Incorrect. Although the guidelines highlight that IMPS may have a genetic background and discuss the role of inherited cardiomyopathies, this is not the purpose of introducing the IMPS term. The term is about clinical presentation overlap, not early genetic triage.

Correct. The guidelines explicitly state that IMPS is introduced as an “umbrella term during the initial diagnostic process” to increase awareness of the “possible myocarditis–pericarditis overlap” and guide tailored early work-up until a final specific diagnosis is established. This makes IMPS a temporary, entering diagnostic term, not a final label.

Incorrect. The IMPS category is not intended to differentiate infectious from immune-mediated causes.The guidelines explain that myocarditis and pericarditis may share similar aetiologies, including infectious, autoimmune, and autoinflammatory mechanisms. IMPS is used because these structures are anatomically contiguous and can involve one another, not to classify underlying mechanisms.

Incorrect. The guidelines clearly state that IMPS is not a permanent replacement for terms such as myopericarditis or perimyocarditis. These remain part of the classification, and IMPS is used only at the initial point of diagnostic evaluation.

Correct. The cut-off is ≥14 leukocytes/mm².

Correct. Active myocarditis requires the presence of myocyte necrosis.

Correct. The criteria require ≥7 CD3+ T lymphocytes/mm².

Incorrect. Non-caseating granulomas are the hallmark of Sarcoidosis, not Lymphocytic Myocarditis.

Correct. RA diastolic collapse is a sign of tamponade (Sensitivity 50-100%, Specificity 33-100%)

Correct. IVC plethora (dilatation >20mm, <50% collapse) is a highly sensitive sign (97%).

Correct. Significant respiratory variation in mitral inflow (>25-30%) indicates ventricular interdependence typical of tamponade.

Incorrect. Septal bounce with high medial e' (>8 cm/s) is a specific criterion for Constrictive Pericarditis, not Tamponade.

Incorrect. While LGE predicts events, the anteroseptal location is the strongest specific predictor; lateral wall LGE is often associated with a more benign course.

Correct. Mid-wall LGE in the anteroseptal segments is the best independent predictor of SCD (HR 4.59) and major ventricular arrhythmias.

Incorrect. Edema indicates acute inflammation but LGE (fibrosis) is the primary predictor of long-term arrhythmic risk.

Incorrect. Effusion size relates to pericarditis risk/tamponade, not specifically to arrhythmic SCD in myocarditis.

Correct. Preserved LVEF is a criterion for low risk.

Correct. Absence of WMA contributes to a low-risk classification.

Incorrect. QRS >120 ms is an independent predictor of death or transplant (High Risk).

Incorrect. Sustained arrhythmias define a complicated myocarditis.

Incorrect. Corticosteroid monotherapy is not associated with improved transplant-free survival compared to no treatment.

Correct. Therapy typically involves 2 or 3 drugs (Steroids + Cyclosporine/Tacrolimus + Azathioprine/Mycophenolate).

Incorrect. Temporary MCS should be performed early in fulminant cases; waiting reduces survival chances.

Correct. Reduction or cessation of immunosuppression is associated with recurrence even years later.

Incorrect. Immediate disruption of ICI is recommended (Class I). Continuing is dangerous.

Correct. Immediate interruption is the first step in management of ICI-associated myocarditis.

Correct. High-dose steroids (500-1000mg methylprednisolone) should start within 24h.

Correct. Abatacept, alemtuzumab, or ruxolitinib are considered for steroid-refractory cases.

Correct. Neuraminidase inhibitors (e.g., oseltamivir) are used for influenza associated myocarditis.

Incorrect. Routine antiviral therapy is not recommended due to insufficient data; it is tailored to specific agents.

Correct. HAART should be started or continued for HIV-associated myocarditis.

Correct. Anti-herpesvirus drugs can be considered for CMV or HHV-6, although direct efficacy data in

Incorrect. Loading doses are not used to improve tolerance/reduce GI side effects.

Correct. Weight-adjusted dose for >70kg is 0.5 mg twice a day.

Correct. Weight-adjusted dose for <70kg is 0.5 mg once daily.

Correct. Duration for the first episode is 3-6 months (at least 3).

