FCPS TOACS · ECG of Myocarditis Mock Test

❓ Q1. Describe the ECG findings.

✅ Model Answer:
• Low voltage QRS (reduced amplitude).
• Diffuse non-specific ST-T changes (ST elevation/depression, T wave inversion).
• Sinus tachycardia (most common rhythm).
• Arrhythmias: PVCs, VT, AV block, prolonged PR.
• Pathological Q waves may appear (if necrosis).

❓ Q2. What are the causes of myocarditis in children? How would you classify them?

✅ Model Answer:
• Viral (Coxsackievirus B – most common, adenovirus, parvovirus B19, COVID-19).
• Post-infectious (MIS-C).
• Bacterial (Lyme, diphtheria), autoimmune (SLE, JIA), drug-induced, giant cell, eosinophilic, idiopathic.

❓ Q3. What is the diagnostic workup for suspected myocarditis? What is the role of cardiac MRI?

✅ Model Answer:
• Workup: troponin, BNP, ECG, echo, CXR, viral studies.
• Cardiac MRI: Lake Louise criteria – T2 edema, early gadolinium enhancement, late gadolinium enhancement (subepicardial/midwall – viral myocarditis pattern).

❓ Q4. What is the role of troponin in myocarditis? Is it always elevated?

✅ Model Answer:
• Troponin is a sensitive marker of myocardial injury, elevated in most cases.
• May be normal in mild or early cases.
• Serial troponin monitoring helps track disease course.

❓ Q5. What are the Lake Louise criteria for cardiac MRI in myocarditis? What is the pattern of late gadolinium enhancement in myocarditis?

✅ Model Answer:
• Lake Louise criteria: T2 edema, early gadolinium enhancement, late gadolinium enhancement (≥2 of 3).
• LGE pattern: subepicardial or midwall (non-ischemic), not following coronary territory.

❓ Q6. What are the echocardiographic findings in myocarditis? How does it differ from dilated cardiomyopathy?

✅ Model Answer:
• Echo: LV dysfunction (global or regional), LV dilation, pericardial effusion, MR.
• Myocarditis: acute onset, fever, troponin elevation, patchy WMA, LGE on MRI.
• DCM: chronic, progressive, symmetric dilation, no LGE (or different pattern).

❓ Q7. What is the management of acute myocarditis? What is the role of inotropes and mechanical support?

✅ Model Answer:
• Supportive: diuretics, inotropes (milrinone preferred), avoid digoxin.
• ECMO for fulminant myocarditis (refractory shock).
• IVIG (controversial), corticosteroids for giant cell or MIS-C.

❓ Q8. When is ECMO indicated in myocarditis? What is the prognosis?

✅ Model Answer:
• ECMO: fulminant myocarditis, refractory shock, cardiac arrest.
• Prognosis: 60-80% survival, many recover LV function within weeks.

❓ Q9. What is the role of IVIG in myocarditis? Is it always indicated?

✅ Model Answer:
• IVIG 2 g/kg – may have benefit, evidence is controversial.
• Not always indicated; used in fulminant, MIS-C, or idiopathic cases.
• Side effects: headache, aseptic meningitis, thrombosis.

❓ Q10. What is the role of endomyocardial biopsy in myocarditis? When is it indicated?

✅ Model Answer:
• Gold standard (Dallas criteria) – low sensitivity (patchy inflammation).
• Indications: fulminant myocarditis (rule out giant cell), giant cell/eosinophilic, vasculitis, inconclusive cases.

❓ Q11. What is giant cell myocarditis? How does it differ from lymphocytic myocarditis?

✅ Model Answer:
• Giant cell: rare, aggressive, multinucleated giant cells on biopsy.
• Requires immunosuppression (corticosteroids + azathioprine).
• Lymphocytic: viral, milder, supportive care.

❓ Q12. A child with MIS-C presents with myocarditis. What is the management?

✅ Model Answer:
• IVIG 2 g/kg (first-line) + corticosteroids (methylprednisolone).
• Milrinone for inotropic support.
• Anakinra for refractory cases.
• Monitor for coronary aneurysms.

❓ Q13. What is the long-term prognosis for a child with myocarditis?

✅ Model Answer:
• Most recover fully with supportive care.
• Complications: DCM, arrhythmias, heart failure.
• Avoid competitive sports for 3-6 months.

⚕️ FCPS MCPS IMM MD Paediatrics TOACS · Mock Test