Cardiovascular #2 (vein disorders, CMP, vascular assessment) Flashcards
Causes of cardiomyopathy
Primary-unknown
Secondary- secondary to another disease process.
Known causes: HTN, chronic etoh intoxication, pregnancy, tumors/post radiation, infections, genetics, valvular disease.
3 major types of cardiomyopathy
Dilated (congestive)
Hypertrophic (thickened muscle wall-thin chamber
Restrictive-wall stiffened so there is decrease in motion.
Dilated Cardiomyopathy (DCM)
Most common type of CM
- often occurs after infectious myocarditis; possible autoimmune process
- characterized by inflammation & rapid degeneration of myocardial fibers. Ventricular dilation.
Characteristics of DCM
- dilated, enlarged ventricles
- decreased muscle wall thickness
- systolic dysfunction–decreased cardiac output
- Atria enlarge
- stasis of blood in Left ventricle. –embolic episodes, increased heart pressure, pulmonary & vascular congestion.
- Cardiomegaly from ventricular dilation.–contractile dysfunction. BP normal to low.
Symptoms of DCM
- Activity intolerance, fatigue, weakeness
- dyspnea at rest, PND, orthopnea
- dry cough
- palpitations
- abdominal bloating, anorexia, N/V
Signs of DCM
- Irregular HR, S3/S4, murmur
- Crackles
- Edema, weak peripheral pulses, pallor
- hepatomegaly, JVD, emboli
- BP below normal
Diagnostic studies for DCM
- patient history
- Endocardiogram & ECG, endomyocardial biopsy, CXR, labs
Treating and Managing DCM
-Treat underlying cause, palliative not curative
GOAL: enhance contractility & decrease afterload…Focus is improving cardiac output
-Automatic implantable cardiac defibrillator, NAS diet, rest & avoid exertion and stress, avoid etoh, heart transplant.
Medications for DCM
-nitrates, loop diuretics, ACE inhibitors, beta blockers, anticoagulants, antidysrhythmias
Hypertrophic Cardiomyopathy (HCM)
- Most common cause of sudden death in otherwise healthy young people.
- 1/2 genetic cause
- More common in men 30-40 yrs
- Usually diagnosed in athletes in late adolescence or early adulthood (Af. Amer.)
Characteristics of HCM
- Massive ventricular hypertrophy
- rapid, forceful LV contraction
- impaired relaxation of ventricles (LV stiff) (diastolic dysfunction)
- Enlarged ventricular septum blocks blood flow from LV to aorta –obstruction of aortic outflow-decreased cardiac output.
Symptoms of HCM
- Asymptomatic to sudden death
- Exertional dyspnea, exercise makes symptoms worse.
- chronic fatigue
- Angina, dizziness, syncope
- dysrhythmias, palpitations
- HF-PND
Diagnosing HCM
PRIMARY: echocardiogram
- history & physical
- ECG, CXR
Medically Managing of treatment
-improve ventricular filling by
-reduce ventricular contractility
-relieve LV outflow obstruction
meds–BB, CCB, anti coags, anti dysrhyths
Surgical therapy –HCM
- for severe symptoms not relieved with medications
- to relieve aortic obstruction from hypertrophic ventricles
- ventriculomyopathy
- myectomoy
- percutaneous transluminal septal myocardial ablatio (decrease outflow obstruction)
Restrictive Cardiomyopathy (RCM)
Least common form
- unknown etiology-myocardial fibrosis, hypertrophy, infiltration, secondary to radiation or disease
- ventricles stiff and resist filling (impaired diastolic filling & stretch, filling pressures increase, decreased CO, HF and mild ventricular hypertrophy
Symptoms of RCM
- exercise intolerance, fatigue
- dyspnea, orthopnea
- syncope, Angina, palpitations
- HF, SOB, JVD
- peripheral edema / ascites, hepatomegaly
- RUQ fullness and discomfort
Managing RCM
GOAL: to diminish HF, improve diastolic filling, treat underlying diseases
-avoid strenuous activity, dehydration, increases in systemic vascular resistance
meds-treat HF, dysrhythmias, prophylactic antibiotics
Surgical Treatment- Cardiac transplatation
-transfer of the heart from one person to another (refractory end stage HF, CMP, inoperable CAD)
Thorough evaluation, transplant list and wait- home or hospital
recipient must match with donors body/heart sixe, ABO blood typer
Heart transplantation surgery
Max time from harvest to transplant: optimal 4 hours
- patient placed on cardiopulmonary bypass machine
- donor heart replaces recipients heart and trimmed to match
- immunosuppressive therapy
Heart transplant: post op
- first year death due to acute rejection and infection
- infection is the primary complication
- grading rejection and guiding treatment by endomyocardial biopsy
Primary complication of heart transplant
Infection
Artificial heart
-possible help for short term survival in pt with end-stage HF- experimental
-designed to minimize coagulation (lifelong)
-motor driven pumping system : internal/external batteries
-artificial ventricles
-no immunosuppressant needed
-electronic abdominal monitor adjusts HR based on activity of pt
-external battery pack: 6-8h power; recharges during sleep
two types: cardiowest, abioCor
Infective endocariditis (IE)/ Bacterial Endocarditis
- infection or inflammatory process of inner layer of heart and heart valves
- classified by cause of affected site
- IV drug abuse IE, fungal IE, prosthetic valve endocarditis
