Myocarditis — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 17 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting myocarditis or death from myocarditis with the circumstances of a person's relevant service:

1. (1)
   undergoing a course of radiotherapy for cancer, where the heart was in the field of radiation, before clinical onset or clinical worsening;
2. (2)
   having a myocardial infection at the time of clinical onset or clinical worsening;
3. (3)
   having a systemic viral infection within the 4 weeks before clinical onset or clinical worsening;
4. (4)
   being infected with human immunodeficiency virus before clinical onset or clinical worsening;
5. (5)
   having tuberculosis before clinical onset or clinical worsening;
6. (6)
   having acute rheumatic fever at the time of clinical onset or clinical worsening;
7. (7)
   having one of the following vasculitides: (a) Behcet disease; (b) eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome); (c) giant cell (temporal) arteritis; (d) granulomatosis with polyangiitis (Wegener granulomatosis); (e) Kawasaki disease; (f) polyarteritis nodosa; or (g) Takayasu arteritis; at the time of clinical onset or clinical worsening;
8. (8)
   having one of the following systemic inflammatory diseases: (a) antiphospholipid syndrome; (b) coeliac disease; (c) dermatomyositis; (d) Graves disease; (e) Hashimoto disease; (f) IgG4-related disease; (g) inflammatory bowel disease; (h) mixed connective tissue disease; (i) polymyositis; (j) psoriatic arthritis; (k) rheumatoid arthritis; (l) scleroderma (progressive systemic sclerosis); (m) Sjögren syndrome; or (n) systemic lupus erythematosus; at the time of clinical onset or clinical worsening;
9. (9)
   having acute pancreatitis at the time of clinical onset or clinical worsening;
10. (10)
    having myasthenia gravis at the time of or before clinical onset or clinical worsening;
11. (11)
    having cardiac graft acute cellular rejection at the time of clinical onset;
12. (12)
    having a haematopoietic stem cell transplant within the 4 years before clinical onset or clinical worsening;
13. (13)
    having a phaeochromocytoma or thymoma at the time of clinical onset or clinical worsening;
14. (14)
    being treated with one of the following medications within the 3 months before clinical onset or clinical worsening: (a) alkylating agents including cyclophosphamide; (b) anthracyclines including doxorubicin, daunorubicin, idarubicin, epirubicin and mitoxantrone; (c) antibiotics including penicillin, cephalosporins, tetracyclines, sulphonamides, isoniazid, and streptomycin; (d) carbamazepine; (e) diuretics including furosemide and thiazides; (f) dobutamine; (g) dopamine; (h) fluoropyrimidines including 5-fluorouracil and capecitabine; (i) immune checkpoint inhibitors including atezolizumab, avelumab, cemiplimab, dostarlimab, durvalumab, ipilimumab, nivolumab, pembrolizumab, relatilimab, retifanlimab, and tremelimumab; (j) mesalazine (5-aminosalicylic acid); (k) methyl dopa; (l) paracetamol poisoning; (m) phenytoin; (n) quetiapine; (o) tricyclic antidepressants; (p) tumour necrosis factor alpha antagonists including infliximab;
15. (15)
    being treated with clozapine within the 2 years before clinical onset or clinical worsening;
16. (16)
    taking a medication for at least 7 days which is associated in the individual with the clinical onset of myocarditis during medication therapy; and which is associated with: (a) an increase in the symptoms and signs of myocarditis during drug therapy; and (b) cessation of the symptoms and signs of myocarditis within weeks of discontinuing drug therapy;
17. (17)
    having a COVID-19 vaccine within the 4 weeks before clinical onset or clinical worsening;
18. (18)
    having smallpox vaccine within the 4 weeks before clinical onset or clinical worsening;
19. (19)
    using cocaine within the 3 months before clinical onset or clinical worsening;
20. (20)
    being envenomated by a scorpion, wasp, hornet, bee, spider of the Latrodectus spp. (including red back spider, katipo spider and black widow spider) or funnel web spider within the 24 hours before clinical onset;
21. (21)
    being envenomated by a brown recluse spider (Loxosceles reclusa) within the one week before clinical onset;
22. (22)
    ingesting wild mushrooms or toadstools within the 7 days before clinical onset;
23. (23)
    having organophosphate poisoning or paraphenylene diamine poisoning at the time of clinical onset or clinical worsening;
24. (24)
    having chronic lead poisoning at the time of clinical onset or clinical worsening;
25. (25)
    having an alcohol use disorder at the time of clinical onset or clinical worsening;
26. (26)
    inability to obtain appropriate clinical management for myocarditis before clinical worsening;