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Etiology of Dilated Cardiomyopathy
(6)*
TIMED:
- Toxic (EtOH, heavy metals)
- Infectious / Ischemic
- Metabolic / Mechanical (arrthymia, valve dz)
- Endocrine
- Drugs
TIMED
what are the Reversible and Irreversible(2) toxic causes of Dilated Cardiomyopathy?
Reversible:
prolonged EtOH use

Irreversible:
Cocaine;
heavy metal toxicity
what are the Reversible and Irreversible(2) endocrine causes of Dilated Cardiomyopathy?
Reversible:
Thyroid disease
(hypo or hyper)

Irreversible:
Acromegaly;
Pheochromocytoma
Reversible metabolic deficiencies that cause Dilated Cardiomyopathy? (4)
HypoC;

HypoP;

Thiamine deficiency (wet beri-beri);

Selenium deficiency
Infections that cause Dilated Cardiomyopathy
(3)
HIV;

Coxsackie virus;

Chagas disease
Drugs that cause Dilated Cardiomyopathy (2)
Doxorubicin (Adriamycin);

AZT
Dx:
Cardiomyopathy w/ R + L Heart failure; A-fib; Mitral regurg; S-3 Gallop
Dilated Cardiomyopathy
Diastolic or Systolic Dz Cardiomyopathy:
1. Dilated
2. Restrictive
3. Hypertrophic
Systolic:
Dilated

Diastolic:
Restrictive & Hypertrophic
Diagnostic results of Dilated cardiomyopathy
- auscultation
- EKG (3)
- CXR (2)
- Echo (2)
Auscultation: S-3;

EKG: Vent Hypertrophy, BBB and/or A-fib;

CXR: Inc heart size; pulm congestion

Echo: low EF, large ventricles
Tx Dilated Cardiomyopathy
(3)
stop any toxic agents;

Anticoagulation w/ coumadin (even w/o evidence of thrombus);

Heart transplant
Dx:
Right or left ventricular enlargement w/ loss of contractile function causing CHF, arrythymia, or thrombus formation.
Dilated Cardiomyopathy
Definition:
Scarring and infiltration of the myocardium causing decreased right or left ventricular filling
Restrictive Cardiomyopathy
Etiology of Restrictive Cardiomyopathy
(7)*
ACHES:
Amyloidosis;
Carcinoid heart dz / Congenital;
Hemochromatosis;
Endomyocardial fibrosis
Sarcoidosis / Scleroderma
ACHES
Dx:
Pulmonary HTN (right CHF); S-4 gallop; Low QRS voltage on EKG; Exercise intolerance; Diastolic dz
Restrictive Cardiomyopathy
*Aside from the normal cardiac work-up, what is the gold standard Dx test for Restrictive CM?
Endomyocardial Bx
Definition:
Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction
Hypertrophic Cardiomyopathy
another name for Hypertrophic Cardiomyopathy
IHSS
(Idiopathic Hypertrophic Subaortic Stenosis)
(3) causes of paradoxical splitting of S-2
Hypertrophic cardiomyopathy (IHSS);

Aortic stenosis;

LBBB
murmur that decrease with squatting (and increases when returning to standing position)
Hypertrophic CM (IHSS)
Etiology of Hypertrophic Cardiomyopathy
(2)
50% idiopathic
50% familial (autosomal dominant, w/ variable penetrance)
Dx:
Angina (at rest or exercise); Syncope; Arrhythmias; CHF
Hypertrophic Cardiomyopathy
sudden death from Hypertrophic CM is usually due to what?
Arrhythmias
Dx:
25-yo man becomes severly dyspneic and collapses while running laps, His father died suddenly at an early age.
Hypertrophic CM (IHSS)
Diagnostic results to Dx Hypertrophic CM
- Auscultation (2)
- EKG (4)
- Echo (2)
Auscultation - Systolic ejection murmur, Paradoxical splitting of S2;

EKG - LVH, PVCs, A-fib, ST + Q abnormalities;

Echo - septal hypertrophy, LVH w/ small LV
Tx for Hypertrophic CM
(2 together)

if becomes more severe?
1. No exercise
2. Beta-blocker

More severe:
implantable Cardiac Defibrillator