Dilated cardiomyopathy Flashcards
Define what dilation is?
When the left ventricle is stretched and weakened
Can occur in more than one chamber
Thrombosis in chamber not uncommon
EJ decrease
What is the general aetiology?
Genetic + Familial:
- SCNSA gene
- Muscular dystrophy
Inflammatory Infectious - viral myocarditis Autoimmune Toxic: drug, endocrine, chemicals Postpartum Injury, cell loss, scar replacement
For aetiology, what are the more classical associations?
Alcohol
Doxorubicin (chemotherapy)
Coxsackie B virus
Roughly, describe the pathophysiology?
Inflammatory damage to myocytes and therefore, cell death -> fibrosis of myocardium -> enlargment of LV chamber without corresponding to increase in myocardial mass -> decrease contractile ability (which is initally partially compensated) -> remodelling + more dilation -> No longer compensation -> Volume overload so decrease CO and increase EDV = Pulm oedema, insufficient tissue oxygenation, increase RV pressure, increase cardiac arrhthmia
What are the symptoms associated?
Dysponoea
Orthopnoea
PND
Progressive slow onset
Weight gain - fluid overload
Ankle swelling - oedema
Cough
What are common post medical histories and social histories?
Systemic illness
Vascular disease
Thyroid neuromuscular disease
SH= Alcohol and Job
What are the signs/examination results?
Poor superficial perfusion Thready pulse Raised BP Raised JVP Irregularly irregular = AF SOB at rest Displaced apex Oedema Hepatomegaly Mitral/tricuspid regurg Ascites
Or
RRRRDOHAAMPJ
What are you looking for in an ECG investigation?
- tachycardia (increase HR)
- LBBB so LV contracts later than RV
- Non specific T wave changes (caused by hyperkaelemia linked to renal failure)
- Poor R wave progression
What are you looking for in an CXR?
Cardiomegaly
Pulm oedema
What are you looking for in a coronary angiogram?
Blocked vessels
What are you looking for in an ECHO?
Dilated heart
Low ejection fraction
Mitral or Tricuspid Regurg
LV thrombus
What are you looking for in bloods?
FBC
U and E
Briefly, list all the investigations you would do?
ECG CXR Coronary angiogram ECHO Bloods
Name some medications used for treatment
Diuretics ( treats high BP and increases urine ) B-Blockers Digoxin ACE-inhibitor Anticoagulant Spironolactone
What are general treatment management?
Reduce salt/fluid
Weight management
Correct anaemia
Remove exacerbating drug
