cardiac module cardiomyopathy section pance boot camp

21
Cardiology Cardiology Module Module Cardiomyopathy Section Cardiomyopathy Section PANCE/PANRE Review Boot Camp PANCE/PANRE Review Boot Camp

Upload: jboroffpacrrt

Post on 07-May-2015

261 views

Category:

Education


2 download

TRANSCRIPT

Page 1: Cardiac module cardiomyopathy section pance boot camp

Cardiology Cardiology ModuleModule

Cardiology Cardiology ModuleModule

Cardiomyopathy SectionCardiomyopathy Section

PANCE/PANRE Review Boot CampPANCE/PANRE Review Boot CampCardiomyopathy SectionCardiomyopathy Section

PANCE/PANRE Review Boot CampPANCE/PANRE Review Boot Camp

Page 2: Cardiac module cardiomyopathy section pance boot camp

Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy

Defined as being characterized by Defined as being characterized by

enlargement of chambers and impaired enlargement of chambers and impaired

systolic function.systolic function.

Can involved one or both ventriclesCan involved one or both ventricles

Page 3: Cardiac module cardiomyopathy section pance boot camp

Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy

CausesCauses

GeneticGenetic

ThyrotoxicosisThyrotoxicosis

Metabolic (Starvation)Metabolic (Starvation)

Peri or Post partumPeri or Post partum

Page 4: Cardiac module cardiomyopathy section pance boot camp

Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy

CausesCauses

Cobalt ingestionCobalt ingestion

SarcoidosisSarcoidosis

HemochromatosisHemochromatosis

RadiationRadiation

Page 5: Cardiac module cardiomyopathy section pance boot camp

Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy

CausesCauses

Thiamine DeficiencyThiamine Deficiency

AlcoholAlcohol

Catecholamine inducedCatecholamine induced

Infectious (Viral and Parasitic)Infectious (Viral and Parasitic)

RadiationRadiation

Page 6: Cardiac module cardiomyopathy section pance boot camp

Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy

Big Picture-can be idiopathic but can be Big Picture-can be idiopathic but can be

caused by ingestion of toxins, radiation, caused by ingestion of toxins, radiation,

infection, or metabolic disordersinfection, or metabolic disorders

Page 7: Cardiac module cardiomyopathy section pance boot camp

Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy

Physical Exam similar to a patient with Physical Exam similar to a patient with

heart failureheart failure

EKG may show some LVH or RVHEKG may show some LVH or RVH

ECHO is necessary for diagnosis ECHO is necessary for diagnosis

Cardiac biopsy only for those who may Cardiac biopsy only for those who may

have treatable causehave treatable cause

Page 8: Cardiac module cardiomyopathy section pance boot camp

Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy

Treatment is similar to heart failure Treatment is similar to heart failure

targeted at increasing preload and targeted at increasing preload and

decreasing after load. decreasing after load.

ACE inhibitors and Beta Blockers are ideal ACE inhibitors and Beta Blockers are ideal

for those patients who can tolerate themfor those patients who can tolerate them

Page 9: Cardiac module cardiomyopathy section pance boot camp

Hypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic Cardiomyopathy

Has normal or small left ventricle sizeHas normal or small left ventricle size

Involves a disproportionate thickening of Involves a disproportionate thickening of

the inter-ventricular septumthe inter-ventricular septum

causes outflow obstruction and diastolic causes outflow obstruction and diastolic

disfunctiondisfunction

Page 10: Cardiac module cardiomyopathy section pance boot camp

Hypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic Cardiomyopathy

Mainly an autosomal dominant causeMainly an autosomal dominant cause

Page 11: Cardiac module cardiomyopathy section pance boot camp

Hypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic Cardiomyopathy

can cause life threatening arrhythmias can cause life threatening arrhythmias

can be asymptomaticcan be asymptomatic

most common symptom is dyspnea on exertionmost common symptom is dyspnea on exertion

May have exertion chest pain from outflow May have exertion chest pain from outflow

obstruction rather than coronary artery diseaseobstruction rather than coronary artery disease

