Myocarditis Quiz

Study Notes

Cardiac failure is the failure of the heart to pump sufficient blood to satisfy metabolic demands, resulting in under-perfusion, fluid retention, and increased blood volume.
Types of cardiac failure:
- Acute heart failure: rapid onset of symptoms, often with a definable cause (e.g., myocardial infarction)
- Chronic heart failure: slow onset of symptoms, associated with conditions like ischaemic or valvular heart disease
- Acute-on-chronic heart failure: chronic failure becomes decompensated by an acute event
Systolic and diastolic cardiac failure:
- Systolic failure: failure of the pump to move blood in systole, reduced ejection fraction, and reduced ventricular contraction
- Diastolic failure: failure of the ventricular wall to relax, restrictive, stiff ventricle, reduced ventricular filling, and elevated end diastolic pressure
Right and left ventricular failure:
- Right ventricular failure: primary effects on the right side of the heart
- Left ventricular failure: primary effects on the left side of the heart

Coronary heart disease
Hypertension
Cardiomyopathies (familial/genetic or non-familial/non-genetic, including acquired, e.g., myocarditis)
Hypertrophic, dilated, restrictive, and arrhythmogenic right ventricular cardiomyopathies
Drugs (e.g., beta-blockers, calcium antagonists, antiarrhythmics, cytotoxic agents)
Toxins (e.g., alcohol, medication, cocaine, trace elements)
Endocrine disorders (e.g., diabetes mellitus, hypo/hyperthyroidism, Cushing syndrome, adrenal insufficiency, excessive growth hormone, phaeochromocytoma)
Nutritional deficiencies (e.g., thiamine, selenium, carnitine, obesity, cachexia)
Infiltrative diseases (e.g., sarcoidosis, amyloidosis, haemochromatosis, connective tissue disease)
Others (e.g., Chagas' disease, HIV infection, peripartum cardiomyopathy, end-stage renal failure)

Left ventricular failure: pulmonary oedema, pulmonary hypertension, and eventually, right ventricular failure
Right ventricular failure: pitting oedema, congested "nutmeg" liver
Combined left and right ventricular failure: often called "congestive" cardiac failure

Systemic hypertension:
- Definition: persistent raised blood pressure above 140/90 mmHg
- Classification: primary vs secondary, essential vs accelerated
- Epidemiology: 1.28 billion adults worldwide have hypertension, with most (two-thirds) living in low- and middle-income countries
Pulmonary hypertension:
- Definition: increased pulmonary vascular resistance
- Causes: diffuse lung disease, elevated left atrial pressure, recurrent pulmonary emboli, primary pulmonary hypertension, left-right shunts
- End-organ effects: pulmonary arteries, heart

Rare, most often metastatic (e.g., melanoma, small cell undifferentiated lung cancer)
Primary benign: atrial myxoma
Primary malignant: angiosarcoma, rhabdomyosarcoma, etc.