3.6 Dilated Cardiomyopathy

Question 1

List causes of DCM

Answer 1

1 Cardiac Ischaemia

2 Cardiac Valvular Abnormalities

3 Post Viral Infection

4 A/W other comorbs

• Chronic alcohol
• SCD
• Muscular Dystrophy
• Hypothyroid
• Drugs

5 Idiopathic

Question 2

Signs

Symptoms

Answer 2

1. Tachycardia
   - Low output state
2. Arrhythmias
3. Cardiac Failure
   - Peripheral Oedema / Dyspnoea / Ascites
4. MR / TR
5. Embolus formation
   - intracardiac
6. Worsening systolic or diastolic fxn
   High LVEDP on echo

Question 3

Important Factors Anaesthetising DCM patient

Answer 3

Preop
Cardiology 
Optimise medical Tx
Ace inhibitors / ARBs / Diuretics / BBloq / 
Anticoag if high risk emboli

Consider Bivent pacing
poor response pharm R

Question 4

Preop Invx:

Answer 4

Preop Invx:
ECG - Ischaemia arrythmias
Echo
Look at valves
systolic and diastoic fn
EF

Aggressive Rx / Correction arrhy

AF
Electrolytes

Question 5

Intraop

Answer 5

Establish invasive BP monitoring prior to induction
- Low threshold CVP monitor

Consider Regional
Especially good in hernia
Care with under perfusion coronary
second to hypotension

Maximise CPP
avoiding tachycardia
Judicious use drugs with negative inotropy
-induction agents

Careful use inotropes and pressors

Question 6

Intraop

Answer 6

Preventon sympatheitc surges

Increased afterload
adequate depth
muscle relax if approp
good analgesia

Raised LVEDP
Maintain preload with IV fluid admin

Question 7

Post op

Answer 7

Straightforward operation under pure regional
- could return to ward after prolong monitoring in recovery

Otherwise
HDU / ICU
Maximize BP / HR / Rhythm 
Optimal fluid Mx
Oxygenation

Analgesia
Consider regional