Cardiomyopathies

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Cardiomyopathy-definition

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heart disease from abnormality in the myocardium
will result inmechanical or electrical dysfunction

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What can cause cardiomyopathies but are not themsevles cardiomyopathies

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Coronary heart disease, hypertension, valvular, congenital, arterial, pericardial abnormalities

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Ischemic cardio myopathy

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inadequate oxygen delivery to the myocardium with CAD being a common cause

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Ischemic cardiomyopathy

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All other causes of cardiomyopathie

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Primary type of CM

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heart muscle disease of unkown cause which can be idiopathic or familial (DRH or DH respectively)
Familial are autosomal dominant pattern and look at first degree relatives

Eosinophilic endomyocardial disease and endomyocardial fibosiis which are RESTRICTIVE

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secondary type of Cm

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hear tmsucle disease associated with known cause or with another disease of other organ systems which are MOSTLY DILATED TYPES:
infective, matabolic (throid mediated) lipid, related to conective tissue disorder including SLE RA or infitrations or granuomla (amyloidosis sarcoidosis)
result of glycogen storage disease, NM diseases, due to sensitivity and toxic reaction to alcohol drugs or cancer treatment

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Classificaitons of Cardiomyopathies:

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Dilated Cardiomyopathy: cardiation dilation and contractile dysfunction: left or right ventrifcular enlargement, impaired systolic function, congestive heart failure, arrhythmias or emboli

Restrictive-endomyo isn't getting enough blood: left or right ventricle filling restriction

hypertropic cardiomyopathy: poorly compliant left ventricular myocardium making abnormal diastolic filling: will lead to: left venticular hypertrophy and interventricular septum more affected.

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Dilated CM characterization

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left or right ventriulcar systolic function failure. reduced EF, reduced CO, and thrombi in LV apex

increased end LV pressure which is secondary to diastolic function

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morphology of dilated CM

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Lv is dilated, normal or increased LV wall thickness

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epidemiology of DCM

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1/500 pts with 30% genetic link mostly in middled aged men and more often in the blacks

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Clinical Manifestation of DCM

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asymptomatic, L or R sided CHF with decreased exercise tolerance, dyspnea on exertion, fatigue orothopenia, PND paroxysmal dyspnea, right upper q pain, peripheral edema, palpations, arrhythmias, emboli

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Kussmaul's sign

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neck veinss distend during inspiration which is abnormal
S3 S4 mitral valve regurg, and tricuspid regurg
narrow pulse pressure (110/90), tachycardia, displaced PMI

crackles, hepatomeglia

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CXR for DCM

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englarged silhoutte
pulmonary venous hypertension
interstitial alveolar edeema

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ECG for DCM

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abnormal ST and Q wave with non specific ST to T interval

Atrial fibrillation/conduction disturbances, PVC, LBBBs

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EKG

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lv dilation, diastolic is greater than six CM
EF is less than 30
Global hypokinesis,

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Treatment of DCM

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Na and fluid restriction, no alcohol, weight reduction, exercise, defibrillator, cardiac transplant with a 1 year survival of 90%

ACEi, Digitalis, Milirone, Amrinone-increase contractility and decrease afterload

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Toxic cardiomyopathy/restrictive CM

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exposure or acute overdose
alcohol causes LV dilation, acetaldehyde,
LV dilation,
less than 25 % survival ate after three years
holiday heart syndrome after binge drinking
peripartum cardiomyopathy CHF in last trimester or six months after delivery, happens in blacks older than 30 years old

NM disease causes dilated CM, DMD, Friedrecch

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Hypertrophic CM

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poorly compliant left ventricular myocardium-impaired dystolic funciton of LV
Defect of proteins, no hypertension or aortic stenosis

hypertrophic obstructive cardiomyopathy, idiopathic hypertrophic subaortic stenossis, asymmetrical hypertrophy

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which regurg are normal

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s1, s2, and only s3 when it's in infants and athletes

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physical exams and things you see with HCM

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carotid upstroke rapid, lv impulse sustained, S1 is norm S2 paradoxical split because PV closes after AV), loud systolic murmor