Cardiomyopathies and valve disease Flashcards
Cardiomyopathies
- disease where contraction and relaxation of the myocardial fibers is impaired
- genetic, acquired or mixed, could also be idiopathic
- overuse of alcohol.drugs, infection, muscular dystrophy
3 primary classifications of cardiomyopathies and how they are determined
- Determined by EKG and heart muscle biopsy
- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- restrictive cardiomyopathy
Dilated cardiomyopathy
clinical features
- increase cardiac mass
- dilation of all 4 chambers
- minimal or no wall thickening
- systolic dysfunction
How does a dilated cardiomyopathy occur
- mitochondrial problem within the muscle fiber
- thins out the muscle
How does the dysfunction impact physiology during a dilated cardiomyopathy
- valves don’t meet = valve dysfunction and pressure changes
- ESV/ESP change
- atrium then dilates and the pressures move backward
- can sustain CO with elevated HR
- later on will need a + ionotrop to assist the workload of the heart
Hypertrophic cardiomyopathy clinical features
- hypertrophy of the cardiac muscle
- increase wall thickness (myocytes lay doesn’t in an asymmetrical fashion)
- no dilation
- normal or increased systolic function
- diastolic dysfunction
- may have outflow obstruction due to septum becoming enlarged
How does the dysfunction of hypertrophic cardiomyopathy impact function?
- more O2 is required for more muscle but outflow gets obstructed
- blood will back up into atria
- may come with arrhythmia
- require (-) inotropic to decrease work of heart
- can remove overgrowth of the heart
Restrictive cardiomyopathy clinical features
- increase stiffness of ventricular walls
- has features of both diastolic and systolic dysfunction
- heart cannot contract as well but also doesn’t relax as well
What has been associated with restrictive cardiomyopathy
- amyloidosis: excess protein lay down
- post radiation
- diabetes
- fibrosis
Heart valve disease symptoms
- my include chest discomfort
- SOB
- dizziness
- edema
- palpitations
- rapid weight gain from increased in fluid
causes of heart valve disease
- birth defects
- infections (rheumatic fever and endocarditis)
- damage caused from other conditions
treatment for heart valve disease
- valvuloplasty
- medications for symptoms
- valve repair/replacement surgery
how does heart valve disease affect the heart
- when valves become stenosed, prolapsed or insufficient overall impact is more work for the PRECEDING chamber
What is heard with a prolasped valved
- murmur
- due to not closing fully and letting some back flow of blood
- there is more space in the chamber below due to the valve ballooning out
Infective endocarditis
what is it and symptoms
- bacterial or fungal infection on valve an prevents it from closing
- presents at first with flu like symptoms then SOB and fatigueT
Treatment for valve disease
Surgical and non surgical
- often anticoagulants to prevent clotting in valves from stagnant flow
- surgical intervention - repair (valvuloplasty) or replacement
valvuloplasty
- blow up ballon to open the valve that has stenosis
Valve repair (annuloplasty
- ring insertion to help maintain leaflet contact
- replace the ring around the valve to help it function better
- Valve replacement
- mechanical vs biological
- mechanical = different types but made form metal
- biological: comes from cows and pigs
Biological prosthetic valve
- lasts 8-10 years
- no anticoagulation meds
- no audible click
Mechanical prosthetic valve
- lasts > 20 years
- lifelong anticoagulants
- click
Valve replacement surgery types
not material used
- TAVR: transfemoral
- TAVR: transapical
- TAVR: transaortic
- open heart (AVR)
- minimal incision valve surgery
Pericardial effusion
- caused by pericarditis
- inflammation of the heart’s pericardium due to injury or disease leading to accumulation of fluid
- affects contraction and relaxations as there is not room to move
cardiac tamponade: factors leading to it
- rate of accumulation
- amount of fluid in pericardium
- compliance of pericardium
pathophysiology of cardiac tamponade
- increased volume in pericardial space = compression of atria, vena cave and pulmonary veins
- reduced RV filling in diastole = decreased stroke volume/CO
- RV collapse occurs leading to cardiac arrest
