CVS

CardiomypathiesChapter 55

Kelly A. Stanichuk D.O.


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

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

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

Restricitve

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

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

Myocarditis

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

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

Cardiac tamponade

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

Constrictive Pericarditis

Fibrous thickening of the pericardium prevents passive diastolic fillingDOE, LE swellingJVD, no friction rub, Pericardial “knock”EKG: no specific findingsTX: pericardiectomy