Causes and Management of Myocarditis - Post Test

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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%
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The condition may present as sudden death in a previously healthy adult
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Greater than 90% of patients have normal cardiac function 1 year after presentation
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It cannot be diagnosed at post mortem
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It can be definitively diagnosed in the emergency department
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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
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Inflammation of the myocardium may be focal or diffuse
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Myocarditis is endemic in some parts of South America
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No clear cause of myocarditis can be identified in some patients
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The disease may progress to a dilated cardiomyopathy
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Question 3 of 10

3. Question

Which one of the following HAS NOT been implicated in the aetiology of myocarditis?

Varicella zoster
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Cocksackie virus
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Lyme disease
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Recreational cocaine use
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Ischaemic heart disease
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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
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A normal creatinine kinase rules out myocarditis in this patient
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An absence of ischaemic changes on the ECG rules out myocarditis in this patient
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A normal CXR rules out myocarditis in this patient
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None of the above
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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
Correct Incorrect Correct answer

If acute myocarditis is suspected intravenous immunoglobulin should be given with out delay
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An elevated troponin will help differentiate between acute myocarditis and acute myocardial infarction
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Urgent endomyocardial biopsy may be required to distinguish between acute myocardial infarction and acute myocarditis
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ECG changes of acute myocarditis are usually confined to the territory of a single coronary artery
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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
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An intravenous fluid bolus is contraindicated in this patient
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An echocardiogram should be performed immediately
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Assessment and stabilisation of airway, breathing and circulation should be performed without delay
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An ECG is unhelpful in a child of this age
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Question 7 of 10

7. Question

Which one of the following ECG findings may be present in acute myocarditis?

Prolonged QT interval
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PR interval depression
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ST segment elevation
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Atrioventricular block
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All of the above
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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
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Left ventricular hypertrophy
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Reduced left ventricular ejection fraction
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Global hypokinesis
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Multichamber dilatation
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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
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24 week course of oral prednisolone and oral azathioprine
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Supportive therapy with inotropic support if required
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Intravenous immunoglobulin
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24 week course of oral cyclosporine
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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
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Ejection fraction less than 40%
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Bundle branch block on the ECG
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Presenting complaint of chest pain
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Ventricular arrhythmia
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Causes and Management of Myocarditis – Post Test

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