It can affect how well the heart works: it means that the heart can’t pump properly and doesn’t work as well as normal. ECGs are virtually always abnormal in children with myocarditis, but a normal ECG does not rule out the possibility of the disease. Myocarditis is an inflammation of the heart’s muscle wall. "Can a normal ecg, bloodwork and X-ray rule out myocarditis? In COVID-19 pandemic the focus of treating doctors has been on respiratory problems and securing enough ventilators and … Around half of all cases are idiopathic (Karjalainen et al. Over three quarters of people will improve within two weeks without any complications. Clinicians should have knowledge of the presentation, causes and treatment of myocarditis to avoid a missed or delayed diagnosis in a patient with a potentially fatal diseaseOn histological examination the inflammation may be focal or diffuse (Brady et al.

Simple blood tests may, however, show signs of inflammation and heart damage. anaemia, intercurrent infection and poor glycaemic control) should be promptly identified and treated.Some patients may not maintain an adequate cardiac output despite these measures and the use of intra-aortic balloon pump or extra-corporeal membrane oxygenation may be required.Immunosuppressive therapy has been used to treat patients with acute myocarditis; however, no good evidence exists to support its use.

2006).Immunosuppression may have a role in patients with myocarditis as part of a systemic autoimmune disease.The natural history of myocarditis is poorly understood and very variable. Other causes include drug abuse and conditions such as systemic lupus erythematosus (SLE).Myocarditis due to a virus is relatively common, but most cases are very mild and are never seen by a doctor.

The Myocarditis Treatment Trial randomised 111 patients with biopsy proven myocarditis to receive placebo or immunosuppression with prednisolone plus either cyclosporine or azathioprine for 24 weeks (Mason et al. However, some cases are severe and can lead to considerable damage to the heart pump, resulting in severe heart failure and even dangerous arrhythmia.People may feel feverish and have generalised aches and pains as with any other viral illness. When the heart is severely affected a person may feel tired and breathless. The ECG may show changes which can come and go, are non-specific and can occur in other heart diseases.

Myocarditis is an acute infectious or immunologically mediated syndrome causing inflammation of the heart muscle.

It is most often due to a virus.

Any condition that presents with the symptoms listed in Table 1 should be considered including: ischaemic heart disease, rheumatic fever, primary cardiac arrhythmia, endocarditis, pericarditis, pulmonary embolus and septic shock.In the ED an ECG, chest radiograph (CXR), echocardiography and cardiac biomarkers should be performed at an early stage.The ECG most commonly demonstrates a sinus tachycardia with or without non-specific ST segment and T wave changes. The enteroviruses (Cocksackie A and B) are most commonly encountered and show a seasonal pattern of presentation with peaks in the spring and autumn.Viruses can be detected by confirming a rising antibody titre or viral culture during the acute phase of the illness or by the presence of the viral genome in endomyocardial biopsy samples. Myocarditis, also known as inflammatory cardiomyopathy, is inflammation of the heart muscle. Right ventricular dysfunction was demonstrated in 23% of these patients.Echocardiograph from an infant with myocarditis showing multi chamber dilatationCardiac biomarkers such as troponin or creatinine kinase may be elevated but normal levels do not rule out a diagnosis of myocarditis.In one study of 88 patients with biopsy proven myocarditis only 34% had an elevated troponin I and 5.7% had an elevated CK-MB. The presence of dead or degenerated cardiac myocytes with surrounding inflammation is the hallmark of the disease process.Many aetiological agents have been implicated as causes of myocarditis. It is likely that as advances in the detection of viruses from blood and tissue samples are made, more patients with a viral aetiology will be identified. This will mandate invasive monitoring and central venous access.Heart failure should be treated following conventional guidelines. 1983). Chest pain and palpitations are relatively common under these circumstances. Those patients who had duration of symptoms for less than one month were significantly more likely to have a rise in troponin which would suggest that most of the cardiac muscle cells necrose early in the disease process.This is of relevance to emergency physicians because we are most likely to see patients at the start of the inflammatory process.The following tests are useful in identifying end organ dysfunction and enabling effective resuscitative measures to be instituted early if required:In addition blood cultures should be sent in a febrile patient.Antimyosin cardiac imaging to demonstrate areas of cardiac myocyte necrosis and cardiac CT or MRI are all being used increasingly to investigate patients with suspected myocarditis. These are unlikely to be available as first line investigations to the emergency physician. Patients with a presentation of chest pain and those with brady-arrythmias or narrow complex tachy-arrythmias tended to have a better recovery of cardiac function and lower mortality (87% 4 year transplant-free survival).

2004). Interestingly, patients who survived the acute phase of a fulminant myocarditis had an excellent 11 year survival of 93% compared with those patients with a non-fulminant picture who had a 45% survival.

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