Podcast
Questions and Answers
Which layer of the heart wall is the outermost layer?
Which layer of the heart wall is the outermost layer?
- Endocardium
- Myocardium
- Epicardium (correct)
- Pericardium
The myocardium is responsible for actively pumping blood out of the heart.
The myocardium is responsible for actively pumping blood out of the heart.
True (A)
The innermost layer of the heart wall, which lines the cavities and valves, is called the ______.
The innermost layer of the heart wall, which lines the cavities and valves, is called the ______.
endocardium
What is the most frequent identifiable cause of myocarditis?
What is the most frequent identifiable cause of myocarditis?
Give one example of a viral agent that can cause myocarditis.
Give one example of a viral agent that can cause myocarditis.
Most individuals infected with cardiotropic viruses develop significant cardiac disease.
Most individuals infected with cardiotropic viruses develop significant cardiac disease.
Which of the following is NOT an infectious cause of myocarditis?
Which of the following is NOT an infectious cause of myocarditis?
Match the following causes of myocarditis with their category:
Match the following causes of myocarditis with their category:
Which age group is typically at greater risk of developing myocarditis?
Which age group is typically at greater risk of developing myocarditis?
Myocarditis is more common in women than in men.
Myocarditis is more common in women than in men.
Individuals with comorbidities like diabetes or HIV/AIDS are more likely to develop myocarditis because they are ______.
Individuals with comorbidities like diabetes or HIV/AIDS are more likely to develop myocarditis because they are ______.
A patient reports a history of inflammatory bowel disease. Which risk factor category for myocarditis does this fall under?
A patient reports a history of inflammatory bowel disease. Which risk factor category for myocarditis does this fall under?
Match the following risk factors with their potential association with myocarditis:
Match the following risk factors with their potential association with myocarditis:
The symptoms of myocarditis are always consistent and easily identifiable.
The symptoms of myocarditis are always consistent and easily identifiable.
Which of the following is a typical symptom of myocarditis?
Which of the following is a typical symptom of myocarditis?
Breathlessness when lying flat is called ______.
Breathlessness when lying flat is called ______.
If a patient reports prodromal symptoms of fever, sore throat, and myalgia, what underlying cause should be suspected?
If a patient reports prodromal symptoms of fever, sore throat, and myalgia, what underlying cause should be suspected?
Changes to medications are irrelevant when investigating possible causes of myocarditis.
Changes to medications are irrelevant when investigating possible causes of myocarditis.
Why is it important to take a family history when evaluating a patient for myocarditis?
Why is it important to take a family history when evaluating a patient for myocarditis?
What social history information is relevant when evaluating a patient for myocarditis?
What social history information is relevant when evaluating a patient for myocarditis?
Which of the following signs would you associate with a cardiovascular examination in myocarditis?
Which of the following signs would you associate with a cardiovascular examination in myocarditis?
A normal cardiovascular examination definitively rules out myocarditis.
A normal cardiovascular examination definitively rules out myocarditis.
If a patient with myocarditis has co-existing pericarditis and pericardial effusion, a clinical sign that may be evident is ______ heart sounds.
If a patient with myocarditis has co-existing pericarditis and pericardial effusion, a clinical sign that may be evident is ______ heart sounds.
Raised jugular venous pressure (JVP) is consistent with:
Raised jugular venous pressure (JVP) is consistent with:
Match the symptoms of myocarditis with the associated clinical features:
Match the symptoms of myocarditis with the associated clinical features:
The myocardium is primarily composed of what type of cells?
The myocardium is primarily composed of what type of cells?
The sinoatrial node directly controls the contraction of the epicardium.
The sinoatrial node directly controls the contraction of the epicardium.
When myocarditis presents as cardiogenic shock, the systolic blood pressure is typically under ______.
When myocarditis presents as cardiogenic shock, the systolic blood pressure is typically under ______.
Match each cause of myocarditis with its specific agent or condition.
Match each cause of myocarditis with its specific agent or condition.
Illicit drugs such as amphetamines can be a toxic cause of myocarditis.
Illicit drugs such as amphetamines can be a toxic cause of myocarditis.
Which of the following conditions is NOT commonly associated with autoimmune-mediated myocarditis?
Which of the following conditions is NOT commonly associated with autoimmune-mediated myocarditis?
List one sign present on a physical examination that may indicate co-existing pericarditis.
List one sign present on a physical examination that may indicate co-existing pericarditis.
Which of the following symptoms is least likely to directly correlate with heart failure in myocarditis?
Which of the following symptoms is least likely to directly correlate with heart failure in myocarditis?
A pleuritic chest pain, which is relieved by leaning forward, suggests an associated ______.
A pleuritic chest pain, which is relieved by leaning forward, suggests an associated ______.
Palpitations are primarily caused by structural damage to heart valves.
Palpitations are primarily caused by structural damage to heart valves.
Which of the following would be least helpful in determining the underlying cause of myocarditis during a systems review?
Which of the following would be least helpful in determining the underlying cause of myocarditis during a systems review?
