cardiomyopathy Flashcards
what is restrictive cardiomyopathy?
impaired DIASTOLIC function with relatively preserved contractility
ventricular rigidity impedes ventricular filling ( decreased compliance)
the stiff ventricle only fills with great effort
etiologies of restrictive cardiomyopathy
infiltrative disease: amyloidosis-MCC
sarcoidosis, idiopathic myocardial fibrosis, chemo and radiation, scleroderma, hemochromatosis, etc.
clinical manifestations of restrictive cardiomyopathy
R sided HF symptoms more common (SOB, fatigue, swelling of leg/abdomen), poorly tolerated tacchyarrythmias
physical exam of restrictive cardiomyopathy
Kussmaul’s sign (JVP increasing with inspiration)
stiff inelastic RV–> impaired filling of RV–> causes increased blood flow to back up in venous system
signs of HF
may be an S3 sound present
Diagnostic Studies in restrictive cardiomyopathy
- Chest x-ray: normal heart size, enlarged atria, may have pulmonary congestion/pleural effusion
- EKG- low voltage, may be arrhythmia-low amplitude signal results in small QRS complex
- ECHO: 1)ventricles non dilated with normal thickness,2) marked dilation in both atria, 3)diastolic dysfunction. may also see systolic dysfunction in advanced restrictive cardiomyopathy
dilated atria is common in restrictive cardiomyopathy and can lead to ___
pulmonary hypertension and a-fib and AVNRT
management of restrictive cardiomyopathy
no specific treatment
TREAT UNDERLYING DISORDER
treatment is symptomatic
What is dilated cardiomyopathy?
systolic dysfunction that results in ventricular dilation which can lead to dilated, weak heart
“dysfunction in heart’s ability to contract”
MC age for dilated cardiomyopathy
20-60 yrs
is dilated cardiomyopathy more common in men or women
men
etiologies of dilated cardiomyopathy
- idiopathic-postviral, probably MCC
- viral myocarditis- enterovirus MC, HIV, Lime dx, PB19, chugs dx, etc.
- toxic: alcohol abuse, cocaine, anthrocycluines, radiation treatment
- other: pregnancy, infiltrative autoimmune, metabolic syndrome (thyroid)
clinical manifestations of dilated cardiomyopathy
Heart failure- systolic HF symptoms: S3, fatigue, signs of L or R sided CHF, lateral displaced PMI, may be mitral or tricuspid regurgitation
Embolic events
Arrhythmias
Chest pain on exertion
diagnostic studies for dilated cardiomyopathy
echo: 1)LV dilation (thin ventricular walls), large ventricular chambers, 2) decreased EF, 3) regional or global left ventricular hypokinesis
chest x-ray: cardiomegaly, pulmonary edema, pleural effusion
EKG: sinus tach or arrythmias
management of dilated cardiomyopathy
standard HF treatment
hypertrophic cardiomyopathy is an inherited genetic disorder of ___ hypertrophy.
LV and/or Rv
especially septal
in hypertrophic cardiomyopathy, sub aortic outflow obstruction narrows LV tract secondary to hypertrophied septum and systolic anterior motion of the mitral valve and papillary displacement.
increased systolic anterior motion is seen with what two things?
- increased contractility-> exercise, digoxin, beta agonists
- decreased left ventricular volume–> decreased venous return, dehydration, valsalva maneuver
diastolic dysfunction: stiff ventricular chamber results in impaired _____
ventricular relaxation/filling
clinical manifestations of hypertrophic cardiomyopathy
Dyspnea, fatigue
angine pectoris
syncope: pre-syncope and dizziness- due to inadequate output on exertion
arrhythmias: palpitations, a-fib, v-tavh, v-fib
sudden cardiac death: especially in young people during times of extreme exertion
what type of murmur will you hear on a patient with hypertrophic cardiomyopathy
harsh systolic crescendo-decrescendo murmur
the murmur with hypertrophic cardiomyopathy is best hear where?
left lower sternal border (sounds similar to Aortic Stenosis)
in hypertrophic cardiomyopathy, when performing handgrip, there is increased venous return which causes the murmur to be ___
decreased
in hypertrophic cardiomyopathy, when performing the valsalva maneuver, there is decreased venous return which results in the murmur to be ______
increased
on physical exam of hypertrophic cardiomyopathy, there will usually be no carotid radiation, but there may be ____.
loud S4, mitral regurgitation, S3 or pulses bisfereins
diagnostic studies for hypertrophic cardiomyopathy
echo: asymmetrical wall thickness, especially septal; systolic anterior motion of the mitral valve, small LV chamber size, dynamic outflow obstruction. there may or may not be mitral regurgitation
ekg: LVH, atrial enlargement, anterolateral and inferior pseudo q waves
TTE
chest x ray: cardiomegaly
