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Acute Viral Myocarditis — RACP Adult Medicine MCQ

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ModerateCardiologyAcute Viral MyocarditisRACP Adult Medicine

A 25-year-old man presents with acute chest pain, dyspnoea, and fever 1 week after a viral URTI. ECG shows diffuse ST elevation. Troponin is markedly elevated (5000 ng/L). Echo shows global hypokinesis (LVEF 35%) with a small pericardial effusion. Cardiac MRI shows diffuse myocardial oedema with late gadolinium enhancement in a non-coronary distribution (mid-wall and epicardial). Coronary angiography is normal. What is the most likely diagnosis?

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Correct answer: E — Acute myocarditis

Chest pain post-viral illness with elevated troponin, diffuse ST changes, reduced LVEF, and CMR showing myocardial oedema with non-ischaemic (mid-wall/epicardial) LGE pattern with normal coronaries is acute myocarditis. The modified Lake Louise criteria (CMR) are the non-invasive diagnostic standard. Most cases are viral (Coxsackie B, parvovirus B19, HHV-6). Management: supportive, HF therapy if needed, avoid exercise for 3-6 months.

Reference: ESC – 2023 – Myocarditis; Modified Lake Louise Criteria 2018