Cardiomyopathy Flashcards
cardiomyopathy definition:
-a group of diseases of varying etiologies in which the main featuer is myocardial involvement
dilated cardiomyopathy definition:
- a disorder of myocardial muscle resulting in dilation and weakening of the left ventricle
- bad systole!
hypertrophic cardiomyopathy definition:
- disorders of myocardial muscle resulting in hypertrophy, left ventricular dysfunction and arrhythmias
- usually familial
restrictive cardiomyopathy definition:
a group of disorders resulting in excessive myocardial stiffening with resultant ventricular dysfunction
-cant fill very well - bad diastole
Most common cause of cardiomyopathy in western hemisphere?
-chagas disease - VIRAL
Functional classifications:
1) dilated-ventricular dilation and contractile dysfunction
- MOST COMMON
2) hypertrophic-thickened walls (symmetric or asymmetric) with preserved contractile function
- FAMILIAL
3) restrictive-impaired diastolic filling without dilation
Dilated cardiomyopathy
-etiologies
most common to least:
- idiopathic
- ischemic
- HTN
- alcohol
- infectious (chagas viral)
- metabolic (beriberi, kwashiorkor, thyroid dis, DM)
Dilated cardiomyopathy - history:
- angina or previous MI
- systemic arterial HTN
- alcohol or other toxins
- foreign travel/residence
- other diagnoses - DM
- signs/symptoms of HF (LV, RV or both)
symptoms of LV failure:
1) fatigue
2) weakness
3) dyspnea
- exertional
- orthopnea (venous return inc when laying = more blood everywhere including lungs = need to sit up bc not gettign good V/Q)
- PND (after youve been asleep)
4) pallor, tachycardia
Signs of LV failre:
- pale, often dyspneic
- vital signs cary - tachycardia often
- cardiac apex displaced left and down
- apical lift and/or thrill
- S1 and S2 normal
- P2 varies
- S3 always present - VOLUME OVERLOADED LV
- many different murmurs (MR, AS)
symptoms of RV failure
- same as LV but dyspnea improves as RV fails (lungs clear up a little)
- anorexia
- early satiety & abdominal fullness (congestion)
- pallor, tachycardia
- elevated jugular venous pulsations (no valves!)
most common cause of RV failure?
LV failure!
signs of RV failure:
- jugular venous pulses elevated
- cardiomegaly, RV lift
- P2 varies
- RV and LV S3 universal
- various murmurs
- pulsus alternans (weak heart- and each beat some muscle fibers cant recover but next cycle they can so the R wave gets bigger and smaller)
- hepatomeg/splenomeg
- ascites
- peripheral edema
- evidence of poor nutrition (muscle wasting)
Dilated cardiomyopathy - imaging:
- chest x-ray = big heart
- echocardiogram
- radionuclide studies
- cardiac catheterization
Dilated cardiomyopathy-cardiac catherterization
1) Hemodynamics
- inc LV end diastolic pressure (LVEDP)
- inc PA, and RV pressures
- dec LV ejection fraction (LVEF)
2) left ventriculogram
- abnormal dilation
- wall motion reduced
3) coronary arteries
common consequence of chronic alcoholism?
-atrial fib!
Alcoholic cardiomyopathy - tx?
-tx like other + thiamine
pt must stop drinking!! or DEAD within 3 years
Alcoholic cardiomyopathy - common reasons for death?
v-fib or pump failure
Hypertrophic cardiomyopathy
-terminology:
1) IHSS - idiopathic hypertrophic subaortic stenosis
2) HOCM - hypertrophic obstructive cardiomyopathy
- hypertrophic, obstructive
- equivalent to IHSS
3) HCM - hypertrophic cardiomyopathy
- hypertrophic, obstructive
- hypertrophic, non-obstructive (most)
- best terminology
pathology of hypertrophic cardiomyopathy:
1) macroscopic:
- inc myocardial mass
- asymmetric septal hypertrophy
- concentric hypertrophy
- apical hypertrophy
2) microscopic
- myofibrillary dysarray - whorls of deformed myocytes
- prominent fibrosis
- abnormal intramural coronaries
Hypertrophic cardiomyopathy
-clinical manifestations:
1) symptoms
- young onset (age 26)
- sudden death
- dyspnea
- angina pectoris
- fatigue
2) signs
- slight displaced, bifid LV impulse
- bisferiens carotid pulse
- S4 very common-stiff ventricle
- systolic murmur of variable qualities
Hypertrophic cardiomyopathy
-ECG?
- inc voltages in anterior leads
- ST and T wave changes (repol abnormality)
- Q-waves (usually inferior, lateral)
Diagnostic for Hypertrophic cardiomyopathy
-echocardiogram!
Tx for hypertrophic cardiomyopathy?
- reduce physical activty
- Drugs: - beta blockers (reduce contractility)
- myotomy/myectomy - carve out a piece of the septum
restrictive cardiomyopathy -what is the hallmark?
diastolic dysfunction
issue with restrictive cardiomyopathy?
- amyloid in the heart muscle walls
- heart gets too stiff
- heart cant fill/pump properly
==> you die!
