In myocarditis, which infection is MOST LIKELY in the recent history?

• A. Coxsackie virus
• B. GABHS
• C. EBV
• D. Streptococcal

Answer: (A)

Viral infections are the most common trigger for myocarditis, with Coxsackie B virus being the classic culprit. This enterovirus can directly infect heart muscle cells and provoke a strong inflammatory response, leading to myocyte injury and impaired cardiac function. Clinically, patients often report a recent mild viral illness before developing chest pain, fatigue, or signs of heart failure, which fits Coxsackie-induced myocarditis well.

The other infections are less typical causes in this scenario. Group A streptococcal and general streptococcal infections are most famously tied to rheumatic fever, where immune-mediated inflammation affects the heart, rather than causing primary viral myocarditis. EBV can occasionally cause myocarditis, but it is less commonly the antecedent agent compared with Coxsackie B.