Details of the Slide Show Covers: These lecture slides are a preview of the Full Cardiovascular Section of the NCCPA Blueprint for the PANCE and PANRE. These slides contain content from the first topic Cardiomyopathy.
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 inter-ventricular 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
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