cardiac module cardiomyopathy section pance boot camp
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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
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
Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy
CausesCauses
GeneticGenetic
ThyrotoxicosisThyrotoxicosis
Metabolic (Starvation)Metabolic (Starvation)
Peri or Post partumPeri or Post partum
Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy
CausesCauses
Cobalt ingestionCobalt ingestion
SarcoidosisSarcoidosis
HemochromatosisHemochromatosis
RadiationRadiation
Dilated CardiomyopathyDilated CardiomyopathyDilated CardiomyopathyDilated Cardiomyopathy
CausesCauses
Thiamine DeficiencyThiamine Deficiency
AlcoholAlcohol
Catecholamine inducedCatecholamine induced
Infectious (Viral and Parasitic)Infectious (Viral and Parasitic)
RadiationRadiation
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
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
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
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
Hypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic CardiomyopathyHypertrophic Cardiomyopathy
Mainly an autosomal dominant causeMainly an autosomal dominant cause
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
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
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
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
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
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
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
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
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
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