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Cardiovascular Blueprint
PANCE Blueprint
Dilated Cardiomyopathy
•
Defined as being
characterized by
enlargement of
chambers and
impaired systolic
function.
•
Can involved one or
both ventricles
Dilated Cardiomyopathy
Causes
-Genetic
-Thyrotoxicosis
-Metabolic
(Starvation)
-Peri or Post
partum
-Cobalt ingestion
Dilated Cardiomyopathy
•
-Sarcoidosis
•
-Hemochromatosis
•
-Radiation
•
-Thiamine Deficiency
•
-Alcohol
•
-Catecholamine induced
•
-Infectious (Viral and Parasitic)
•
-Radiation
Dilated Cardiomyopathy
Big Picture-can be idiopathic but can be caused by ingestion of
toxins, radiation, infection, or metabolic disorders
-Physical Exam similar to a patient with heart failure
-EKG may show some LVH or RVH
-ECHO is necessary for diagnosis
-Cardiac biopsy only for those who may have treatable cause
-Treatment is similar to heart failure targeted at increasing
preload and decreasing after load.
-ACE inhibitors and Beta Blockers are ideal for those patients
who can tolerate them
Hypertrophic
Cardiomyopathy
•Has
normal or small left
ventricle size
•Involves a disproportionate
thickening of the interventricular septum
•Causes outflow obstruction
and diastolic disfunction
•Mainly an autosomal dominant
cause
•Can cause life threatening
arrhythmias
Hypertrophic
Cardiomyopathy
•
Can be asymptomatic
•
Most common symptom is
dyspnea on exertion
•
May have exertion chest pain
from outflow obstruction rather
than coronary artery disease
•
Syncope or dizziness may be
present
•
can cause life threatening
arrhythmias
Hypertrophic
Cardiomyopathy
•Can
be asymptomatic
•Most
common symptom is dyspnea on exertion
•May
have exertion chest pain from outflow
obstruction rather than coronary artery disease
•Syncope
or dizziness may be present
•Physical
Findings-crescendo-decrescendo
systolic murmur
•S4
gallop from increased ventricular stiffness
Hypertrophic
Cardiomyopathy
•
Can hear an S3 if left ventricular systolic problems
•
ECHO is needed for diagnostic confirmation and to determine
the severity
•
May need cath to rule out concomitant coronary artery disease
•
Treatment is targeted at improving diastolic disfunction
•
Calcium channel blockers are ideal
•
Beta blockers can be used to
•
These increase preload and allow the ventricle to fill better
Restrictive
Cardiomyopathy
•
Has a small ventricle size
•
May involve one or two ventricles
•
Characterized by diastolic
dysfunction
•
Elevated ventricular filling
pressures
•
Systolic function normal
•
Most common causes is
amyloidosis
•
Can be idiopathic
•
Can be caused by Sarcoidosis,
Hemochromatosis, Radiation,
scleroderma, Gaucher’s disease
Restrictive
Cardiomyopathy
Physical exam-signs of right heart failure are present
Elevated right side heart pressures and dilated neck veins
ECHO is needed in the diagnosis
Right heart cath sometimes needed to make sure it is not
constrictive pericarditis
Treatment is similar to heart failure
Diuretics help decrease systemic vascular resistance
Cardiomyopathy Summary
Dilated Cardiomyopathy-systolic dysfunction, may affect one or
both ventricles. Symptoms similar to CHF. Dilated
chambers
Hypertrophic Cardiomyopathy-diastolic problem, small chambers can
cause outflow obstruction. Can cause DOE or chest pain with
activity
Restrictive Cardiomyopathy-diastolic problem, elevated right heart
pressures, amyloidosis most common cause, treatment similar to
heart failure