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Myocarditis Troponin — RACP Adult Medicine MCQ

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EasyCardiologyMyocarditis TroponinRACP Adult Medicine

A 25-year-old woman presents with chest pain and dyspnoea 1 week after a viral illness. Troponin is 2500 ng/L (markedly elevated). ECG shows diffuse ST elevation and PR depression. Echo shows global hypokinesis (LVEF 40%) with a small pericardial effusion. Coronary angiography is normal. What is the most likely cause of raised troponin?

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Correct answer: D — Acute myocarditis

Post-viral chest pain with markedly elevated troponin, diffuse ST changes, global hypokinesis, pericardial effusion, and normal coronaries is acute myocarditis. CMR with modified Lake Louise criteria (myocardial oedema + non-ischaemic LGE pattern) confirms the diagnosis non-invasively. Endomyocardial biopsy is gold standard but rarely needed. Treatment: supportive, avoid exercise 3-6 months, HF therapy if LVEF reduced.

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