Cardiomyopathy and Obstructive Sleep Apnea Flashcards
What is the most important thing to control in HF?
Blood Pressure
Cardiomyopathy can lead to what?
Heart failure
Arrhythmias
Conduction Abnormalities
Thromboembolic strokes
Clinical forms of cardiomyopathy
Dilated MC
Hypertrophic
Restrictive (diastolic)
Dilated Cardiomyopathy etiologies and general characteristics
Common etiologies
- Post Viral (MC)
- EtOH
- Cocaine
- Familial
- Post partum
4 Chamber cardiac enlargement
CO may be normal at rest, but does not adequately increase with exertion
Dilated Cardiomyopathy Physiology
EF <30% may improve with time and tx
RIsk for ventricular tachyarrhythmias and sudden death
Dilated Cardiomyopathy sxs
Non-specific non-ischemic CP
Syncope
Sxs of HF (DOE, PND, orthopnea, peripheral edema)
Dilated Cardiomyopathy PE
Cardiomegaly
Signs of L sided HF
- Rales
- Wheezing
Signs of R Sided HF
- Edema
- HJR
- Concurrent signs of L sided HF
Dilated Cardiomyopathy Tx
Treat underlying cause
Tx HF
Tx arrhythmias and conduction disturbances
Prevent thromboembolic complications
Hypertrophic Cardiomyopathy Etiology
Genetic heterogenous autosomal dominant mutation in genes coding for sarcomeres
Lead to thickening of L ventricle and septum
Presents between ages 20-40
Hypertrophic Cardiomyopathy Physiology
EF >60%
L ventricular volume decreased (doesn’t eject as much blood)
Sxs: DOE, CP, syncope, palpitations
Risk for ventricular tacchyarrhythmias and A Fib
Common cause of sudden death in athletes
Hypertrophic cardiomyopathy
Syncopal episode during exercise is a warning sign of HD and requires cardio evaluation
EKG (makes Dx), Echo, Exercise stress test
Hypertrophic Cardiomyopic PE
Prominent L Ventricular Impulse
S4 gallop
Murmur along L sternal border that increases on expiration, increases going from squatting to standing
Etiology of Restrictive Cardiomyopathy
Infiltrative diseases: amyloidosis, sarcoidosis
Restrictive pericarditis
Chemo
Radiation
Restrictive Cardiomyopathy Physiology
Diastolic and systolic dysfunction
EF dec’d 25-50%
LV internal dimension decreased
Sxs: exertional intolerance
Risk for arrhythmia: ventricular, conduction block, A fib
Restrictive Cardiomyopathy PE
May be normal
May be signs of L sided HF
A fib may be present
Evaluation of Restrictive Cardiomyopathy
CXR
EKG
Echo
Systolic dysfunction (Causes HF)
Inability of heart to contract strongly enough to supply blood to periphery
Primarily in dilated cardiomyopathy
Diastolic Dysfunction (Causees HF)
Associated with reduced filling of the ventricle because heart cannot relax properly
Hypertrophic or Restrictive Cardiomyopathy
Left Ventricular Failure
Acute MI
Papillary muscle rupture secondary to AMI
CAD
Cardiomyopathy
Right Ventricular Failure
PE
Pumonary HTN
RV Infarct
Cardiomyopathy
Can have L, R or Biventricular failure
True or False?
True
High Output Failure
Heart is unable to meet abnormally high metabolic demands of peripheral tissue
Anemia, thiamine deficiency (EtOH, Refeeding Syndrome), Thyroid disorders
Low Output Failure
insufficient forward output at rest or with increasing metabolic demands
Dilated, restrictive, ischemic cardiomyopathy
Acute vs. Chronic Heart Failure
Previously normaly, develops HF because of AMI, papillary muscle rupture or PE
Pre-existing heart disease, can be compensated and then have decompensation
HF/Cardiomyopathy Evaluation
H&P
EKG
CXR
Echo
MRI
Cardiac Cath
Lab Tests
Genetic Tests
Left Sided HF PE
Rales & Wheezes
R Sided HF PE
Distended neck veins, HJR
Peripheral Edema
EKG Findings
LVH
Sum V1 + V5 or V6 >35mm
Cardiomyopathy Cardiac Cath
Chamber size
EF
Valvular Function
Coronary Artery Anatomy
Cardiomyopathy Labs
**BNP **
- secreted by ventricles in setting of volume expansion and pressure overload
- >100 indicates HF
Maybe also:
- Thyroid function (TSH)
- Drug screenings
- Viral titers
- Renal and liver function
Pathophys of Sleep Apnea (2 kinds)
Obstructive–narrowing or collapse of upper airway (MC)
Central–absent drive to breathe
Obstructive Sleep Apnea Sxs
Snoring
Nocturnal arousal
excessive daytime sleepiness
personality changes
intellectual deterioration
morning HAs
chronic fatigue
Associated Disorders of Sleep Apnea
Obesity
Nasal obstruction
Adenoidal or tonsillar hypertrophy
Small jaw (micrognathia)
Macroglossia
Hypothyroidism
Neuromuscular disease
Associated Cardio Disorders with Sleep Apnea
Systemic HTN
HF
Stroke
DM
Metabolic Syndrome
Diagnosis of Sleep Apnea
Epworth Sleepiness Scale (normal 1-10)
H&P
Gold Standard–Sleep Study
Treatment of Sleep Apnea
Weight loss
CPAP
Surgery
Treatment results in cardiac remodeling, improving cardiac function, improves metabolic syndrome, better sleep and decreased daytime sleepiness
