Myocardia and Pericradial Diseases Flashcards
types of cardiomyopaties
dilated
restrictive
hypertrophic
diseases that have to be excluded before diagnosis of cardiomyopathy
coronary artery disease
valvular heart disease
pericardial disease
hypertension
diseases of the greata vessels
common pathologic features of cardiomyopathies
elevated LV and ED pressures
reduced SV or CO
mitral regurgitation
supraventricular and ventricular arrhythmias
LV systolic function in cardiomyopathies
DCM - reduced
RCM - normal to reduced
HCM - normal to increased
etiologies for dilated cardiomyopathy
- Post-viral
- Post-partum
- Inflammatory
- Alcoholic
- Infectious
- Metabolic
- Toxins
- Chemotherapy
- End-stag restrictive cardiomyopathy
**most cases are now known to be inherited
dilated cardiomyopathy
LV dilated, systolic pump function depressed
elevated LV ED pressure, LA pressure, and pulmonary venous pressure
reduced CO leads to hypertrophy, apoptosis, and fibrosis, and finally congestive heart failure
physical findings of DCM
displaced apical impulse
apical S3
systolic murmur
treatment for DCM
removing or treating primary precipitating causes
beta blockers
ACE inhibitors
drugs that antagonize aldosterone
implantable defibrillators for arrhythmias
cardiac resynchronization therapy
three leads in right atrium, right ventricle, and coronary sinus
used to ensure heart depolarizes in snyc
causes of restrictive cardiomyopathy
amyloidosis
hemochromatosis
eosinophilia
sarcoidosis
radiation
neoplastic
infiltrative
idiopathic/inherited
pathophysiologic mechanisms of RCM
impaired LV diastolic filling
LV systolic dysfunction (late)
arrhythmias
due to thickening and stiffening of the ventricular myocardium
treatment for RCM
no specific treatments
treat underlying cause
most treatment is nonspecific and tries to deal with adverse effects
causes of hypertrophic cardiomyopathy
geneticallt transmitted diseaes with chormosomal abnormalties involving the contractile proteins
pathophysiology of HCM
hypertrophy of the LV without dilation
increases stiffness and impairs ventricular illing in diastole
lowered EDV reduces stroke volume during exercise
MI is common due to the hypertrophy
may have dynamic obstruction of LV outflow
management of HCM
directed toward reducing heart rate and LV contractility to improve LV filling
beta blockers and calcium channel blockers
diuretics if dyspnea is present
monitor arrhythmias, ICD implantation
surgery to increase outflow tract
pericardial diseases
acute pericarditis
constrictive pericarditis
pericardial effusion
pathophysiology of acute pericarditis
acute inflammation of the visceral and parietal pericarium
results in chest pain, a pericardial friction rub, and ECG changes
if untreated, can progress to chronic constrictive pericarditis
causes of acute pericarditis
most common is idiopathic or viral infection
other causes include:
TB
bacteria
fungus
acute MI
uremia
neoplasia
surgery
radiation
autoimmune
drugs
trauma
aortic dissection
chylopericardium
myxedema
causes of chronic constrictive pericarditis
can arise from acute pericardial inflammation
viral, bacterial, TB, uremic, radiation, myxedema, and chylopericardium
surgery also may precipitate
pathophysiology of chornic constrictive pericarditis
impairment of RV and LV filling
elevation of filling pressures and reduced CO
physical findings of constrictive pericarditis
Kussmaul’s Sign
jugular venous distension
pericardial knock
Kussmaul’s sign
increase in jugular venous pressure upon inspiration
compliance relationship between DCM, RCM, and HCM
pericardial effusion and cardiac tamponade pathophysiology
marked effusions cause rapid increases of pressures
severely reduces ventricular filling and forward output
most common causes of pericardial effusions
neoplasia
idiopathic
uremia
infection
bacterial
iatrogenic cardiac perforation
TB
radiation
myxedema
acute aortic dissection
physical findings of pericardial effusions
jugular venous distension
pulsus paradoxicus
hypotension
treatment of pericardial effusion
pericardiocentesis
surgically placed pericardial window
pulsus paradoxicus
a greater than 10 mmHg drop in blood pressure upon inspiration
