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22 Cards in this Set
- Front
- Back
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Types of STRUCTURAL cardiomyopathies |
-dilation (60%) w/ or w/o systolic dysfunction
-hypertrophic (5%) w/ or w/o obbstruction
-restrictive diastolic (lusitropic) dysfunction (35%) |
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Clinical presentation of cardiomyopathy |
-fxn limitation (reduced exertional capacity) -fatigue -orthopnea -dependent edema -anorexia -sleep disturbance |
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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) |
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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)
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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
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Primary causes of Dilated cardiomyopathy |
-familoial genetics -RV arrhythmogenic dysplasia -muscular dystrophy (Duchenne's) |
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Secondary causes of Dilated cardiomyopathy |
-ischemia -infection (viruses (any), HIV) -valvular heart disease (aortic or mitral insuffic) -toxins (ETOH, anthracyclines, antiretrovirals) -endocrinoopathy (DM, hypothyroidism) -post-partum -CT disorders (SLE, RA)
(anything that doesn't get resolved eventually leads to dilated cardiomyopathy= final common pathway) |
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Mycocardial dysfunction leads to what 4 main pathophysiologies? |
-fluid retention -tachycardia -inc afterload -remodeling
(all failed attempts to inc fxn) |
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Causes of RESTRICTIVE cardiomyopathy |
-infiltrative diseases (sarcoidosis, tuberculosis( -endomyocardial fibrosis -early myocardial ischemic scarring -CT disease |
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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 |
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Dx for cardiomyopathy |
-history & physical exam (esp ask about supplements) -ECG -lab eval -CXR -stress test -angiography |
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What can an ECG reveal? |
-presence of ischemia -conduction system dysfxn (BBB) -rhythm disturbance
*normal ECG = little value |
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Stress testing is ONLY for what pts? |
stable pts w/o hypertrophic obstructive cardimyopathy |
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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) |
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Objective therapy for dilated cardiomyopathy |
1. diuresis 2. reduce preload 3. reduce afterload 4. augment contractility -maintain sinus rhythm -device therapy |
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Objective therapy for restrictive cardiomyopathy |
1. diuresis
-no meds to relax -maintain sinus rhythm |
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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)
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Drugs that reduce preload |
diuresis nitrates salt/fluid restriction spironolactone morphine (acutely) |
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Drugs that reduce afterload |
-ACE inhibitors -angiotensin receptor blockers -Hydralazine -Digoxin (does not reduce mortality) -infusion therapy (only in hospital- dobutamine, milrinone, amrinone -beta-blockers (carvedelol, bucindolol, metoprolol)
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ACE inhibitors & beta blockers have the greatest combined ability to reduce mortality in __________ |
dilated cardiomyopathy |
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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) |
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What test is the most important to identify whether cardiomyopathy is stiff (restricted) or dilated? |
echocardiograph |