Correct. Low- to medium-dose corticosteroids should be considered for patients with pericarditis in cases of contraindication/failure of aspirin/NSAIDs and colchicine. (Class II)

Correct. Low- to medium-dose corticosteroids should be considered for patients when there is a specific indication. (Class II)

Correct .Corticosteroids are indicated when NSAIDs are contraindicated (e.g., renal failure). (Class II)

Incorrect. Corticosteroids are not recommended as the first option for patients with pericarditis therapy without a specific indication. (Class III)

Correct. Anakinra is recommended (Class I) for corticosteroid-dependent/colchicine-resistant recurrence.

Correct. Rilonacept is also recommended (Class I) in this setting.

Incorrect. Azathioprine is a slower-acting alternative, not the primary recommendation over Anti-IL-1 for acute control/steroid dependence.

Correct. Hydroxychloroquine is a Class IIb recommendation to prolong recurrence-free survival.

Correct. A "Proven" CMR diagnosis requires 2 out of 2 updated LLC criteria: at least one T2-based criterion (edema) AND one T1-based criterion (injury/fibrosis).

Incorrect. Having only one criterion (T2-based) classifies the CMR result as "Uncertain" or "Possible," not "Proven".

Incorrect. Having only a T1-based criterion classifies the CMR result as "Uncertain".

Pericardial effusion is a supportive criterion but does not fulfill the T1-based injury requirement for a "Proven" diagnosis of myocarditis.

Correct. Surgery is indicated for chronic/permanent constriction or failure of medical therapy.

Correct. Radical pericardiectomy offers superior outcomes and lower recurrence than partial/waffle procedures.

Incorrect. Operative mortality ranges from 6-10%, though it is lower (<1.5%) for idiopathic causes, it is not negligible for all.

Correct. Repair is recommended (Class I) for severe TR to improve symptoms and survival.

Correct. ECP involves effusion and constriction; tamponade signs are often the presenting feature.

Correct. Hemodynamic definition includes failure of RAP to drop by ≥50% after drainage.

Correct. Hemodynamic definition includes failure of RAP to drop <10 mmHg.

Incorrect. If hemodynamics resolve immediately, it is simple tamponade, not effusive-constrictive pericarditis.

Correct. Standard 6-month therapy is recommended (Class I).

Incorrect. Empirical treatment is not recommended (Class III) in non-endemic areas.

Correct. Adjunctive steroids reduce constriction risk in HIV-negative patients (Class IIa)

Correct. Drainage is essential for diagnosis and therapy (Class I).

Incorrect. NSAIDs are contraindicated after the 20th week due to fetal ductus arteriosus issues.

Correct. NSAIDs should be considered in pregnant patients with pericarditis until the 20th week to treat an incessant/recurrent course. (Class IIa)

Correct. Colchicine may be considered in pregnant patients with pericarditis, especially in patients already receiving this drug to prevent recurrences. (Class IIb)

Correct. During pregnancy and breastfeeding, corticosteroids at the minimal effective dose (preferably up to 20 mg prednisone daily) should be considered in patients with active pericarditis. (Class IIa)

Correct. Follow-up CMR is recommended within 6 months to identify a potential progression or new risk factors. (Class Ic)

Incorrect. It is recommended for all patients, not just symptomatic ones, to assess potential progression or new risk factors.

Correct.

Incorrect. A long-term follow-up, e.g. after 5 years, is suggested only for complicated cases of IMPS, usually myocarditis.

Incorrect. Both GCM and CS have giant cells.

Incorrect. Cardiac sarcoidosis presents with well-formed noncaseating granulomas.

Correct. GCM is characterized by giant cells in the absence of well-organized granulomas.

Incorrect. Eosinophils are present in GCM (and Eosinophilic Myocarditis), but the key distinction from Sarcoid is the granuloma structure.

Incorrect. Tumor markers are not accurate enough for definitive diagnosis (Probable only).

Cytology is is recommended in patients with neoplastic pericarditis for the confirmation of malignant pericardial disease. (Class I).

Correct. Pericardiocentesis is recommended for patients with cardiac tamponade to relieve symptoms and establish the diagnosis of malignant pericardial effusion.

