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22 Cards in this Set

  • Front
  • Back

Types of STRUCTURAL cardiomyopathies

-dilation (60%)

w/ or w/o systolic dysfunction

-hypertrophic (5%)

w/ or w/o obbstruction

-restrictive diastolic (lusitropic) dysfunction (35%)

Clinical presentation of cardiomyopathy

-fxn limitation (reduced exertional capacity)



-dependent edema


-sleep disturbance

Key findings for a DILATED cardiomyopathy

-jugular venous distention> 8 cm

-S3 at apex (volume overloaded ventricle)

-ant chest wall heave (enlarged heart)

-laterally displaced PMI

-basilar pulmonary rales (congestion/fluid)

-hepatomegaly/peripheral edema (R sided congestion)

Key findings for a RESTRICTIVE cardiomyopathy (stiff heart, higher contractile fxn)

-jugular venous distention when decompensated

-S4 at apex (stiff heart)

-PMI normal (at mid-clavicular line)

-basilar pulmonary rales

-peripheral edema

(normal size heart= no heaves)

Key findings for a HYPERTROPHIC cardiomyopathy

(abnormal thickened myocardium, due to genetics)

-S4 at apex

-systolic murmur in 2nd parasternal interspace (in obstructive hypertrophy)

-hyperdynamic precordium

-PMI normal

-bifid carotid upstroke

Primary causes of Dilated cardiomyopathy

-familoial genetics

-RV arrhythmogenic dysplasia

-muscular dystrophy (Duchenne's)

Secondary causes of Dilated cardiomyopathy


-infection (viruses (any), HIV)

-valvular heart disease (aortic or mitral insuffic)

-toxins (ETOH, anthracyclines, antiretrovirals)

-endocrinoopathy (DM, hypothyroidism)


-CT disorders (SLE, RA)

(anything that doesn't get resolved eventually leads to dilated cardiomyopathy= final common pathway)

Mycocardial dysfunction leads to what 4 main pathophysiologies?

-fluid retention


-inc afterload


(all failed attempts to inc fxn)

Causes of RESTRICTIVE cardiomyopathy

-infiltrative diseases (sarcoidosis, tuberculosis(

-endomyocardial fibrosis

-early myocardial ischemic scarring

-CT disease

Causes of HYPERTROPHIC cardiomyopathy

*obstructive cardiomyopathy (HOC):

-genetic somatic dominant w /variable penetrance

-most common in young athletes

*non-obstructive hypertrophy:

-diffuse myopathy w/ diastolic dysfunction & normal systolic fxn

Dx for cardiomyopathy

-history & physical exam (esp ask about supplements)


-lab eval


-stress test


What can an ECG reveal?

-presence of ischemia

-conduction system dysfxn (BBB)

-rhythm disturbance

*normal ECG = little value

Stress testing is ONLY for what pts?

stable pts w/o hypertrophic obstructive cardimyopathy

Therapy for cardiomyopathy (tx steps)

1. determine baseline functional capacity & resolve fluid overload (diuresis)

2. address/fix acute reversible factors (hypertension, ischemia, anemia, fever, uncontrolled DM)

3. investigate w/ tests

4. investigate cause of pathology (lab eval)

Objective therapy for dilated cardiomyopathy

1. diuresis

2. reduce preload

3. reduce afterload

4. augment contractility

-maintain sinus rhythm

-device therapy

Objective therapy for restrictive cardiomyopathy

1. diuresis

-no meds to relax

-maintain sinus rhythm

Objective therapy for hypertrophic cardiomyopathy

1. beta-blocker or Ca2+ blocker (slow contractility)

- defibrillator in high risk pts

-septal ablaction/excision (remove obstruction)

(do NOT use diuresis)

Drugs that reduce preload



salt/fluid restriction


morphine (acutely)

Drugs that reduce afterload

-ACE inhibitors

-angiotensin receptor blockers


-Digoxin (does not reduce mortality)

-infusion therapy (only in hospital- dobutamine, milrinone, amrinone

-beta-blockers (carvedelol, bucindolol, metoprolol)

ACE inhibitors & beta blockers have the greatest combined ability to reduce mortality in __________

dilated cardiomyopathy

what mechanical interventions can be used in patients who are waiting for a heart transplant?

-intra-arotic balloon counterpulstation (IABP)

-Left ventricular assist device (LVAD)

What test is the most important to identify whether cardiomyopathy is stiff (restricted) or dilated?