Re: Acute Myocarditis
"Acute myocarditis is a rare inflammatory disease characterized by lymphocytic infiltration and myocyte necrosis, which may lead to the sudden onset of cardiac failure. Myocarditis can cause considerable morbidity and mortality and may lead to dilated congestive cardiomyopathy. Despite tremendous advances in our understanding of myocarditis, considerable controversy exists regarding etiology, pathogenesis, and the role of immunosuppressive therapy. Myocarditis can be caused by a variety of pathogens including bacteria, viruses, and parasites. Viruses, especially enteroviruses such as group B coxsackie and echovirus are probably the most common. Many cases remain idiopathic. The clinical diagnosis of myocarditis is difficult and many times is arrived at only after more common pediatric problems including asthma, recurrent vomiting, and chronic viral illness such as mononucleosis are excluded. Viral myocarditis is preceded many times by a flu-like illness or gastroenteritis. When patients present with the classical findings of congestive heart failure, tachypnea, tachycardia and hepatomegaly, the diagnosis is more apparent. Occasionally, patients present with respiratory distress or shock. The EKG can show low voltage QRS complexes, ST elevation, or heart block. Atrial or ventricular arrythmias are common. Serial 24-hour Holter recordings should be obtained in all patients. Chest x-ray show pulmonary edema. Echo is extremely useful in excluding congenital structural defects; pericardial effusion with tamponade should also be excluded. Acute and chronic serum viral titers should be drawn in an attempt to identify the causative agent. Cardiac catheterization with endomyocardial biopsy remains the gold standard for the diagnosis of myocarditis. Acute myocarditis usually presents with symptoms of mild to moderate congestive heart failure from left ventricular dysfunction. Most patients respond well to bed rest, digitalization, diuresis, and probably most important, after-load reduction with angiotensin-converting enzyme inhibitors such as captopril. Occasionally, patients experience profound cardiovascular collapse and require high-dose inotropic support and mechanical ventilation."
It's almost always viral in nature.
Have a good one.