Define the timing for which myocarditis is classified as 'acute'.
Define the timing for which myocarditis is classified as 'acute'.
What is the primary mechanism by which viral infections damage cardiac myocytes in myocarditis?
What is the primary mechanism by which viral infections damage cardiac myocytes in myocarditis?
Syncope is an unlikely symptom in patients experiencing heart failure.
Syncope is an unlikely symptom in patients experiencing heart failure.
The final and outermost layer of the heart wall is formed by the visceral layer of the ______.
The final and outermost layer of the heart wall is formed by the visceral layer of the ______.
Which of the following is NOT a risk factor for myocarditis related to lifestyle or substance use?
Which of the following is NOT a risk factor for myocarditis related to lifestyle or substance use?
Flashcards
Endocardium
Endocardium
The innermost layer of the heart wall that lines the cavities and valves.
Myocardium
Myocardium
Middle layer of the heart wall, composed of cardiac myocytes responsible for autonomous depolarization and contraction.
Epicardium
Epicardium
Outermost layer of the heart wall, formed by the visceral layer of the pericardium.
Myocarditis
Myocarditis
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Common cause of myocarditis
Common cause of myocarditis
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Myocarditis Risk Factors
Myocarditis Risk Factors
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Common Myocarditis Symptoms
Common Myocarditis Symptoms
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Infective Cause Symptoms
Infective Cause Symptoms
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Clinical signs of Myocarditis
Clinical signs of Myocarditis
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Study Notes
- Myocarditis is inflammation of the heart muscle
Anatomy of the Heart Wall
- The heart wall has three layers: the endocardium, myocardium, and epicardium.
- The endocardium is the innermost layer, lining the cavities and valves.
- The myocardium is the middle layer, made of cardiac myocytes that contract autonomously, ejecting blood.
- The epicardium is the outermost layer, formed by the visceral layer of the pericardium.
Causes of Myocarditis
- Causes are broadly classified into infectious and non-infectious categories.
- In 50% of cases, the cause is not identified (idiopathic).
- The most common identified cause is a viral infection.
- Viral infections can directly injure cardiac myocytes and cause secondary immune reactions
- This leads to myocarditis and dilated cardiomyopathy.
- Most individuals infected with cardiotropic viruses do not develop significant cardiac disease.
Infectious Causes
- Viruses: e.g., coxsackievirus, parvovirus B-19, human herpesvirus 6, Epstein-Barr virus
- Bacteria: e.g., staphylococcus, streptococcus, mycobacterium
- Fungi: e.g., aspergillus, candida, histoplasma
- Parasites: e.g., leishmania
Immune-Mediated Causes
- Allergens: e.g., vaccines, medications like penicillin
- Alloimmune: e.g., rejection after heart transplant
- Autoimmune: e.g., systemic lupus erythematosus, inflammatory bowel disease, sarcoidosis, thyrotoxicosis
Toxins
- Illicit drugs: e.g., amphetamines
- Alcohol
- Medications: e.g., lithium, clozapine
- Radiation
Risk Factors for Myocarditis
- Age: Younger people (under 50) are at greater risk.
- Sex: More common in men.
- Immunocompromised patients: Those with diabetes, HIV/AIDS, cancer treatments, or steroid use.
- History of autoimmune disease
- Alcohol and drug consumption
Clinical Features of Myocarditis
- Myocarditis can present as fulminant (cardiogenic shock), acute (less than 1 month), or chronic (over 1 month).
- Symptoms result from inflammation, heart failure, and arrhythmias.
Common Symptoms
- Chest pain: Described as squeezing or heavy, may radiate to the neck, jaw, or arms, mimicking acute coronary syndrome, or be pleuritic and relieved by leaning forward.
- Shortness of breath: New or worsening, on exertion or at rest, may include orthopnea or paroxysmal nocturnal dyspnea.
- Palpitations
- Dizziness
- Syncope
- Fatigue
History to Identify Underlying Cause
- Systems review: Look for prodromal symptoms indicating an infective cause (fever, sore throat, myalgia, cough, vomiting, or diarrhea) or autoimmune condition (rash, hair loss, changes to bowel habits, or uveitis).
- Past medical and surgical history: Autoimmune conditions or heart transplant history are important.
- Medications: Ask about recent vaccinations or medication changes.
- Family history: Screen for inherited cardiomyopathy or autoimmune disease.
- Social history: Establish alcohol consumption, illicit drug use, and recent travel.
Clinical Examination Findings
- A full cardiovascular examination should be performed.
- Findings may be normal or indicate heart failure, arrhythmia, or an underlying cause.
- Tachypnea
- Gallop rhythm
- Raised jugular venous pressure (JVP)
- Peripheral pitting oedema
- Inspiratory crackles
- Arrhythmias: Fast or slow heart rate
- Rash
- Ocular inflammation
- Lymphadenopathy
- Pericardial rub and signs of cardiac tamponade (muffled heart sounds, hypotension, and raised JVP) if co-existing pericarditis and pericardial effusion.
- Severe cases may present as cardiogenic shock (low systolic blood pressure).
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