Cardiomyopathies

Front 1

What is Dilated Cardiomyopathy?

Back 1

ventricular enlargement (dilation) with systolic dysfunction

Front 2

PP of DCM -

Back 2

myocyte degeneration gives fibrosis, huge heart with normal wall thickness

Front 3

Etiology of DCM -

Back 3

idiopathic (majority),
infection (Coxsackievirus) peripartum,
EtOH,
connective tissue disorders, cocaine,
nutrition deficiency (wet beriberi)

Front 4

Presentation of DCM -

Back 4

o CHF findings: displaced PMI, S3, SOB, orthopnea, JVD, edema
• S3: rapid ventricular filling in setting of volume overload
o New onset arrhythmia: palpatations, dizziness
o Embolic phenomenon: stroke, ischemic bowel, peripheral clots

Front 5

Dx of DCM -

Back 5

o CXR: enlarged cardiac shadow, pulmonary congestion
o Echo: enlarged 4 chambers
o ECG/Holter if arrhythmias suspected

Front 6

Prognosis of DCM -

Back 6

worsens as Sx worsen. Complete recovery rare. 5 year mortality 40-80%

Front 7

What is hypertrophic Cardiomyopathy (HCM)?

Back 7

hypertrophied and non-dilated left ventricle

Front 8

PP of HCM -

Back 8

results in a small LV, assymetrical septal hypertrophy and systolic anterior motion of the mitral valve
o During systole: anterior leaflet of mitral valve obstructs the outflow tract
o During diastole: small ventricle is non compliant, resulting in impaired filling

Front 9

Etiology of HCM -

Back 9

classic HOCM (Hypertrophic Obstructive Cardiomyopathy) is autosomal dominant, due to mutations in actin, myosin and other muscle components

Front 10

Presentation of HCM -

Back 10

o History: Syncope, angina, palpatations, fatigue
o Classic picture: athlete presenting with sudden death during activity
o S4: stiff, noncompliant ventricle with increased atrial kick
o Systolic crescendo-decrecendo murmur can be differentiated from aortic stenosis
• Obstruction increases with decreased preload → ↑murmur with valsalva
• Obstruction decreases with increased afterload → ↓murmur with hand grip

Front 11

Dx of HCM -

Back 11

o Strongly suspect with history and family history of early death
o Echo: asymmetrically thickened left ventricular wall

Front 12

Tx of HCM -

Back 12

o Avoid strenuous activity
o Beta-blockers, Calcium channel blockers to decrease heart rate and promote filling of ventricle
o Antiarrythmics as needed
o Surgery to trim down septum, mitral leaflet.

Front 13

What is restrictive cardiomyopathy? (RCM)

Back 13

impaired ventricular filling, normal systolic function early in disease; systolic dysfunction may be seen in the infiltrative types

Front 14

PP of RCM?

Back 14

infiltration of the myocardium or fibrosis of the endocardium, gives reduced ventricular size, significant loss of compliance and congestion

Front 15

Etiology of RCM?

Back 15

Idiopathic,
Infiltrative (amyloidosis, sarcoidosis, metabolic diseases, hemochromatosis), Endomyocardial (malignancy, radiation)

Front 16

Presentation of RCM -

Back 16

o Heart failure symptoms, R > L
o Must differentiate this from constrictive pericarditis, which is operable
• Constrictive pericarditis may give pericardial knock & friction rub

Front 17

Dx of RCM -

Back 17

o ECHO or cardiac catheterization
o Lab tests, possible biopsy looking for etiology

Front 18

Tx of RCM -

Back 18

o Treat the underlying cause
o Drug therapy is not too effective, but may use diuretics as needed for symptoms of CHF, antiarrythmics as needed