Investigations of Acute myocarditis:
ECG findings are usually non-specific ST-T changes. Occasionally, ECG changes may mimic myocardial infarction or display arrhythmias or LBBB. Q waves or new LBBB are ominous prognostic signs.
Echocardiography may show global or segmental hypokinesia with or without pericardial effusion.
Diastolic filling patterns are abnormal in most patients, and the presence of right ventricular dysfunction is an ominous prognostic sign.
Cardiac biomarkers of myocardial injury are elevated in up to 35% patients with myocarditis. Increased serum concentrations of troponin T (TnT), and especially troponin I (TnI), are more common than increased levels of CK-MB in both adults and children with acute myocarditis.
Cardiac MRI provides information about tissue necrosis and fibrosis, hyperaemia, and interstitial oedema, and is a useful prognostic tool.
Endomyocardial biopsy The usefulness of biopsy is limited by sampling error but is necessary in certain conditions, such as suspicion of giant cell or fulminant myocarditis.
