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Myocarditis — RCPSC EM MCQ

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HardCardiovascular emergenciesMyocarditisRCPSC EM

A 24-year-old has chest pain after a viral prodrome, troponin elevation, mild LV dysfunction and a six-beat run of nonsustained ventricular tachycardia. BP is 104/66 mmHg and coronary disease is not suspected. What is the appropriate disposition?

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Correct answer: D — Admit for monitored care with cardiology assessment and further imaging

The best answer is “Admit for monitored care with cardiology assessment and further imaging”. Suspected acute myocarditis can deteriorate through heart failure or ventricular arrhythmia. Canadian emergency-care guidance recommends hospital admission for all suspected acute myocarditis, with escalation for instability; LV dysfunction and nonsustained VT strengthen the need for monitored care and specialist assessment. Stress testing, NSAID-only treatment and outpatient imaging defer necessary monitoring.

Reference: Emergency Care BC: Myocarditis—Diagnosis and Treatment: https://emergencycarebc.ca/clinical_resource/clinical-summary/myocarditis-diagnosis-and-treatment/