Incorrect. CT is supportive but does not provide histological/cytological confirmation.

Incorrect. Atrioventricular block is often transient and typically resolves within 1–2 weeks of antibiotic treatment, therefore permanent pacemaker placement is not warranted for AVB associated with LC before starting therapy.

Correct. Intravenous therapy with ceftriaxone is the recommended first-line treatment for patients with LC and AV disturbances,

Incorrect. Oral antibiotics (doxycycline, amoxicillin, or cefuroxime) serve as follow-up therapy after intravenous therapy with ceftriaxone.

Correct. Temporary transvenous external pacing should be considered in patients with acute myocarditis and high-degree conduction disorders as a bridge to recovery (Class IIa).

Incorrect. PET detects inflammation, not specific viruses.

Correct. 18F-FDG-PET is recommended for the diagnostic work-up, including detection of inflammation, as well as for follow-up and assessment of therapeutic response in patients with CS(Class I).

Incorrect. CT or angiography is primarily performed for coronary assessment.

Correct. In these cases carb-free 18F-FDG-PET or 18F-FDG-PET/CT should be considered. (Class IIa)

Incorrect. A low pericardial-to-serum glucose ratio is suggestive of Purulent (Bacterial) pericarditis, while TB usually has a ratio of about 0.7. High levels of Adenosine Deaminase (ADA) or Interferon-gamma (IFN-y) in the fluid are diagnostic markers for TB.

Correct. Standard 6-month MDT is a Class I recommendation.

Correct. Adjunctive steroids are recommended in HIV-negative patients because they significantly reduce the risk of progressing to constrictive pericarditis.

Incorrect. TB is a high-risk etiology for constriction (occurring in up to 10-20% of cases), unlike viral/idiopathic causes.

Correct. The guideliness list fever >38 as major high-risk feature.

Incorrect. QRS duration >120ms is a major risk factor for myocarditis, not specifically pericarditis etiology.

Correct. Subacute onset is one of major high-risk features along with a fever >38°C, large pericardial effusion, cardiac tamponade and lack of response to aspirin or NSAID after at least 1 week of therapy.

Incorrect. Pericarditis associated with myocarditis along with imunodepression, trauma and oral anticoagulant therapy, represents a minor indicator within the broader set of features used to identify non-viral etiologies and potential complications (high-risk features or red flags) in acute pericarditis.

Correct. ICM is defined as myocarditis resulting in DCM that is confirmed by histological/immunohistochemical evidence of inflammation on EMB.

Incorrect. Empiric immunosuppression for DCM of unknown origin is not recommended (Class III) due to a lack of proven benefit.

Correct. Immunosuppressive therapy is a Class IIa recommendation for biopsy-proven, virus-negative ICM to improve LVEF.

Correct. In virus-positive ICM, immunosuppression is not recommended (Class III). Management should focus on GDMT and specific antiviral/antibacterial therapy if available.

Incorrect. Immediate implantation is not appropriate because LVEF may normalize with resolution of myocardial inflammation.

Correct. It is generally accepted to wait 3–6 months after an acute episode of myocarditis to evaluate the need for an ICD.

Correct. A WCD should be considered for 3–6 months in patients with sustained ventricular arrhythmia during the acute phase of myocarditis as a bridge to recovery. (Class IIa)

ICD implantation is recommended in patients with non-active myocarditis and haemodynamically not-tolerated sustained VT to prevent SCD. (Class I)

Correct. Colchicine administration before surgery is recommended to prevent PCIS.

Incorrect. Asymptomatic post-op effusions should not be treated with NSAIDs (e.g. diclofenac) as they are ineffective (POPE trial), and may be associated with an increased risk of side effects.

Correct.IL-1 antagonists are recommended (Class I) for refractory PCIS

Incorrect. Colchicine is preffered prevention strategy; steroids are not first-line prevention.

Incorrect. Biopsy is rarely indicated for routine/viral cases.

Correct. Pericardial or epicardial biopsy may be considered as part of the diagnostic work-up when the diagnosis cannot be reached with multimodality imaging and laboratory examinations. (Class IIb)

Correct. Indicated if malignancy is suspected but multimodality imaging or cytological analysis are inconclusive. (Class IIb)

May be considered (Class IIb) in non-endemic areas for illness >3 weeks without etiology.

