Cardiomyopathies Flashcards
Chamber dilation > decrease contractility, increase compliance, decrease EF > systolic dysfxn
cardiomyopathy
20-60 yo
Hx: progressive CHF from LV systolic dysfunction
dilated cardiomyopathy
i. LV heave RV heave
ii. Cardiomegaly – diffuse, slightly sustained, downwardly displaced apex
iii. S3; Mitral + tricuspid regurgitation
iv. Increase JVP; Crackles; peripheral edema
dilated cardiomyopathy
TTE: dilated ventricles and systolic dysfunction (low EF)
dilated cardiomyopathy
i. Cox B, parvovirus B19, HHV 6, adenovirus, enterovirus
ii. C/F: young adult <60, fever, malaise, myalgia’s, tachycardia, HF, +/- chest pain if with pericarditis, sudden cardiac death
iii. Dx: TTE – 4 chamber dilation, diffuse hypokinesia, low EF
post viral myocarditis
Pathogenesis: Ventricular concentric hypertrophy; decrease compliance diastolic dysfxn
Hypertrophic obstructive cardiomyopathy (HOCM): asymmetrical septal hypertrophy and systolic anterior motion of the mitral valve LVOT obstruction
Genetics – mutations in sarcomere protein genes – ch. 14
hypertrophic cardiomyopathy
20-40 yo
increase of sudden death in young athlete < 35 yo
FxHx
HOCM
pathophysiology - eject > obstruct > leak
- asymmetric hypertrophy of a non dated ventricle
- mitral systolic anterior motion (SAM)
- MR
HOCM
Hx: asymptomatic, pre/syncope, chest pain on exertion, dyspnea, CHF, palpitations
PE: bisferiens carotid pulse w/ obstruction, double impulse, S4, normal S1 and S2
HOCM
murmur: harsh, diamond shaped, ejection murmur
1. Decrease preload (dehydration, standing, Valsalva) – increase murmur
2. Increase preload (squatting, passive leg raising) – decrease murmur
HOCM
TTE: asymmetric hypertrophy; mitral systolic anterior motion with regurgitation
ECG: LVH
HOCM
mimics constrictive pericarditis
restrictive cardiomyopathy
Pathogenesis: rigid, non complaint myocardium small stiff ventricles
Etiology
- Inflammatory – post radiation fibrosis, loeffler endocarditis, endocardial fibroelastosis
- Deposition – infiltrative: amyloidosis, sarcoidosis; storage: hemochromatosis; fabry dz, glycogen storage dz
- Idiopathic – scleroderma, neoplastic, familial
restrictive cardiomyopathy
Hx: predominate RHF
PE:
- increase JVP, kussmaul sign
- no RV heave
- S3 and S4
- Bibasilar rales
- Peripheral edema
- Advancing dz: hepatomegaly, ascites
restrictive cardiomyopathy
ECG: diffuse low voltage
TTE: LAE, RAE, wall thickness – concentric LVH in infiltrative type: thick walled and non dilated ventricles; diastolic dysfunction, preserved EF
restrictive cardiomyopathy
