A decreased (below 50%) LVEF is indicative of a systolic or diastolic dysfunction?
Systolic; the heart is failing to contract enough to eject the blood.
Recall the symptoms of left-sided heart failure.
Pulmonary congestion, resulting in rales and decreased breath sounds, dyspnea/orthopnea/PND.
Recall the symptoms of right-sided heart failure.
Ascites/Edema of lower limb, weakness/fatigue, JVD, hepato/splenomegaly, decreased appetite (results from liver congestion)
In chronic heart failure, what is the physiological response's impact on afterload?
SNS and angiotensin cause peripheral vasoconstriction, increasing resistance/afterload.
For each of the following etiologies, give the type of cardiomyopathy it is associated with:
Sarcomeric gene mutation
Sarcomeric gene mutation: Hypertrophic
In dilated cardiomyopathy, which chambers increase in size?
What happens to LVEF?
All four, but disease results especially from that of the left ventricle.
It decreases, generally below 40%.
Explain why an S3 gallop and soft S1 are heard in dilated cardiomyopathy.
S3 from increased atrial pressure.
Softened S1 from mitral regurgitation?
Describe the course of peripartum cardimyopathy?
When during pregnancy does it occur?
50% improve, 25% persist, 25% get worse.
Occurs late in pregnancy or shortly following pregnancy.
Alcohol-induced dilated CM occurs following what level of intake?
How is it treated?
80-90gm/day (for years!)
Abstinence usually promotes recovery.
Viral myocarditis follows an infection such as echovirus or coxsackie. How does it present?
Describe its prognosis.
With chest pain, heart failure, and/or myocardial injury markers (troponin).
Full recovery is possible, and more likely if initial presentation is more serious.
How does a dilated cardiomyopathy appear on echocardiography?
The walls are thinner and the chambers dilated. The myocardium is not rigorously contracting.
What can cause restrictive cardiomyopathies?
What are some important exam findings to watch out for?
Often systemic diseases such as amyloidosis or hemochromatosis.
Systemic findings are often present. ECG is low voltage (diminished QRS).
How does an amyloid restrictive CM present on echocardiography?
Walls are thicker and brighter. Filling is visibly impaired, as is contraction somewhat.
What part of the heart is most affected by hypertrophic cardiomyopathy?
What are its most typical causes?
Left ventricle, including the septum and outflow tracts.
Autosomal dominant mutations in sarcomeric proteins (eg myosin).
How does a hypertrophic cardiomyopathy present on echocardiography?
The walls are massively thickened and contract vigorously.
In hypertrophic CM, why does the systolic murmur get louder with valsalva?
The murmur results from LV outflow obstruction. Valsalva increases pressure here, worsening the murmur. The same is true of standing upright...