Correct. QRS >120ms is an independent predictor of poor outcome.

Correct. In a multicentre study with AM and preserved EF, the presence of anteroseptal LGE in the mid-wall layer was the best independent predictor of the combined endpoint of cardiac death, appropriate ICD interventions, resuscitated cardiac arrest, and hospitalization for HF

Correct. In acute myocarditis diagnosed by endomyocardial biopsy, up to 50% of patients have spontaneous recovery.

Incorrect. Eosinophilic myocarditis, Giant-cell myocarditis and Giant-cell myocarditis as well are generally associated with worse prognosis.

Correct

Correct

Correct

Correct.

Correct. A risk of CP is high for bacterial pericarditis (20%– 30%), especially if purulent.

Incorrect. the risk of CP is low after presumed viral/idiopathic pericarditis(<1%).

Correct. TB is a major cause of CP.

Incorrect. Neoplastic pericarditis has an intermediate risk (2%–5%).

Incorrect. Non-steroidal anti- inflammatory drugs remain the mainstay of therapy at high dosages . Most paediatricians avoid aspirin.

Correct. Colchicine halved recurrences in children, similarly as for adults.

Correct. Use should be restricted because side effects, including striae rubrae and growth impairment, are particularly deleterious in growing children.

Correct.

Correct. The majority of cases are diagnosed after delivery, typically in the first month post-partum.

Correct. LMWH does not cross the placenta and is preferred; DOACs are less well studied and should be avoided during pregnancy

Incorrect. Bromocriptine has been shown to improve LVEF at 6 months, but the results are contradictory.

Incorrect. While CMR is useful, gadolinium-based contrast agents should be avoided during pregnancy. Non-contrast techniques should be used.

Correct. The guidelines recommend caution in the elderly due to potential renal impairment and drug interactions. Therefore, lower doses of Colchicine (0.5 mg OD) are often appropriate, even if the patient is >70 kg, which is a key recommendation.

Incorrect. Co-administration of high-dose NSAIDs/Aspirin with anti-platelet doses of aspirin should be avoided because it reduces the effectiveness of the anti-platelet effect and increases bleeding risk.

Correct. Given the higher incidence of comorbidities and the risk of GI bleeding, gastroprotection with a PPI is strongly recommended when using NSAIDs.

Incorrect. Colchicine duration is 3-6 months. Given the lower risk of recurrence in the elderly, a 6-month course is not strictly mandatory for all first episodes.

Incorrect. Pericardial friction rub is included as additional criterion for pericarditis which is a superficial scratchy or squeaking sound, caused by friction between the two inflamed pericardial layers.

Incorrect. Pericardial effusion often accompanies pericarditis (>50% of cases).

Correct. Elevated troponin indicates myocardial injury. While it may present in myopericarditis, it is not a primary diagnostic criterion for pericarditis itself.

Incorrect. The main presenting symptom of pericarditis is positional chest pain, which is reported in most affected individuals. Typical pericardial pain is sharp and is worse when coughing and taking a deep breath (pleuritic).

Incorrect. Elderly patients have a lower risk of recurrence compared to younger patients (approx. 10% vs. 30%).

Correct. Elderly patients are noted to present less frequently with the typical clinical signs of pericarditis, such making diagnosis more challenging.

Correct. The elderly are more likely to have pericarditis secondary to another underlying cause, such as malignancy, systemic disease, or medication.

Incorrect. The risk of constriction is related to the etiology (e.g., TB, purulent), not age alone, and the lower rate of recurrence in the elderly suggests a lower overall risk for chronic complications.

Correct. Aspirin is the preferred choice for patients already on antiplatelet therapy or with ischemic heart disease. ESC dosing: 750–1000 mg 3 times daily for 1–2 weeks.Tapering: Decrease by 250 mg every 1–2 weeks

Incorrect. Tapering is recommended to reduce the persistence/recurrence of symptoms.

Correct. Gastroprotection with a PPI is recommended when using high-dose aspirin or NSAIDs.

