tags: myocarditis, sports, return-to-play, high-yield
Q: What mechanical support options exist for fulminant myocarditis? A: ECMO (VA-ECMO for circulatory support), VAD (bridge to recovery or transplant) Tags: myocarditis, treatment, ecmo
Q: What is fulminant myocarditis? A: Rapidly progressive myocarditis with severe hemodynamic compromise requiring inotropic or mechanical support; paradoxically may have better prognosis if supported through acute phase Tags: myocarditis, fulminant, definition
Q: What is giant cell myocarditis? A: Aggressive inflammatory myocarditis with multinucleated giant cells on biopsy; poor prognosis, may respond to immunosuppression; high arrhythmia risk Tags: myocarditis, giant-cell
Q: When is endomyocardial biopsy indicated in myocarditis? A: Not routine; consider for fulminant/refractory cases, suspected giant cell myocarditis, or when specific diagnosis would change management Tags: myocarditis, biopsy
Q: How does myocarditis associated with COVID-19 mRNA vaccines typically present? A: Chest pain and troponin elevation in young males 2-4 days after 2nd dose; generally mild course with full recovery Tags: myocarditis, covid, vaccine
Q: What differentiates MIS-C myocardial involvement from acute viral myocarditis? A: MIS-C: Usually mild LV dysfunction that recovers rapidly (days-weeks), multisystem inflammation, shock disproportionate to cardiac dysfunction, coronary involvement possible Tags: myocarditis, misc, covid
Q: An 8-year-old presents with chest pain, diffuse ST elevation, and mildly reduced LV function. Troponin is elevated. What is the most likely diagnosis? A: Acute myocarditis (myopericarditis if pericardial effusion also present) Tags: myocarditis, clinical, high-yield
Q: What medication should be used cautiously or avoided in acute myocarditis? A: NSAIDs (may worsen inflammation in animal models); beta-blockers in acute phase if hemodynamically unstable Tags: myocarditis, treatment, avoid
Q: What follow-up is recommended after acute myocarditis? A: Echo at 2-4 weeks, 3-6 months, and annually until confirmed normal; Holter before sports clearance; consider cardiac MRI for risk stratification Tags: myocarditis, follow-up
Q: A teenager had myocarditis 4 months ago. Echo is normal. What else is needed before sports clearance? A: Holter monitor (24-48h) AND exercise stress test - both must be normal along with echo Tags: myocarditis, sports, clearance, high-yield