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Cardiomypathies Chapter 55

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  1. CardiomypathiesChapter 55 Kelly A. Stanichuk D.O.

  2. Diseases that alter myocardial structure and function • Dilated, Hypertrophic, Restrictive, arrhythmogenic right ventricular cardiomyopathy

  3. Dilated Cardiomyopathy • Low cardiac output, end systolic and diastolic ventricular volumes, dilation with hypertrophy • CHF like symptoms, peripheral embolization, chest pain • CXR: CM, cephalization • EKG: LVH, atrial enlargement, poor R wave progression • Tx: Digoxin, diuretics

  4. Hypertrophic • Impaired diastolic relaxation, restricted LV filling • DOE, palpitations, syncope • SEM best at L sternal border or apex (inc. by valsalva) • EKG: LVH, atrial enlargment • CXR: normal • Tx: Exercise restriction, beta blockers

  5. Restricitve • Elevated end diastolic pressures, normal systolic function • CHF symptoms without CM or systolic dysfunction • S3 present • EKG: low voltage • Tx: Symptom directed

  6. Arrhythmogenic Right Ventricular Cardiomyopathy • Progressive replacement of RV myocardium with fibrofatty tissue • Sudden death or ventricular dysrhythmia in a young pt • EKG: RBBB, precordial T wave inversion • TX: antidysrhythmics, defribillator

  7. Myocarditis • Inflammation of the heart muscle • Fever, sinus tach, chest pain • PE: friction rub • Elevated cardiac enzymes • Supportive treatment

  8. Pericarditis • Sharp chest pain worse when supine • Low grade fever, dyspnea, dysphagia • PE: friction rub • EKG: ST segment elevation • Cardiac enzymes may be elevated if assoc with myocarditis • TX: NSAIDS

  9. Cardiac tamponade • Increased fluid in the pericardial sac • Distant heart sound, JVD, hypotension • Pulsus paradoxicus • EKG: low voltage • TX: Fluids, pericardiocentesis

  10. Constrictive Pericarditis • Fibrous thickening of the pericardium prevents passive diastolic filling • DOE, LE swelling • JVD, no friction rub, Pericardial “knock” • EKG: no specific findings • TX: pericardiectomy