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 filling

DOE, LE swelling JVD, no friction rub, Pericardial “knock” EKG: no specific findings TX: pericardiectomy