Myocardial and Pericardial lecture Flashcards
(77 cards)
What is the cause of primary dilated cardiomyopathy?
Idiopathic-unknown cause
Toxic- alcohol, adriamycin, etc Post-partum (third trimester or after birth) Post infectious- myocarditis* Endocrine "Ischemic cardiomyopathy"
Secondary dilated cardiomyopathy
Patients present with signs and symptoms of HF which usually develops slowly.
Dilated cardiomyopathy
In dilated cardiomyopathy, left or biventricular failure, ______ dysfunction predominates.
Systolic
Right or Left dilated cardiomyopathy?
DOE, orthopnea, PND, weakness, fatigue, peripheral edema, etc.
Left sided
Right or Left dilated cardiomyopathy?
unexplained weight gain, peripheral edema, abdominal fullness (hepatomegaly, ascites).
Right sided
Cardiomegaly (PMI displaced laterally), low pulse amplitude (pulsus alternans when severe), often with ↓BP, pulmonary congestion, crackles, S3 gallop, MR murmur.
(left) Dilated cardiomyopathy
Elevated JVP, hepatomegaly, HJR, pitting edema, TR murmur.
(right) Dilated cardiomyopathy
right sided murmurs get louder with..
inspiration
Echocardiography/Doppler: LV/RV dilation, global LV dysfunction with reduced EF; Mitral regurgitation common.
Dilated cardiomyopathy
CxR: Cardiomegaly, pulmonary congestion, pleural effusions.
Dilated cardiomyopathy
Do you need to do a cardiac cath in a pt with dilated cardiomyopathy?
NO! Only used to rule out other dx
Tx like HF: Afterload reduction: ACEI or alternatives (ARB’s) Preload reduction: Diuretics, nitrates Beta Blockers Spironlolactone- class III and IV NYHA criteria Digoxin ICD’s if indicated, +/- antiarrhythmics Anticoagulation unless contraindicated*
Dilated cardiomyopathy
If dilated cardiomyopathy pt has an EF of 35% or less…
use ICD
Only meds that may improve survival rate in dilated cardiomyopathy:
ACEi (or ARB)
Beta blockers
Spironolactone
Genetically transmitted in >50% of cases.
Autosomal dominant with high penetrance.
*may require genetic counseling
(remaining cases occur spontaneously)
Hypertrophic cardiomyopathy
Marked increase in left ventricular mass, especially the septum - marked hypertrophy; remaining LV segments hypertrophied to a lesser degree; often called *ASH. Hypertrophy is unrelated to pressure overload; often present at birth, progressively worsens during childhood.
HCM
LV cavity small, systolic function normal or hyperdynamic early on.
Diastolic dysfunction common
Obstructive (below AoV) and non-obstructive forms
HCM
Asymmetric septal hypertrophy, AKA
HCM
When present LVOT obstruction is dynamic and varies with activity/rest, and LV volume.
Obstruction: MV moves abnormally towards the IVS, obstructing the LVOT.
HCM
Pathology: myocardial fiber hypertrophy and disarray, primarily in IVS.
Mitral valve often thickened and moves abnormally as noted above, well seen on echocardiogram.
HCM
Often asymptomatic in childhood; may be detected via ultrasound in the offspring of patients with known disease.
Symptoms: dyspnea, chest pain and syncope are most common. In some, sudden death may be presenting symptom. One of few causes of sudden death in young athletes.
HCM
Sudden death often occurs during strenuous activity.
Arrhythmias are common: ventricular and supraventricular; Afib may lead to sudden decompensation and is a bad prognostic sign.
HCM
Pulse brisk, often with bisferiens carotid pulse.
Double or triple apical impulse due to atrial filling wave and early and late systolic impulses.
Loud S4 and S3 gallops.
HCM