Incorrect. Ibuprofen is usually preferred for the first episode of acute pericarditis.ESC dosing: 600–800 mg 3 times daily
Tapering: Decrease by 200 mg every 1–2 weeks. Indomethacin is usually considered for incessant/recurrent cases.

Correct. ESC discourages high-dose NSAIDs in isolated myocarditis due to concerns about worsening myocardial healing and function.

Incorrect. ESC does not recommend low-dose Aspirin for chest pain alone. Pain relief is addressed by the main anti-inflammatory strategy for the pericardium (if present) or general analgesics.

Incorrect. While NSAIDs and GDMT drugs (like ACEi/ARBs) can interact (e.g., renal effects), the primary reason for avoiding high-dose NSAIDs in myocarditis is the potential harm to the myocardium, not solely drug-drug interactions.

Correct. When myocardial involvement coexists with pericarditis, NSAIDs/Aspirin are the first-line treatment for the pericardial component. The treatment is directed at the predominant syndrome (the pericarditis).

Incorrect. Tapering must not begin until two conditions are met. The patient is fully asymptomatic, and CRP has normalised. Reducing the high starting dose (Aspirin 750–1000 mg 3 times daily or Ibuprofen 600–800 mg 3x a day) prematurely increases recurrence risk.

Correct. ESC recommends maintaining the full anti-inflammatory dose for 1–2 weeks.

Correct. Tapering is a critical step. The guidelines recommend slow dose reduction over several weeks (typically 2-4 weeks) to minimize the risk of recurrent pericarditis.

Correct. Colchicine should be initiated immediately with the anti-inflammatory agent and maintained throughout the entire tapering phase to prevent rebound inflammation and recurrence.

Incorrect. Troponin marks myocardial injury, it is not a primary marker for monitoring pericardialn inflammation.

Incorrect. D-dimer is primarily used for thrombosis/embolism. While it can be elevated in inflammation, it is not standard guide for pericarditis therapy.

Incorrect. Procalcitonin is marker for bacterial sepsis, idiopathic or viral pericarditis is the most frequent etiology in developed countries.

Correct. C-reactive protein is used to guide the duration of anti-inflammatory therapy.

Correct. The Updated Lake Louise Criteria require evidence of edema (T2-based, like T2 mapping) and non-ischemic injury/fibrosis (T1-based, like LGE or T1 mapping) for the most specific diagnosis of active myocarditis.

Incorrect. Reduced LVEF is a functional consequence, not a required tissue criterion.

Correct. The Updated Lake Louise Criteria require evidence of edema (T2-based, like T2 mapping) and non-ischemic injury/fibrosis (T1-based, like LGE or T1 mapping) for the most specific diagnosis of active myocarditis.

Incorrect. Pericardial rub is a sign of pericarditis.

Correct. In cardiac tamponade, rising pericardial pressure restricts ventricular filling, causing diastolic pressures in all chambers to increase and equalize—a classic invasive hemodynamic hallmark.

Correct. Pulsus paradoxus is due to exaggerated ventricular interdependence occurring in CTP, when the overall volume of ventricles becomes unable to expand, and any change in the volume on one side of the heart causes opposite changes on the other side.

Correct. Hypotension and Jugular Venous Distension are included in Beck's triad along with quiet heart sounds as presenting symptoms of cardiac tamponade.

Incorrect. Central venous pressure is elevated (JVD) in tamponade.

Correct. Patients with reduced LVEF should receive standard GDMT to promote reverse remodeling, initiated after the acute inflammatory phase stabilizes.

Incorrect. Ibuprofen is an NSAID, not a heart failure drug.

Correct. Patients with reduced LVEF should receive standard GDMT to promote reverse remodeling, initiated after the acute inflammatory phase stabilizes.

Incorrect. Verapamil is contraindicated in heart failure.

Correct. Tapering starts after symptoms and CRP normalize.

Correct. Tapering is the most critical step, it must be very slow, especially at low doses (<15-25 mg).

Correct. Tapering should be protected by simultaneous high-dose Colchicine to prevent recurrence.

Incorrect.Tapering is often prolonged over several weeks.