CHAPTER 55 CMP AND PERICARDIAL DISEASE Flashcards
(27 cards)
Diseases that solely or predominantly involve the myocardium and are usually familial in origin
Primary cardiomyopathies
Include heart muscle diseases associated with specific systemic disorders
Secondary cardiomyopathies
Second most common cause of sudden cardiac death in the adolescent population
Leading cause of sudden death in competitive athletes
Hypertrophic cardiomyopathy
Systolic and diastolic dysfunction CMP type
Dilated CMP
Myocarditis
Diastolic dysfunction CMP type
HCOM
Restrictive CMP
Most commonly manifests as dilated cardiomyopathy
Peripartum cardiomyopathy
It is characterized by systolic and diastolic dysfunction and diminished left ventricular (LV) and, often, right ventricular contractile force, resulting in a low cardiac output and increased end-systolic and end-diastolic ventricular volumes.
Dilated cardiomyopathy
Hallmarks of DMCP
LV and RV dilatation + Normal LV wall thickness
It is the inflammation of the heart muscle
Most frequently characterized pathologically by focal infiltration of the myocardium by lymphocytes, plasma cells, and histiocytes
Myocarditis
Designed as a bridge to transplant in end-stage heart failure patients but offer long-term quality of life improvement for patients who are not candidates for transplant
Left ventricular assist devices (LVADs)
CAN ONE PERFORM CHEST COMPRESSIONS ON AN LVAD PATIENT?
Avoid chest compressions if at all possible unless absolutely necessary
Chest compressions can potentially dislodge the LVAD from the heart and aorta –> left ventricular rupture, intractable hemorrhage
What is audibly heard when auscultating the precordium in px with LVAD –> functional
“whirr”
Gold standard for diagnosis of myocarditis
Endocardial biopsy
Treatment for idiopathic or viral myocarditis
Supportive
-Antibiotics are needed for myocarditis complicating rheumatic fever, diphtheria, or meningococcemia
“A disease state characterized by unexplained LV hypertrophy associated with NONDILATED ventricular chambers is the absence of another cardiac or systemic disease that itself would be capable of producing the magnitude of hypertrophy evident in a given patient.”
Hypertrophic cardiomyopathy
Echocardiographic hallmark for HCOM
LV wall thickening >15 mm
Cause of chest pain in HCOM
Due to an imbalance between the oxygen demand of the hypertrophied left ventricle and the available myocardial blood flow
Interventions that DECREASE LV filling and the distending pressure in the LV outflow tract or that increase the force of myocardial contraction –> accentuate the murmur of HOCM
Standing
Valsalva
Upppp uhhh
Maneuvers that INCREASE LV filling –> DECREASE murmur
Passive leg elevation
Squat
Hand grip
T/F: The murmurs of hypertrophic cardiomyopathy and mitral valve prolapse, when associated with murmur, are similar
T
except HAND GRIP (increases in MVP)
Hallmarks of restrictive CMP
(1) elevated LV and right ventricular end-diastolic pressure
(2) normal LV systolic function (ejection fraction >50%)
(3) a marked decrease followed by a rapid rise and plateau in early diastolic ventricular pressure observed during invasive hemodynamic assessment
Amount of fluid in the space between the parietal and visceral pericardium
50 ml
The most common symptom of acute pericarditis
sharp or stabbing precordial or retrosternal chest pain
-sudden or gradual onset; radiate to the back, neck, left shoulder, or arm; and aggravated by inspiration or movement.
-most severe when the patient is supine and is relieved when the patient sits up and leans forward.
Distinguishing feature of acute pericarditis
Referral of pain to the left trapezial ridge - (due to inflammation of the joining diaphragmatic pleura)
