Question

Diagnosis of Myocarditis.

Hint:

Cardiac MRI is highly sensitive for diagnosing myocarditis and can detect myocardial inflammation even before changes in heart function occur.

Answer 1

The diagnosis of myocarditis involves a combination of clinical evaluation, laboratory tests, imaging, and biopsy. The key diagnostic steps include:
1. Clinical History:
- Detailed patient history to identify risk factors like recent viral infections (e.g., influenza, COVID-19) or autoimmune diseases.
2. Electrocardiogram (ECG):
- Myocarditis often shows nonspecific ST-segment and T-wave changes, which may mimic acute coronary syndrome. In severe cases, arrhythmias like atrial fibrillation or ventricular tachycardia can occur.
3. Blood Tests:
- Troponin levels: Elevated in myocarditis due to myocardial injury.
- C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Markers of inflammation, which may be elevated in inflammatory myocarditis.
- Viral PCR or antibody tests: To detect viruses that can cause myocarditis, such as enteroviruses or adenoviruses.
4. Echocardiography:
- This imaging technique assesses heart function and identifies signs of heart failure. It can reveal left ventricular dysfunction and reduced ejection fraction.
5. Cardiac Magnetic Resonance Imaging (MRI):
- The gold standard for imaging in suspected myocarditis. MRI shows late gadolinium enhancement in areas of myocardial injury and inflammation.
6. Endomyocardial Biopsy:
- This is the definitive diagnostic test for myocarditis, though it is rarely performed. It involves taking a small sample of heart tissue for histological examination to look for evidence of inflammation and viral particles.