Syncope or dizziness may be presentSyncope or dizziness may be present

Page 12: Cardiac module cardiomyopathy section pance boot camp

Hypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic Cardiomyopathy

Physical Findings-crescendo-decrescendo Physical Findings-crescendo-decrescendo

systolic murmursystolic murmur

S4 gallop from increased ventricular S4 gallop from increased ventricular

stiffnessstiffness

Can hear an S3 if left ventricular systolic Can hear an S3 if left ventricular systolic

problemsproblems

Page 13: Cardiac module cardiomyopathy section pance boot camp

Hypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic Cardiomyopathy

ECHO is needed for diagnostic ECHO is needed for diagnostic

confirmation and to determine the confirmation and to determine the

severityseverity

May need cath to rule out concomitant May need cath to rule out concomitant

coronary artery diseasecoronary artery disease

Page 14: Cardiac module cardiomyopathy section pance boot camp

Hypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic Cardiomyopathy

Treatment is targeted at improving Treatment is targeted at improving

diastolic disfunctiondiastolic disfunction

Calcium channel blockers are idealCalcium channel blockers are ideal

Beta blockers can be used toBeta blockers can be used to

These increase preload and allow the These increase preload and allow the

ventricle to fill betterventricle to fill better

Page 15: Cardiac module cardiomyopathy section pance boot camp

Restrictive Restrictive CardiomyopathyCardiomyopathy

Restrictive Restrictive CardiomyopathyCardiomyopathy

has a small ventricle sizehas a small ventricle size

may involve one or two ventriclesmay involve one or two ventricles

characterized by diastolic dysfunctioncharacterized by diastolic dysfunction

Elevated ventricular filling pressuresElevated ventricular filling pressures

Systolic function normalSystolic function normal

Page 16: Cardiac module cardiomyopathy section pance boot camp

Restrictive Restrictive CardiomyopathyCardiomyopathy

Restrictive Restrictive CardiomyopathyCardiomyopathy

Most common causes is amyloidosisMost common causes is amyloidosis

Can be idiopathicCan be idiopathic

Can be caused by Sarcoidosis, Can be caused by Sarcoidosis,

Hemochromatosis, Radiation, Hemochromatosis, Radiation,

scleroderma, Gaucher’s diseasescleroderma, Gaucher’s disease

Page 17: Cardiac module cardiomyopathy section pance boot camp
Page 18: Cardiac module cardiomyopathy section pance boot camp

Restrictive Restrictive CardiomyopathyCardiomyopathy

Restrictive Restrictive CardiomyopathyCardiomyopathy

Physical exam-signs of right heart failure Physical exam-signs of right heart failure

are presentare present

Elevated right side heart pressures and Elevated right side heart pressures and

dilated neck veinsdilated neck veins

ECHO is needed in the diagnosis ECHO is needed in the diagnosis

Right heart cath sometimes needed to Right heart cath sometimes needed to

make sure it is not constrictive pericarditismake sure it is not constrictive pericarditis

Page 19: Cardiac module cardiomyopathy section pance boot camp

Restrictive Restrictive CardiomyopathyCardiomyopathy

Restrictive Restrictive CardiomyopathyCardiomyopathy

Treatment is similar to heart failureTreatment is similar to heart failure

Diuretics help decrease systemic vascular Diuretics help decrease systemic vascular

resistanceresistance

Page 20: Cardiac module cardiomyopathy section pance boot camp

Cardiomyopathy Cardiomyopathy SummarySummary

Cardiomyopathy Cardiomyopathy SummarySummary

Dilated Cardiomyopathy-systolic Dilated Cardiomyopathy-systolic

disfunction, may affect one or both disfunction, may affect one or both

ventricles. Symptoms similar to CHF. ventricles. Symptoms similar to CHF.

Dilated chambersDilated chambers

Hypertrophic Cardiomyopathy-diastolic Hypertrophic Cardiomyopathy-diastolic

problem, small chambers can cause problem, small chambers can cause

outflow obstruction. Can cause DOE or outflow obstruction. Can cause DOE or

chest pain with activitychest pain with activity

Page 21: Cardiac module cardiomyopathy section pance boot camp

Cardiomyopathy Cardiomyopathy SummarySummary

Cardiomyopathy Cardiomyopathy SummarySummary

Restrictive Cardiomyopathy-diastolic Restrictive Cardiomyopathy-diastolic

problem, elevated right heart pressures, problem, elevated right heart pressures,

amyloidosis most common cause, amyloidosis most common cause,

treatment similar to heart failuretreatment similar to heart failure